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parenteral medications Flashcards

1
Q

Parenteral medications

A

include those that are injected or infused into body tissues or into the bloodstream via the intradermal, subcutaneous, IM, or IV routes.

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2
Q

Rationale from asepsis in the preparation and administration of parenteral medications

A

reduce microbial contamination risk. Aseptic techniques are methods designed to prevent contamination from microorganisms.

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3
Q

The ______________the gauge, the _____________the diameter

A

smaller larger

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4
Q

Choose the gauge based on the (3)

A

(1) patient’s size and skin condition,

(2) viscosity of medication used, and

(3) speed of administration desired.

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5
Q

Smaller needles ( sizes n reasons)

          vs

Larger needles (sizes n reasons)

A

25- to 30-gauge) cause less pain and trauma to the tissue, so they are useful for patients who must have frequent or long-term injections (e.g., insulin and heparin).

(14- to 18-gauge) are used for blood and more viscous medications, to mix IV medications, or for rapid infusion of IV medications.

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6
Q

Bevel

A

is the sharp slanted tip of the needle that creates an opening to administer medications or withdraw blood.

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7
Q

A long bevel ( purpose)

       vs

Short bevels (purpose)

A

A long bevel tip is sharper and narrower and therefore causes less discomfort during injection. Long bevels are used for subcutaneous and IM injections.

Short bevels are used for intradermal or IV injections.

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8
Q

Needle Length

A

The distance from the hub (bottom) of the needle to the tip is the needle length. Lengths usually range from 3⁄8 inch to 3 inches.

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9
Q

Choose the length according to the (3)

A

(1) thickness of the patient’s muscle,

(2) amount of adipose tissue, and

(3) site in which the drug is to be injected

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10
Q

A _______needle is common for IM injections.

A shorter _______ needle is used for intradermal injections.

A

1½-inch

3⁄8- to 3⁄4-inch

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11
Q

A safety syringe

A

is a syringe with a built-in safety mechanism to reduce the risk of needlestick injuries to healthcare workers and others

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12
Q

Intradermal

SITE
MAX VOLUME (mL)
NEEDLE GAUGE
NEEDLE LENGTH (inch)
SYRINGE SIZE (mL)
ANGLE OF INJECTION (degree)

A

Inner aspect of forearm

0.1

26–28

3⁄8– 3⁄4

1.0

5°–15°

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13
Q

Subcutaneous insulin

SITE
MAX VOLUME (mL)
NEEDLE GAUGE
NEEDLE LENGTH (inch)
SYRINGE SIZE (mL)
ANGLE OF INJECTION (degree)

A

Fatty area over triceps, abdomen, anterior thigh

0.3, 0.5, and 1.0

28–31

3⁄16–1 (max 5⁄8 for upper arm)

0.3, 0.5, 1 (0.3–0.5 for upper arm)

45°–90°

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14
Q

Subcutaneous other

SITE
MAX VOLUME (mL)
NEEDLE GAUGE
NEEDLE LENGTH (inch)
SYRINGE SIZE (mL)
ANGLE OF INJECTION (degree)

A

Subcutaneous other

Fatty area over triceps, abdomen, anterior thigh

0.5–1

25–27

3⁄8–5⁄8

1.0–3.0

45°–90°

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15
Q

Intramuscular

SITE
MAX VOLUME (mL)
NEEDLE GAUGE
NEEDLE LENGTH (inch)
SYRINGE SIZE (mL)
ANGLE OF INJECTION (degree)

A

Deltoid

0.5–1

22–25

5⁄8–1 (infants and children)

1–11⁄2 (adults)

1.0

90°

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16
Q

Rectus femoris (not recommended)

SITE
MAX VOLUME (mL)
NEEDLE GAUGE
NEEDLE LENGTH (inch)
SYRINGE SIZE (mL)
ANGLE OF INJECTION (degree)

