Parenteral Med Admin Flashcards
What equipment is needed for parental admin
Gloves
meds
alcohol swabs
appropriate syringes: needle to withdraw and needle to inject
Med labels
Clean med drawer
What kind of medication vials can we use
Single/multidose
Plastic or glass (clear or dark)
Liquid or powder med
What should we do before giving a pt a med from a vial
Clean top before use
Check expiration
Always date and initial multi-dose vial
What should the needle be to reach the targeted tissue ofthe pt respective to age, wt, and muscle/tissue mass
Long enough
Why should we care about the needle being long enough
Because we want the medication to reach the correct tissue and be correctly absorbed
How far does a dermis (id) injection go
1/2” to 5/8”
How far do we inject a subcutaneous (SQ) anticoagulants
3/8” to 5/8”
How far do we inject subcutaneous (SQ) insulin
1/2” to 5/16”
How far do we inject meds into the muscle (IM)
1” to 1 1/2” most common in adults
What can smaller gauge needles inject best
Thin solutions
What can larger gauge needles best inject
Thicker solutions
What is the filter needle
Small filter in hub that catches debris
What should we always use filter needles with
Ampules
What is a blunt fill needle used with
Used with vials
Why should we not use a blunt fill needle on a pt
Because it will hurt them
If you choose to recap a blunt fill needle or filter needle what technique should you use
The one-hand technique
What is the most common syringe used to deliver the medication
3ml syringe
What is our first check when giving meds
Looking at the dr ‘s order for the meds
What is our second check when giving meds
Verifying against the eMAR
Where is our third check when giving meds
At the bed side w/ the pt
What do we do in the med room to prepare medications
Don gloves
Select appropriate syringe and needle - based on placement, injection site, volume, & med
Table syringe witha blue label which includes initials date and time
What is our first step when preparing to withdraw a single dose vial med
After cleaning top for 15 secs or more, inject air equal to amount of meds to be withdrawn
What is it called when we inject air equal to amount of med to be withdrawn
It is called charging
Why should we withdraw the entire amount out of the vial
They cannot be used again
How do we deliver the exact amount of medication when we are using a one use vial
We will draw up the meds that we need to get and then we need to waste the medication so no one abuses it
What do meds have to be in order to draw up two and administer them together
They must be compatible with each other
What should redo it we have air bubbles when drawing meds up
Make sure needle is below fluid level
Withdraw meds slowly
What should we do when we have air bubbles when drawing up a single dose vial
Withdraw entire volume of med needed - expect air to follow this
Expel the air and medication, if more than required is in the syringe, to ensure the exact dose
What should we do if we have air bubbles with multi-dose vials
Withdraw more med than what is needed, leave the needle in vial, then push med back
Into the vial via plunger to exact dose
If there are still bubbles then gently thump syringe
Are ampules single or multi-dose meds
Single-dose always
What do we need for an ampule med admin
A needle syringe and filter needle
When we withdraw from an ampule what do we do first
Tap the top of the ampule to dislodge any med from the neck
What do we do after taping the ampule and making sure all medication will be given
Place a barrier on top of the ampule and break away from you
What do we do after breaking the ampule
Withdraw all medication and dispose of excess
Connect correct needle
Do reconstituted meds volume always equal the amount of diluent
They do not because the med itself has volume
What technique should be used when withdrawing diluent
Sterile technique
What do we use to add the diluent to the solute med
Use a blunt-fill needle
How do we get the solute and diluent to combine
Mix it well
What do redo after mixing the reconstituted med
Pull off the blunt fill needle and place the needle that will be used for injection
What should we compare the meds to in the pts room
Compare them to the eMAR
What should we always address after scanning medications
Adress the Pop ups on the computer to acknowledge that we gave the med
What should we do prior to administering the injection
Select the proper site and landmark, visualize, and palpate
What should we always consider before giving an injection
Med
Age
Muscle/tissue mass
Last injection site
How do we clean the injection site
Start in the center and work our way out
What do we verify with the needle and volume
Verify integrity
what angle should we pull the needle out of the skin after giving the injection
