Parenteral Med Admin Flashcards
3 parts of syringe
tip, barrel, and plunger
slip tip vs leur lock
slip tip= no thread/grooves
leur lock = screws on like light bulb
2 parts not touch on syringe
- tip without needle on it
2. plunger that will go back into barrel
Tuberculin syringe, volume, needle
- always 1 ml volume
- needle typically 25 g, 5/8” length (small length and gauge needle)
Insulin syringe, measurement
- only used to draw up insulin
- measured in UNITS not ml
Carpuject
- prefilled syringe usually with controlled substance
- usually contains IV meds but can use with IM
Shaft of needle
length of needle
- colors do coordinate with size but varies by manufacturer
- 5/8, 1, 1 1/4
gauge of needle size
diameter of needle
- smaller gauge needle = larger diameter
- larger gauge needle = smaller diameter
When to use larger gauge needle?
-increase viscosity of medication = increase size of gauge (smaller #)
Bevel of needle
diagonal slant in tip of needly
Bevel up =
hole facing up
when can you recap a needle?
-unused , clean needle after draw up med
one hand scoop technique
- lay cap flat on surface
- insert needle into cap laying flat on surface
- pick up needle and pull cap onto needle until you hear snap
blunt fill needles
used to fill syringe and draw up med
-not as sharp
Needles for drawing up vs administering med?
- use blunt needle to draw up med
- switch to appropriate length and gauged needle for administration
what does changing between blunt need and administration needle prevent?
irritation on patient skin from medication outside of needle
when reading the measurement on syringe what do you look at?
be in middle of first black line, not the hump
Can you lay an uncapped needle down?
no, change by holding in hand
filter needle
mechanism inside to filter glass out from glass ampoule
when should you use safety needles?
at all times in general patient care
example of med in ampoule
Vitamin K
Ampoule Steps
- TAP top to get med below neck
- wrap neck in ALCOHOL WRAPPER or gauze
- break neck AWAY from body
- FILTER NEEDLE inserted into solution, instill air
- invert needle or leave on table
- pull back to dose, remove needle
- tap to remove air
- remove excess air or med
- scoop to recap
- change to ADMIN NEEDLE
- Discard ampoule in SHARPS
Which way do you break ampoule?
away from you
which part of ampoule do you break?
neck
What is unique about a vial?
Pressurized system that you can instill air into
Vial steps
- remove vial COVERING
- clean with ALCOHOL swab with FRICTION
- fill syringe with AIR EQUIVALENT to dose
- insert needle into MIDDLE of rubber stopper
- INSTILL AIR
- INVERT vial while providing stability
- pull back on plunger to desired dose with tip in fluid
- remove needle/ tap for air bubble
- recap with scoop
- change to ADMIN NEEDLE
- discard blunt needle to SHARPS
reconstituting meds- how to mix it?
follow manufacturer instruction for type of liquid and final concentration
Mixed dose insulin- 2 types?
Regular and NPH
Mixed dose insulin steps
- INSTILL air in BOTH vials with vial flat on table to needle in not in liquid, have ANOTHER NURSE CHECK calculation
- draw up REGULAR insulin , have ANOTHER NURSE CHECK
- Draw up NPH insulin , have ANOTHER NURSE CHECK
which insulin can you push back into vial?
1st, regular
-if push second in = contamination
Regular insulin=
clear
fast acting
“pure”
NPH insulin=
cloudy
slow acting
contaminated
insulin pens
- DIAL dose
- INSERT need SubQ
WAIT UNTIL dial returns to ZERO - remove needle from patient once dial at zero
Intradermal administration: site, volume, equipment, angle
site: inner forearm
volume: 0.1-0.5 ml
equipment: gloves, tb syringe, needle (26-28 gauge, 1/4-5/8 length), alcohol swab
angle: 5-15 degrees
When using an alcohol swab how to clean skin?
circle from inside to out
Intradermal needle gauge
26-28
intradermal needle length
1/4-5/8
Bevel for intradermal?
BEVEL UP
Needle should be ____ under skin for intradermal injection
visible
What do you create with intradermal injection?