A

2

22–25

11⁄2–3

1.0

90°

no other site accesible ….ONLY FOR ADULTS

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17
Q

Vastus lateralis

SITE
MAX VOLUME (mL)
NEEDLE GAUGE
NEEDLE LENGTH (inch)
SYRINGE SIZE (mL)
ANGLE OF INJECTION (degree)

A

1.0 (infants younger than 12 months)

1–2 (infants and children 1 to 12 years)

3–5 (adults, depending on muscle size)

22–25

1 (infants younger than 12 months)

1–11⁄4 (infants 12 to 24 months)

11⁄2–3 (adults, depending on if obese)

1.0–3.0

45°–90°

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18
Q

Ventrogluteal

SITE
MAX VOLUME (mL)
NEEDLE GAUGE
NEEDLE LENGTH (inch)
SYRINGE SIZE (mL)
ANGLE OF INJECTION (degree)

A

2.5–3

20–25

11⁄2–3

3.0

90°

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19
Q

Intravenous
Basilic veins

SITE
MAX VOLUME (mL)
NEEDLE GAUGE
NEEDLE LENGTH (inch)
ANGLE OF INJECTION (degree)

A

Continuous infusion

18–25

1–11⁄2

N/A

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20
Q

Cephalic veins

SITE
MAX VOLUME (mL)
NEEDLE GAUGE
NEEDLE LENGTH (inch)
ANGLE OF INJECTION (degree)

A

Continuous infusion

18–25

1–11⁄2

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21
Q

Intradermal (ID) injections RATIONALE ( think about ppd test)

(absorption)

A

have the longest absorption time of all parenteral routes because there are fewer blood vessels and no muscle tissue.

These types of injections are used for sensitivity testing because the patient’s reaction is easy to visualize, and the degree of reaction can be assessed.

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22
Q

Standard syringes

A

are supplied in 3-, 5-, and 10-mL sizes. They are commonly supplied without needles or with 18-, 21-, 23-, or 25-gauge needles that are 0.5 to 3 inches long.

23
Q

Tuberculin syringe

A

Use tuberculin syringes to administer small, precise doses of medication (e.g., to infants or children), for allergy tests, or when administering potentially dangerous medications (e.g., as heparin).
stronger medicine

24
Q

Insulin syringes

A

are calibrated in units and are used to administer insulin. KEY POINT: Insulin syringes are marked in 100 units per milliliter. They are made in 0.3-, 0.5-, or 1-mL sizes with very small-gauge needles (26- to 30-gauge).

