Parenteral Injections Flashcards
Is subcutaneous or IM injection absorbed faster?
IM injection
With what injection do you aspirate before giving the medication?
IM injection (but not vaccines)
What angle do you put the needle in for subcutaneous?
45 or 90 degree angle depending on the patient
What sites would you be able to insert over 2 mL of medications to subcutaneously?
Abdomen, outer thigh..
When inserting SubQ injection to outer upper arm, what is the maximum amount of med to give?
2 mL
What is the subQ injection inserting the medication to?
Loose connective tissue underlying the dermis (not as many BV as muscle, therefore it absorbs more slowly)
Where is an IM injection inserting medication to?
Body of a muscle
When would you use the “Z tract technique” when inserting medication?
When inserting medication to the muscle
Pull skin 1 1/2 inch over, insert med, hold for 10 seconds, let skin move back.
Z tract prevents leakage of medication, and locks medication in.
What size needle would you use for a IM in an adult?
1 - 1 1/2 inches (site depending..)
When inserting a medication to IM, what are you trying to avoid?
Nerves and major BV
Where to insert IM med to infant?
Vastuslateralis
What is the maximum dose to administer IM to deltoid?
2 mL
Why do you not administer meds to infants in deltoid?
Not well developed muscle
How do you landmark the deltoid?
3 finger length from acromion proccess
At what age would you start injecting vaccines to the deltoid?
18 months +
Is drug absorption rapid in the muscle?
Yes.
When would ID injections be used?
Testing for allergies and TB
What do you expect to see when giving ID injection?
Bleb appear. 6 mm or 1/2 an inch.
What angle would you insert for ID?
5 - 15 degrees
What angle would you insert needle for subQ for obese pt.?
90 degrees.
Maximum amount of medication to give ID?
0.01-0.1 mL
What way should the bevel face when inserted into the skin?
Bevel up!
To minimize pt. discomfort, what would you do?
Use sharp needles in the shortest length and gauge possible
If you insert a needle at 45 degrees, at what angle would you then take the needle out at?
45 degrees
What is the range for capacity in a syringe?
0.5 - 60 mL
Are syringes ever reused?
Heck no.
Needles contain three parts. What are they?
The hub (fits into the syringe) the shaft (connects to the hub) the bevel creates a narrow slit that closes after needle is removed)
When is a filter needle used?
When preparing medication from an ampule.
Needles vary in what lengths?
3/8 of an inch to 3 inches
A gauge that is 25 is thiner or thicker than a gauge that is 27?
Thicker.
What size needle used for subQ?
5/8 inch to 1/2 an inch (normally, unless patient has lots of adipose, then may use 1 inch)
Viscous meds require a larger or smaller gauge?
Larger.
Ampules are single use or reusable?
single use.
How do you mix meds in a vial?
Roll in your palms
T or F: Vials only contain liquid meds.
F. Vials can also contain dry meds
What is the first step of preparing a medication from a vial?
Put the amount of air equal to the amount of med you will be taking from the vial, into the vial.
What should you do if you can see air bubbles in the syringe?
Tap with a pen. Make sure all air bubbles are gone before inserting med.
What would be the factors in selecting a needle length for subQ injection
pt.s weight / estimate of subQ tissue
When injecting low molecular weight heparin, how far must you stay away from the umbilicus?
2 inches away.
What are you palpating for before administering a subQ?
Hardness and tenderness
What are you assessing for 30 minutes post med admit?
pain, numbness, burning, tingling
Can subQ injections be done at home?
After proper teaching, yes.
Maximum pediatrics subQ injection ?
0.5 mL
When mixing meds from vial and ampule, which med would you prepare first?
The vial.
Maximum IM injection for:
Adult:
Kids 6 - 12:
0 - 6 years:
Adult: 5 mL
Kids 6 - 12: 2 mL
0-6: 1 mL
Doses less than one mL, round to what?
The nearest hundredth.
giving 0.7 mL of a med, what size syringe would you use?
1 mL
When giving medications over 1 mL, round to what?
Nearest tenth.
Insulin is measured in what form?
Units.
What is the most commonly used diluents for reconstituting medications?
0.9% NaCl (normal saline) and water
What would you label on a multi dose vial that has been reconstituted?
Date / Time of prep Strength or concentration of volume Potency expiration Recommended storage Your initials Example of insturctions
When the nurse would select the strength of the reconstitution… what would they be deciding this on?
Depends on the patients dose.
When reconstituting medications.. if you add less solvent the final solution will be more or less concentrated?
More concentrated.
D X Q = X means what?
When reconstituting medications
The desired solution strength multiplied by the quantity of the desired solution = amount of the solute
SubQ butterfly should be changed how often?
Once a week
When priming a subQ butterfly using Maxzero, what do you prime it with?
Additional 0.4 mL to the dose of the med
When priming SubQ butterfly using clearlink, prime it with what?
Additional 0.28 mL to the dose of the med
Insulin is classified on what?
Rate of action: Short, moderate, and long
T or F: a subQ butterfly can have meds of various concentrations?
F. Different concentrations and different meds require different subQ butterfly.
What are you assessing the site of a subQ butterfly for?
Irritation, swelling, redness
What site is preferred IM injection site for adults?
Deltoid
How do you landmark the vasutslateralis?
One hand from above knee, one hand below hip. Anywhere in the muscle here
How would you decrease a patients pain when inserting med to deltoid?
Have pt. relax the arm
Is inserting a 3 mL med to the deltoid okay?
No. No more than 2 mL
Ampules are opened how?
Breaking the neck off.
What angle do you insert a SubQ butterfly at?
30 - 45 degree angle
When would you aspirate?
Before IM, accept for vaccines
Where would you document that you inserted a SubQ butterfly?
PPN
Where is the site for a ID injection?
Front and back of forearm
Why would you not insert med to atrophied muscle?
Med will not absorb well
Why would “literature” believe that ventrogluteal = best site for IM injection?
Deep, situated far away from BV and major nerves. Easily identifiable by prominent bony landmarks (hand over the greater tronchanter, point index finger towards the superior ilic spine, extend the middle finger back along the iliac crest. V shaped triangle then formed: this is the injection site.
What is important when inserting to an IM?
The muscle is well developed.
The Z tract is helpful in what?
Decreasing pain, decreasing leaking, helps to lock the medication in.
Why hold an IM needle in the site for 10 seconds after injection?
Allows the med to spread evenly.
When would you insert a SubQ at 90 degree angle?
When the pt. has a lot of subQ tissue
Why do we rotate injection sites?
To avoid Lypohypotrophy