WHEAL
-if no wheal, start over
Intradermal- massage or no massage?
do NOT massage
what do you do with used needle after administering to patient?
activate safety feature, place in sharps container immediately
Sub Q administration:site, volume, equipment, angle
site: deltoid, 1” lateral from umbilicus, scapula, love handle, front of thigh
volume: up to 1 mL typically (can also use up to 3 mL syringe)
equipment: TB/insulin syringe, needle (25-27 gauge, 1/2-5/8” length), gloves, alc swab
angle: 45 to 90 degrees
general steps before any injection:
- prepare med
- gather supplies
- identify site
- don gloves
- cleanse site with alcohol swab
Which 2 injection methods can have the same syringe and needle size?
Sub Q and intradermal
How to administer SuBQ injection
- BUNCH skin
- hold needle like DART
- pierce at 45 or 90 degree QUICKLY
- do NOT ASPIRATE
- INJECT med SLOWLY
- QUICKLY REMOVE
Which injection method do you bunch skin for?
Sub Q
Sub Q onset
w/in a 1/2 hour
Intramuscular Injection site, volume, equipment, angle
site: deltoid, vastus lateralis, ventral gluteal, dorsal gluteal
volume: up to 4 mL depending on muscle
equipment: gloves, 1-5 ml syring, needle 21-25 g, 1-3 inch, alc swab
angle: 90 degree
Who is responsible for choosing the needle size and gauge?
Nurse
sub q needle size selection below waist vs above waist
below waist = > 1 .25- 1.5”
above waist = 1”
palpating deltoid for injection
- place 3 fingers BELOW ACROMION PROCESS (base)
- imaginary line to AXILLA (point of triangle)
- injection site = center of triangle
palpating Vastus lateralis for injection
-1 hand on greater trochanter
-1 hand on knee
-midline of anterior thigh and midline of lateral thigh
injection site = middle third of thigh
palpating ventral gluteal for injection
- palm/heel of hand on greater trochanter with thumb pointing to peepee
- index finger on anterior superior illiac spine
- middle finger extended up to iliac crest
- injection site= w/in triangle formed by index and middle finger
test for ventral gluteal
place heel on ground and move toes left to right, feel muscle move
preferred injection site below waist for IM
ventral gluteal
least preferred injection site below wait for IM
dorsal gluteal
palpating dorsal gluteal for injection
one hand on trochanter and one hand on posterior illiac spin
-imaginary line /w 2
injection site= 1/2 way on imaginary line above and out
When to use dorsal gluteal IM site?
only if directed by manufaturer
IM admin
- pull skin TAUT
- hold needle like DART
- INSERT QUICKLY at 90 degree
- stabilize needle
- ASPIRATE for blood
- no blood= SLOW AND STEADY inject med
- QUICKLY REMOVE
- SAFETY/SHARPS
- MASSAGE site with ALC swab
- remove gloves
CDC, immunization, aspiration
CDC says do not have to aspirate for immunizations
Ztrack, when to use?
method used w/ irritating medications to decrease pain by trapping medication in muscle
Z trak steps
- DISPLACE skin LATERALLY
- while holding skin aside DART at 90 degree into skin
- ASPIRATE
- no blood = inject slow and steady
- WAIT 10 SECONDS
- QUICKLY REMOVE needle
- cover with swab- NO MASSAGE
- dispose needle
IM Complications
- pain
- damdage to tissue: sterile abscess, hematoma, muscle contraction, bruising, skin discoloration
- nerve damage
- bone injury
- speed shock
- infection
when does speed shock occur?
complication from IM injection when medication goes into vein or artery
which type of injection do you massage site with alc swab afterwards?
IM
Which injections = no massage after
z track, sub q, intradermal
intradermal needle gauge
26-28 g
intradermal needle length
1/4 - 5/8
subq needle gauge
25-27
subq needle length
1/2 - 5/8
sub q angle admin
45 or 90
intradermal angle admin
5-15
IM needle gauge
21-25
IM needle length
1-3 inch
IM needle angle admin
90
IM syringe volume
up to 4 mL
Sub q syringe volume
up to 1 mL
intradermal syringe volume
up to 1 mL
