Pottery & Perry CP34- Injections Flashcards
what is a purpose of the filter needle?
to prevent small glass fragments from entering the syringe. used in to draw up medications in ampules.
what is important to consider when drawing up medication from a vial?
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.
considerations when drawing medication from ampule
- 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
mixing two medications from two vials
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
mixing meds from one vial and one ampule
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
what type of insulin can be administered intravenously?
only regular (short-acting) insulin
when taking blood glucose from pts in hospital ensure you do what?
swab the fingertip with an alcohol swab. use of an aseptic technique prevents infection while in the hospital
proper syringe size and needle for subcutaneous
syringe (1-3mL) and needle (25-27 gauge, 1-1.6cm)
IM syringe size
2-3mL for adults
0.5-1mL for infants and small children
syringe size for vastus lateralis (adults)
2.5-3.8cm
syringe size deltoid (adults)
2.5-3.8cm
syringe size for ventrogluteal (adults)
3.8cm
considerations for subcut injections
- 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
why do we pinch the skin in subcut injections?
pinching the skin elevates the subcut tissue and may desensitize the area
do you aspirate a subcut injection?
no, piercing a blood vessel during a subcut injection is very rare, so aspiration is not needed
considerations for intramuscular injection
- 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
z-track method
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.
considerations for intradermal injection
- 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
what are the best subcut injection sites
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
considerations for heparin injections
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
what are the recommended sites for insulin?
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
subcut max dose for injection
0.5-1mL of water-soluble medication b/c the tissue is sensitive to irrigating solutions and large volumes of medications
subcut injection-gauge and needle
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
what is the subcut rule to ensure the med reaches the subcut tissue
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
