Pottery & Perry CP34- Injections

Question 1

what is a purpose of the filter needle?

Answer 1

to prevent small glass fragments from entering the syringe. used in to draw up medications in ampules.

Question 2

what is important to consider when drawing up medication from a vial?

Answer 2

the vial is a closed system. ensure you inject air into the vial to permit easy w/drawal of the solution. failure to inject air creates a vacuum w/in the vial that makes w/drawal difficult.

Question 3

considerations when drawing medication from ampule

Answer 3

• tap the top of the ampule lightly with your fingers until the fluid moves from the neck of the ampule to the bottom
• place a small gauze pad or an unopened alcohol swab around the neck of the ampule-protects the fingers from injury when the glass tip is broken off
• snap the neck of the ampule firmly away from you
• draw up the medication using a filter needle long enough to reach the bottom of the ampule
• hold the ampule upside down, or set on a flat surface
• do not allow the needle tip or shaft to touch the rim of the ampule
• aspirate the medication into the syringe
• if air bubbles are aspirated, do not expel the air into the ampule
• do not dispose of any excess liquids in sink, toilet, or garbage can

Question 4

mixing two medications from two vials

Answer 4

use only one syringe w/ a needle
-aspirate a volume of air equivalent to the first medication dose (vial A). inject the air into vial A. ensure the the needle does not touch the solution
-w/draw needle, and aspirate a volume of air equivalent to the 2nd medication dose-vial B
-inject air to vial B
-immediately w/draw medication from vial B into the syringe, then insert the needle back into vial A
be careful not to push the plunger
-withdraw the desired amount of med from Vial A into the syringe

Question 5

mixing meds from one vial and one ampule

Answer 5

use the vial first, then use the same syringe and filter needle to w/draw the med from ampule.
do it in this order bc ampule b/c you do not need to add air to w/draw meds from an ampule

Question 6

what type of insulin can be administered intravenously?

Answer 6

only regular (short-acting) insulin

Question 7

when taking blood glucose from pts in hospital ensure you do what?

Answer 7

swab the fingertip with an alcohol swab. use of an aseptic technique prevents infection while in the hospital

Question 8

proper syringe size and needle for subcutaneous

Answer 8

syringe (1-3mL) and needle (25-27 gauge, 1-1.6cm)

Question 9

IM syringe size

Answer 9

2-3mL for adults

0.5-1mL for infants and small children

Question 10

syringe size for vastus lateralis (adults)

Answer 10

2.5-3.8cm

Question 11

syringe size deltoid (adults)

Answer 11

2.5-3.8cm

Question 12

syringe size for ventrogluteal (adults)

Answer 12

3.8cm

Question 13

considerations for subcut injections

Answer 13

• assess pt for circulatory shock and reduced local tissue perfusion (reduce tissue perfusion interferes w/ medication absorption and distribution)
• assess adipose tissue
• palpate the site for masses or tenderness
• insulin injections-rotate site daily
• have the pt relax the arm, leg, or abdomen depending on the site chosen for injection
• clean the site in a circular direction 5cm around
• hold the syringe like you’re holding a dart, palm down
• for an averaged-sized pt, spread the skin tightly across the injection site or pinch the skin w/ your nondominant hand
• inject at 45 or 90 degree angle (correct angle prevents accidental injection into muscle)
• for obese pt, pinch the skin and insert at 90 degree angle

Question 14

why do we pinch the skin in subcut injections?

Answer 14

pinching the skin elevates the subcut tissue and may desensitize the area

Question 15

do you aspirate a subcut injection?

Answer 15

no, piercing a blood vessel during a subcut injection is very rare, so aspiration is not needed

Question 16

considerations for intramuscular injection

Answer 16

• note integrity and size of the muscle
• palpate for tenderness or hardness
• if injections are given frequently, rotate the site
• use the ventrogluteal site (preferred site for adults and children)
• for infants-the vests lateralis should not be used
• depending on the site chosen position the pt sitting, lying flat, on one side, or lie prone
• hold the syringe like you were holding a dart-90 degree
• w/ nondominant hand pull the skin down 2.5-3.5c or laterally w/ the ulnar side of your hand to administer the injection in a z-track method

Question 17

z-track method

Answer 17

z-tract creates a zigzag path through the tissues to seal the needle track and avoid tracking of the medication

• should be used for all intramuscular injections
• skin must remain pulled until after the drug is injected to ensure z-track administration
• it minimizes local skin irritation by sealing the medication in the muscle tissue.

