Week 4/2: Subcutaneous, Intradermal, Intramuscular Injections Flashcards
What is some injection equipment?
Syringes
Needles
Ampoules/Vials
What do syringes have?
A tip, barrel, and plunger
What does luer lock mean?
They are threaded
What is luer lock referred to?
“slip tip”
What is the range of syringes?
0.5 to 60 mL
What size is an average is a subcut and IM?
1 to 3mL
When should a syringe be increased?
If the string is more than 2/3 full 75% full, a bigger syringe size should be used
What do smaller syringes often have?
A non-removable needle
Syringes can measure medication dose in?
Units, decimals (tenths), or fractions
What are needles made of
Made of stainless steel
Needles consist of 3 parts:
Hub
Shaft
Bevel
Needle length is measured in?
Inches and/or mm
Needles length vary from
1/2” to 1 1/2”
Gauge is
The diameter of the shaft
What do gauges vary from?
16 to #28
The larger the gauge number
the smaller the diameter of the shaft
how is gauge determined?
by the viscosity of the medication
What are ampoules range?
from 1mL to 10 mL
Steps to opening an ampoules
- Ensure all fluid is located in the bottom the ampoule
- Cover top of ampoule with plastic cap, gauze, or alcohol swab package
- Break the ampoule by applying pressure and pushing away from you
- The top of the ampoule goes in the sharps container
Steps to withdrawing medication from ampoule
- Use a blunt fill needle
- Pull medication into a syringe
- Remove and discard the blunt filtered needle
- replace with desired needle for injection + prime
Syringes must be labelled with?
2 client identifies
Name of medication
Dose/volume
route
How much is administered via subcut route?
<1mL
What is the needle size usually used for subcut?
25 gauge and 5/8” long
when should a 45 degree angle be administered?
if 2.5cm tissue can be grasped at the site
When should a 90 degree angle be administered?
if 5cm tissue can be grasped at the site
Why rotate injection sites?
minimize tissue damage
maintain absorption
avoid discomfort
How far away should the injection be from the umbilicus
at least 5cm
Steps to administer heparin?
- Swab with alcohol
- Pinch and hold skin
- Administer very slowly 10 to 20 seconds
- remove and apply pressure
what does heparin require?
An IDC
What are the various insulin syringe sizes?
30, 50 and 100 units
Insulin needles usual gauge and length?
26-31 gauge and 1/4 to 1/2 inches long
what must be done with cloudy insulin before withdrawing?
Rolled between hands to mix
Steps to mixing 2 types of insulin?
- Mix cloudy
- swab both
- draw up air + insert into cloudy first
- Insert air into second vial + draw up insulin
- Draw up cloudy insulin
- Final IDC
SCBF Supplies
- Saf T Device (the insertion needle)
- Chlorhexidine wipe
- MicroClave clear needless cap
- Tegaderm
When initiating a SCBF,
The line and needless cap must be primed after insertion
What is the initial priming volume
Saf T Intima device line: 0.17mL
MicroClave Needless cap: 0.04mL
Priming total: 0.21mL
SCBF Insertion Steps
- Prepare and label
- swab with chlorhexidine
- Use thumb and index finger and pinch site
- Grasp textured size of wings and pinch together
- Insert at 30-45 degree angle
- Pull white end out of deice
- Apply tegaderm + administer priming and initial dose
What gets charted in SCBF Insertion
insertion of the device, location, and how the client tolerated the process, document in Kardex
Subcutaneous devices can only be used for
The specific medication and concentration that is on the label
How long can a SCBF be used
7 days (IH usually 4 days)
IM injections onset
faster onset of action
Why is IM sometimes used over Subcut
Muscles can accept some irritating medications
what is the usual IM syringe size, gauge, and length
1-3mL, 21-23G and 1/2 1 1/2” long
IM needles should be long enough to
Reach the muscle but not long enough to reach blood vessels or bone
Syringe size is determined by
the medication and volume
IM volume administered is determined by
muscle development and mass
Ventrogluteal is
side of the glutes
preferred site in adults
What is the typical amount administered into Ventrogluteal
Up to 3mL (some cases up to 5mL)
What is the ventrogluteal landmark identifiers
Greater Trochanter
Iliac Crest
Anterior superior iliac spine
Deltoid
lateral aspect of the arm
Volume into deltoid
up to 2 mL
Landmark identifiers
Acromion process - inject into muscle approx 3-5cm below acromion process
axilla (deltoid narrows)
Vastus Lateralis
thick well developed muscle - side of thigh
Volume into vistas laterals
up to 3mL (in some cases 5mL)
Vastus lateralis landmark identifiers
anterior lateral aspect of thigh
greater trochanter
lateral femoral condyle
Rectus Femoris
anterior aspect of thigh
Rectus Femoris volume
up to 3mL (max 5mL)
Rectus Femoris landmark identifiers
Anterior aspect of the thigh
anterior superior iliac crest
patella
Dorsogluteal
No longer recommended in acute care
risk for sciatic nerve damage
often ends up in subcut tissue and not muscle
Risks of IM injections
Pain
Bleeding
Abcess
Cellulitis
Tissue necrosis
Granuloma
Muscle fibrosis
Contractures
Hematoma
Injury to blood vessels, bone, nerves
Is aspiration recommended for subcut injections?
