Skin and Joint Injections Flashcards
Clean Technique
Involves reducing the numbers of micro-organisms to minimize the risk of transmission from the environment or HCP, using appropriate hand hygiene and clean gloves and a clean environment (minimal)
Aseptic Technique
Requires the use of various barriers to prevent the transfer of micro-organisms from HCPs and the environment to the patient during a procedure, using: all Sterile supplies, antiseptic skin prep for procedure, a controlled environment.
As sterile as one could get, outside of the operating room (OR)
Sterile Technique
Complete absence of microorganisms, all instruments and protective clothing are sterile, the environment (field) is sterile. OR setting. (maximum standard required through standard and Universal Precautions recommended by OSHA.
Major Contraindications to Injections (4)
- Known hypersensitivity to the drug or its excipients ( i.e. Flu vaccine contains egg)
- Skin is inflamed, irritated, excoriated or infected.
- Patient is pregnant or breastfeeding (drug may be contraindicated: Botox, Rubella, Hormones, opiates)
- Stopper is latex and patient is allergic to latex (switch needle before administering the shot)
Intradermal (ID)
- Directly under the epidermis at an angle of 10-15°
- Syringe Size = amount 1cc, 3cc, 5cc, etc
- Gauge Size = higher the number the smaller the needle width (14-30)
- Needle lengths: 3/8” to >6”
Subcutaneous (SQ)
- Subcutaneous layer at an angle of 45° .
- Allows for slow sustained absorption of medications, such as insulin, and opiates, such as morphine, dialudid and demerol
- Larger Syringe and larger needle then ID but variable depending on what medication is being given.
- Common sites are the abdomen, lateral and posterior upper arm, anterior thighs, and ventrolateral gluteal region.
Wherever there is a good layer of subcutaneous fat.
Intramuscular (IM)
- Injected into a well perfused muscle at a 90° angle and aspiration.
- Provides rapid systemic action of relatively large doses of 1-2cc, with least amount of tissue damage.
- Syringe and needle size can vary greatly; usually 3-5 cc syringe, 21-25 gauge, 1-1.5” needle
Why do you aspirate 1st when giving a IM injection and what to do if you have hit a vessel?
To ensure you are not giving an IM medication IV
No blood, continue with injection
Blood present- withdraw slightly and redirect the needle, then inject; if needle comes out of skin, then start over.
Sites for giving an IM injection
Deltoid, Gluteus Medius, Vastus Lateralis, Rectus Femoris, Gluteus Maximus
Diagnostic Indications for Joint Injections (4)
- Acute or chronic symptoms present
- Diagnosis is unclear or needs confirmation 3. Consideration of other diagnostic modalities has been made
- Septic arthritis has been ruled out
Therapeutic Indications for Joint Injections (4)
- Acute or chronic symptoms are present
- After the diagnosis and therapeutic plan have been made
- After consideration of obtaining radiographs
Arthrocentesis
AKA Joint Aspiration
Removal of fluid from a joint.
Absolute contraindications for Joint Injections (8)
- Local cellulitis
- Septic arthritis
- Acute fracture
- Bacteremia
- Joint prosthesis
- Achilles or patella tendinopathies
- History of allergy or anaphylaxis to injectable pharmaceuticals or constituents
- More than 3 previous corticosteroid injections within the past year in a single joint*.
Relative contraindications for Joint Injections (6)
- Minimal relief after 2 previous corticosteroid injections
- Underlying coagulopathies
- Anticoagulation therapy
- Evidence of surrounding joint osteoporosis
- Anatomically inaccessible joints
- Uncontrolled diabetes mellitus
What type of technique should be used for joint injections?
Sterile gloves & technique