Question 18

considerations for intradermal injection

Answer 18

• hold the bevel of the needle pointing up -less likely to be deposited into the tissue below the dermis
• have pt extend the elbow and support the elbow and forearm on a flat surface
• with nondominant hand stretch the skin over the injection site w/ your forefinger or thumb
• insert it slowly w/ the bevel up at 5-15 degree angle until resistance is felt
• advance the needle through the epidermis to approx 3mm below the surface
• if resistance is not felt, the needle is too deep
• slow the injection to minimize pain/discomfort
• you should notice a small bleb of approx 6mm in diameter -this is normal
• do not massage the site- will tamper w/ results
• stay w/ pt for 3-5 mins to observe for any allergic reactions
• draw a circle around the perimeter of the site

Question 19

what are the best subcut injection sites

Answer 19

outer posterior aspect of the upper arms, the abdomen from below the costal margins to the iliac crests, and the anterior aspect of the thighs

Question 20

considerations for heparin injections

Answer 20

recommended site is the abdomen
other recommended site are the scapular area of the upper back and upper. ventral or dorsal gluteal areas
-ensure at least 5cm from the umbilicus
-do not rub the site after injection to eliminate bruising
-slow the injection of 30 seconds to reduce bruising and pain

Question 21

what are the recommended sites for insulin?

Answer 21

the upper arm, the anterior and lateral portions of the thigh, buttocks, and abdomen

• rotate sites (at least 2.5cm from the previous site)
• no injection site should be used again for at least 1 month
• abdomen has the quickest absorption, then arms, then thighs, then buttocks

Question 22

subcut max dose for injection

Answer 22

0.5-1mL of water-soluble medication b/c the tissue is sensitive to irrigating solutions and large volumes of medications

Question 23

subcut injection-gauge and needle

Answer 23

normal size pt use a 25 gauge 1.6cm needle, inserted at 45 degree angle
or 1.3cm needle inserted at a 90-degree angle
(a child may only require 1.3cm needle)
the preferred needle length is one-half the width of the skin fold
for thin pt use the upper abdomen

Question 24

what is the subcut rule to ensure the med reaches the subcut tissue

Answer 24

if you can grasp 5cm of tissue, insert the needle at 90 degree
if you can grasp 2.5cm of tissue insert at 45 degree

Question 25

IM injection- how much can you inject?

Answer 25

a normal well-developed pt- 3mL into.a larger muscle
for children older people, and thin patients- can tolerate only 2mL of an IM injection
-do not give more than 1mL to small children and older infant
-no more than 0.5mL to smaller infants

Question 26

what is the preferred site of injection for adults, children, and infants? (IM injections)

Answer 26

ventrogluteal site

safe for all pt b/c it is a large muscle that is well developed in all age groups even those who do not walk

Question 27

how to landmark the ventrogluteal muscle for injection?

Answer 27

place the heel of your hand over the greater trochanter of the patient’s hip with the wrist perpendicular to the femur. Use your right hand for the left hip, and your left hand for the right hip. Point your thumb toward the patient’s groin and point your fingers toward the patient’s head; point your index finger to the anterior superior iliac spine, and extend your middle finger back along the iliac crest toward the buttocks. The index finger, the middle finger, and the iliac crest form a V-shaped triangle; the injection site is the centre of the triangle
- patient may lie on his or her side or back. Flexing of the knee and hip helps the patient to relax this muscle

Question 28

vastus lateralis muscle

Answer 28

• thick and well developed muscle
• located on the anterior lateral aspect of the thigh and extends in an adult from handbreadth above the knee to a handbreadth below the greater trochanter of the femur
• use the middle third of the muscle for injection
• when administering injections to young children or cachectic patients, grasp the body of the muscle during injection to ensure the medication is deposited in the muscle tissue
• to help relax the muscle have sitting or lie flat w/ legs extended
• very common in infants, toddlers, and children

Question 29

dorosogluteal muscle

Answer 29

if a needle hits the sciatic nerve, the pt may experience permanent or partial paralysis of the involved leg. we do not USE THIS SITE ANYMORE

Question 30

deltoid muscle

Answer 30

• this muscle is not well developed in all pts
• a potential injury exists when using this site b/c the axillary, radial, brachial, and ulnar nerves and the brachial artery lie w/in the upper arm along the humerus
• use this site only when giving small amount of medication (covid vax)
• or when other sites are inaccessible b/c of dressings/casts

Question 31

how to locate the deltoid muscle

Answer 31

palpate the lower edge of the acromion process, which forms the base of a triangle in line w/ the midpoint of the lateral aspect of the upper arm

• the injection site is in the centre of the triangle, approx 3-5 cm below the acromion process
• can also be located by placing 4 fingers across the deltoid muscle, w/ the top finger along the acromion process. the injection site is then 3 fingers widths below the acromion process

Question 32

proper technique to administer medication using the z-track method?

Answer 32

After preparing the site with an antiseptic swab, pull the overlying skin and subcutaneous tissues approximately 2.5 to 3.5 cm laterally to the side.

• Holding the skin taut with the nondominant hand, insert the needle deep into the muscle, and slowly inject the medication.
• The needle remains inserted for 10 seconds to allow the medication to disperse evenly rather than channelling back up the track of the needle.
• Then, withdraw the needle and release the skin.

Question 33

what is the preferred site for an intradermal injection

Answer 33

-inner forearm and upper back are ideal locations

Question 34

high alert meds

Answer 34

-insulin, heparin, anticoagulation and opioids (must verify 2nd nurse)