Not typically recommended for subcut
What is Parenteral injection?
Injection into body tissues
4 major sites on injections
- Intradermal
- Subcutaneous
- Intramuscular
- Intravenous
Intradermal Injection
Injected into dermis just under epidermis
Subcutaneous injection
injected into tissues just below dermis
Intramuscular injection
into a muscle
Intravenous injection
Into a vein
Administering injections is a
Invasive procedure that must be performed with aseptic technique
What is important for the nurse to understand with parenteral medications?
Effects of parenteral medications occur quickly and are often hard to reverse
What do syringes consist of?
A close fitting plunger and a cylindrical barrel with a tip to fit the hub of a needle
What are the 2 types of syringes?
Leur Lock and Non Leur Lock
Leur Lock
Requires special needles, twisted to lock into place
Non Leur Lock
Requires needle that slips onto the tip
What is the range for syringe sizes?
0.5mL to 60mL
What are the IM syringe sizes most commonly?
1-3mL
What is an unusual syringe size for IM injections?
greater than 5mL
What are larger syringes used for?
IV medications, adding to IV solutions, irrigating or draining
Insulin syringe sizes
0.3-1mL & calibrated in units
What is a low dose syringe?
Holds 0.3mL
What is most insulin syringes units?
U-100 (100 units per mL)
what do tuberculin syringes look like?
Long, thin barrel with pre attached needle
What are tuberculin syringes capacity?
1mL
What are tuberculin syringes good for?
Small precise doses (e.g infants or young children)
How are needles packaged?
In individual sheaths to allow flexibility in choosing the right needle
What are most needles made of?
stainless steel + disposable
What are the 3 parts to a needle?
The hub
The shaft
The bevel
What are the 3 parts to a needle?
The hub
The shaft
The bevel
What is needle length?
0.6 to 7.6cm
What is needle length?
0.6 to 7.6cm
How is needle length determined?
By patients weight and size
What are the size of long needles + what are they used for?
2.5 to 3.8 and used for IM injections
What are the size of short needles + what are they used for?
1 to 1.6cm and used for subcutaneous injections
how is needle diameter measured?
By gauge
As gauge becomes SMALLER…..
needle diameter becomes LARGER
what does gauge selection depend on?
The viscosity of the fluid
Gauge of IM injections
18-27
Gauge of subcut injections
25
typical gauge used for intradermal injections
26
What are disposable injection units
Single dose pre-filled syringes
Size of ampules?
1 to 10 or more mL
What must happen to vials?
air injected into them to prevent vacuum seal
What influences absorption rate
Characteristics of the tissues
What should the nurse know prior to injections?
The volume, characteristics, viscosity, anatomical location
What are some complications from incorrect administration?
Nerve/bone damage
Pain/tissue damage
injection into artery/vein
What are ways to minimize patient discomfort with injections?
Smallest needle length/gauge
position comfortably
proper site selection
divert attention
quick smooth insertion
hold syringe steady
inject med slow and steady
What kinds of meds are administered into the dermis?
Potent medications
What is the ideal spot for dermis injections
light pigment, no lesions, hairless (mostly) - so nurse can assess
how many staff receive needle stick injury
1/3 hospital staff
