Skin and Joint Injections Flashcards
universal precaution
system of infection control used in the US
endorsed by OSHA and the CDC
what should be treated as if bloodborne?
all human and blood and OPIM
OPIM
other potentially infectious material
-all other bodily fluid
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
needle use
very common but can cause lots of unnecessary stress
**must wear gloves!!
proper way to remove contaminated gloves?
yeah, there actually is.
-just don’t touch that shit
and clean yo hands afterwards!
needlestick
break in skin from needle or other sharp
-ex scalpel
how many needlestick injuries occur immediately after use or before disposal?
40%
what can be acquired by needlesticks?
Hep B/C and HIV
two common problems with injections?
fainting and allergic reactions
what is required for all injections?
aseptic technique
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
contraindications to injections?
- known hypersensitivity
- skin is inflamed, irritated, excoriated, or infected
- pregnancy or breastfeeding
- stopper is latex and patient is allergic to latex
informed consent
required for ALL procedures
- includes injections
- involves a consent form!
what discuss for informed consent
1 indications 2 potential risks 3 complications and side effects 4 alternatives 5 potential outcomes for injection procedure
three types of cutaneous injections?
intradermal (ID)
subQ (SQ)
intramuscular (IM)
**difference is DEPTH of needle
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
syringe
tube holding substance
needle gauge
number based on size of hole in needle
-larger number is smaller needle
number based on length of needle
wheal
created by intradermal injection
little bump
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