25
An ampule
is a thin-walled, disposable glass container with a narrow neck that you must snap off to access the medication. Each ampule holds a single dose of a liquid medication, usually 1 to 10 mL, but some hold 50 mL Single Dose Ø Pre-scored around neck to break open Ø Use filtered needle to prevent drawing up any glass particles Ø Do not inject air into Identify the medication Tap top or flick to ensure med all in body of ampule Wrap neck with unopened alcohol wipe or gauze Snap the top off Break away from face Use filter needle
26
A vial
is a single-dose or multidose plastic or glass container with a rubber stopper that reseals the top after each needle introduction. A plastic or metal cap covers the rubber stopper to protect it until it is used (
27
Hub
The distance from the hub (bottom) of the needle to the tip is the needle length
28
Pre-filled syringe
is a single dose of medication to which a needle has been fixed by the manufacturer. A
29
Subcutaneous ( 45 vs 90)
Give the injection at a 90 degree angle if you can grasp 2 inches of skin between your thumb and first finger. If you can grasp only 1 inch of skin, give the injection at a 45 degree angle. * not too much fat*
30
Needle length subcutaneous
depending on the amount of adipose tissue that the patient has and the type of injection needed (e.g., insulin, immunization). For most subcutaneous injections, a 3⁄8- to 5⁄8-inch needle is preferred. However, shorter needles (e.g., 3⁄16- to 5⁄16-inch) are more comfortable for some insulin users.
31
IM injections (injections into muscle tissue) are absorbed
faster than subcutaneous medications because of the rich blood supply in the muscles. Large muscles (e.g., vastus lateralis, ventrogluteal) can tolerate 3 to 5 mL of liquid. The smaller the muscle, the less fluid it can tolerate.
32
Because of their proximity to major nerves and vessels, the _____________ &___________are no longer recommended sites
rectus femoris and dorsogluteal
33
Vastus Laterilas
is the preferred site for young infants, particularly before walking age it is a convenient site for those who self-administer injections.
34
Z track method ( think of skills)
The Z-track method is recommended for all IM injections because it is less painful and helps to prevent irritation of subcutaneous tissues. For this technique, it is best to use the larger muscles: the ventrogluteal and the vastus lateralis.
35
Ventrogluteal Muscle—
Site of Choice This is the preferred IM site for adults and young children who are walking because it is located away from major blood vessels and nerves. However, some medications (e.g., vaccines) may recommend the deltoid. The ventrogluteal site, located on the lateral hip, involves the gluteus medius and gluteus minimus muscles
36
Deltoid Site
The deltoid site is located in the middle third of the upper arm. It is small and lies close to the radial nerve and brachial artery. The area has a small muscle mass with little subcutaneous tissue, so medications are absorbed rapidly. This muscle is easily accessible but is not well developed in many older adults. You should use the deltoid site only for small amounts of up to 1 mL or when other sites are inaccessible. Avoid using the deltoid site in infants, and assess children for adequate muscle mass before use. Some medications (e.g., vaccines, flu shot) may specify the deltoid muscle.
37
Rectus Femoris Site
—For Adults Only The rectus femoris site, located in the anterior thigh, is no longer recommended for infants and children. You will use this site for adults only when other sites are inaccessible and the medication needs to be administered intramuscularly. The rectus femoris is often used by patients who self-administer their IM injections because it is easy for them to reach. A disadvantage is that it is usually painful
38
what degree to i inject subcutaneous?
45 degree
39
First step to use a vial
wipe off with alcohol wipe then let dry NEVER WAVE or BLOW
40
Frial pts when use ____ degree
45 degree
40
sites of subcutaneous + tips
back of arm/abdomen only these
41
gauges for subcutaneous | state max ml
25-27 0.5-1ml maximum, 25 – 27 gauge
42
Heparin = blood thinner injection tips
no massage or aspirate/ must hold skin the whole time/ rotate different areas *mostly abdomen unless they has surgery* do NOT GIVEN IM. ( danger of hematoma)
43
Needle and angle judgment based on size of needle 1/2” needle = angle > 1/2” needle = angle
90 angle 45 angle
44
Which inject will air bubbles be allowed?
LOVENOX
45
when would i use 3ml?
ventrogluteual
46
# LOVENOX SUBCUTANEOUS ENOXAPARIN INJECTION postion( patient) explain the set up tips ( where )
Supine position Pre-filled enoxaparin syringe contains an air bubble – Do not expel air bubble Give deep SQ – alternate between right and left anterolateral and posterolateral abdominal wall ONLY (45/90◦) “Love handles” Hold skin fold for entire injection and for 30 seconds prior to withdrawing
47
Lovenox (location-wise)
Give deep SQ – ALL OF NEEDLE alternate between right and left anterolateral and posterolateral abdominal wall ONLY (45/90◦)
48
# insulinpumps SUBCUTANEOUS (SC) PORTS Indications/Usage Procedure Sites a. Pediatric vs adults Medications (NOT HEPARIN)
SUBCUTANEOUS (SC) PORTS Indications/Usage Continual infusion Intermittent Infusion Procedure HCP order Competent, trained Sites- Abdomen, thighs. Pediatric-thigh and upper arm Medications- IV, med pumps, pain meds Not Heparin
49
2ml, 3ml, 5ml
standard
50
I should go slow when injecting a needle? T or F
F ! bullseye
51
aqueous medication vs oil-based – viscous (gauge)
Usually 20 – 25 gauge (aqueous medication)  18 – 25 gauge (oil-based – viscous)
52
Which injection must you hold the whole time?
HEPARIN!

nur 112 (23 decks)

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