required for ALL procedures - includes injections - involves a consent form!

Skin and Joint Injections Flashcards by Matt Stanton

universal precaution

system of infection control used in the US

endorsed by OSHA and the CDC

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what should be treated as if bloodborne?

all human and blood and OPIM

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OPIM

other potentially infectious material

-all other bodily fluid

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risk of infection depends on what?

type of pathogen
type/route of exposure
amount of virus in infected blood
amount of infected blood involved in the exposure
whether post-exposure treatment was taken
specific immune response of infected individual

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needle use

very common but can cause lots of unnecessary stress

**must wear gloves!!

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proper way to remove contaminated gloves?

yeah, there actually is.
-just don’t touch that shit

and clean yo hands afterwards!

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needlestick

break in skin from needle or other sharp

-ex scalpel

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how many needlestick injuries occur immediately after use or before disposal?

40%

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what can be acquired by needlesticks?

Hep B/C and HIV

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two common problems with injections?

fainting and allergic reactions

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what is required for all injections?

aseptic technique

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purpose of injections?

prevention and treatment of disease and pain
allow for some control in distribution of medication
reserved for meds that cannot be administered by other routes

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contraindications to injections?

known hypersensitivity
skin is inflamed, irritated, excoriated, or infected
pregnancy or breastfeeding
stopper is latex and patient is allergic to latex

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informed consent

required for ALL procedures

includes injections
involves a consent form!

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what discuss for informed consent

1 indications
2 potential risks
3 complications and side effects
4 alternatives
5 potential outcomes for injection procedure

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three types of cutaneous injections?

intradermal (ID)
subQ (SQ)
intramuscular (IM)

**difference is DEPTH of needle

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intradermal injection

directly under epidermis

10-15 degree angle

primarily for diagnostic purposes
-allergy, TB, candida)

or local anesthetics

small syringe and small gauge needles

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syringe

tube holding substance

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needle gauge

number based on size of hole in needle
-larger number is smaller needle

number based on length of needle

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wheal

created by intradermal injection

little bump

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subQ injection

into subQ at 45-90 degree angle

for testing - know 45 DEGREES!

slow, sustained absorption of medications
-insulin, hormones, opiates

variety of syringe and needle sizes

common sites for subQ injections

abdomen, lateral and posterior upper arm, anterior thigh, ventral gluteal region

-where there is a layer of subQ

intramuscular injection

well perfused muscle at 90 degree angle and aspiration

rapid systemic action of large dose
with least amount of tissue damage

vaccines:
-Hep A/B, MMR, DPT Pentacel, tetanus, B12, epinephrine, opiates, promethazine

syringe and needle size can vary greatly

location of IM injections?

Deltoid, Gluteus Medius, Vastus Lateralis, Rectus Femoris, Gluteus Maximus

skin injection site reactions

irritation inflammation infection

prevention of skin site reactions?

``` cool pack clean and dry cotton ball or gauze pad not injecting into skin that is tender, red, or hard rotating injection sites ```

Mantoux Skin Test

for TB

after injections

needle is no CONTAMINATED - put er in the sharps container - don't recap

complications of injections?

vasovagal syncope infection ??

vasovagal syncope

fainting | -have them lay down

indications for joint injections

diagnostic -aspiration or arthrocentesis of synovial fluid for analysis therapeutic - aspiration/arthrocentesis of fluid from grossly swollen joint - delivery of local anesthetic - delivery of corticosteriods or visco-supplementation (hyaluronic acid) for suppression of inflammation and improved ROM

contraindications for joint injections**

``` ABSOLUTE local cellulitis septic arthritis acute fracture bacteremia joint prosthesis achiles or patellar tendinopathies allergy from injectables more than 3 corticosteriods within past year in single joint*** ``` RELATIVE minimal relief after 2 previous coagulopathies etc.

timing of joint injections

important ??

supplies for injection

make sure you have everything you need

anesthesia needle

30 gauge half inch 1-3 cc

injection needle

22-25 1.5 inch 1-10cc

aspiration needle

18-25 gauge

lidocaine

aka xylocaine acts instantly short duration**

bupivacaine

aka marcaine quick onset long duration (up to 7-8 hours)** **can be mixed

epinephrine

vasoconstrictor -often combined with lidocaine or bupivacaine used in very vascular areas

where not use EPI?

fingers, nose, penis, toe, earlobe

types of corticosteroids

don't worry about this now **know the anesthetics

corticosteroids

great for people with articular conditions | -RA, OA, gout, ankylosing spondylitis

MISSED SLIDES

on corticosteroids

site preparation

place patient in supine position** sterile technique ice or topical vapo-coolant spray to skin aspirate before injecting injection should flow easily small quantity of anesthetic can be injected subQ

aspirate

during IM injection -to see if you are in a vessel if you are in a vessel -take it back and shift around

post procedure care

adhesive dressing to wound 8-12 hours instruct patient to ice use of NSAIDs ok for first 24-48 hours

good NSAID

naprosen 500mg

prescription of ibuprofen?

higher dosage is for anti-inflammatory | -600mg

procedure note

description of procedure performed