Pull out the same way you pur it in to avoid skin/tissue damage
What should we discharge immediately after the injection
The safely mechanism
What should we base IM injections on
Med
Volume
Injection site
Pt
What three muscles can we select to do an IM injection
Deltoid
Ventrogluteal
Vastuslateralis
How do we choose where to do an IM injection
We choose based on which muscle can accommodate the med
What should we visualize and palpate for before giving the injection
A “belly” of well-developed and relaxed muscle (this sister deepest/densest part)
What should we avoid for IM injections
Scars
Irritations
Bruises
Lesions in muscle
What rate should we use for an IM injection
1mL/10 sec
How many seconds should we wait before removing the needle for IM injections
3-5 secs
Why do we wait 3-5 secs before removing the needle for IM injections
Allows muscle tissue time for it to expand to accommodate med (1mL/10 sec) and then 3-5 secs to make sure the med stays
Why do we not rub an injection site post-injection
To prevent displacement of med
What angle do we inject for IM meds
90° angle
What is the deltoid muscle used for injections wise
For smaller volumes, less irritating meds
What are some examples of deltoid injections
Vaccines
B-12
What is the max volume recommended
1mL
What is the recommended needle length for deltoid injections
1”
How to we landmark the deltoid site
Find acromion process, 2-3 fingers down, feel for densest part of muscle
For leg IM injections which one do we use first (ventrogluteal or vastus lateralis)
Ventrogluteal
Why is the ventrogluteal the first choice
It is the most dense to accommodate the meds
What injectable meds is the vastus lateralis is used for
Thicker, painful, or irritating meds (deep IM)
What is the maximum volume recommended for ventrogluteal and vastus lateralis injections
3 ml syringe
What is the recommended needle length for deep IM injections
1”- 1 1/2”
Why is 3ml the recommended syringe size for deep IM injections
We have to aspirate for blood return
How should we position the pt for a deep IM injection
Have the hip up for the injection
Opposite leg is straight
Bend the leg and hip the injection will be given
What is the Z-track method
It is pulling the shin back to better give an injection
Do we z-track for deep IM injections
Yes
How do we inject with deep IM injections
Inject @90°
Aspirate 3-5 secs
Why do we aspirate for 3-5 secs after inserting the needle for deep IM injections
We need to make sure we are not in a vein or artery
What happens it we see blood return when we aspirate deep IM injections
We du not inject and startover
What rate do we inject for deep IM injections
1mL per 10 secs
How long do we wait to pullout the needle for deep IM injections
Wait 3-5 secs then withdraw needle
What do we do after withdrawing the needle from deep IM injections
Release the z-track
What do we inject sub-q
Insulin and anticoagulants
Do insulin injections have their own needles
Yes
What needle do we use for anticoagulant injections
3/8” - 5-8”
What should we do with the skin if we are injecting a sub-q med @ a 90° angle
Bunch it for more than 2”
How do we inject a sub-q med if we cannot bunch the skin more than 2 inches
Inject it at a 45° angle
What type of vials do we use for insulin
Multi-dose vials
What 3 types of insulin do we have
Short acting
Intermediate acting
Long acting
What should we verify before administering insulin
Blood sugar/levels
Why should we give insulin first to our pt
Because it be comes less potent over time
How should we mix insulin
Gently rotate it in palms
Why do we not Shake insuin
Can destroy properties to create air bubbles
Where do we administer sub-q injections
In fatty areas of arms, abdomen, back, thighs
What areas should we avoid when giving sub-q injections
Bruising
lipodystrophy
Linea alba
Umbilicus
How do we administer insulin
Bunch skin
Inject @90°
Release the bunch
Wait 3-5 secs and withdraw needle
Where do we give enoxaparin
In the abdomen / love handles
Do we bunch for the entire enoxaparin injection
Yes
What angle do we inject for enoxaparin
90°
Do we aspirate or expel the nitrogen bubble in enoxaparin injections
No
Why do we not aspirate/expel the nitrogen bubble for sub-q injections
This seals the med deep within the sub-q tissue
How long do we wait before withdrawing the needle
3-5 secs then withdraw at 90°
What should the site be free of when doing intradermal injections
Tattoos
Blemishes
Hair
Scarring
Bruises
What angle do we do intradermal injections
5 -15°
Which way should the bevel face for intradermal injections
Face up
Why should the level face up for intradermal injections
Because you will barely push it under the skin
What should we see after injecting the solution for an intradermal injection
Should see a bleb or wheal
