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NRSG 202 > Week 4/2: Subcutaneous, Intradermal, Intramuscular Injections > Flashcards

Week 4/2: Subcutaneous, Intradermal, Intramuscular Injections Flashcards

1
Q

What is some injection equipment?

A

Syringes
Needles
Ampoules/Vials

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2
Q

What do syringes have?

A

A tip, barrel, and plunger

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3
Q

What does luer lock mean?

A

They are threaded

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4
Q

What is luer lock referred to?

A

“slip tip”

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5
Q

What is the range of syringes?

A

0.5 to 60 mL

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6
Q

What size is an average is a subcut and IM?

A

1 to 3mL

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7
Q

When should a syringe be increased?

A

If the string is more than 2/3 full 75% full, a bigger syringe size should be used

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8
Q

What do smaller syringes often have?

A

A non-removable needle

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9
Q

Syringes can measure medication dose in?

A

Units, decimals (tenths), or fractions

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10
Q

What are needles made of

A

Made of stainless steel

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11
Q

Needles consist of 3 parts:

A

Hub
Shaft
Bevel

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12
Q

Needle length is measured in?

A

Inches and/or mm

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13
Q

Needles length vary from

A

1/2” to 1 1/2”

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14
Q

Gauge is

A

The diameter of the shaft

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15
Q

What do gauges vary from?

A

16 to #28

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16
Q

The larger the gauge number

A

the smaller the diameter of the shaft

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17
Q

how is gauge determined?

A

by the viscosity of the medication

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18
Q

What are ampoules range?

A

from 1mL to 10 mL

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19
Q

Steps to opening an ampoules

A
  1. Ensure all fluid is located in the bottom the ampoule
  2. Cover top of ampoule with plastic cap, gauze, or alcohol swab package
  3. Break the ampoule by applying pressure and pushing away from you
  4. The top of the ampoule goes in the sharps container
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20
Q

Steps to withdrawing medication from ampoule

A
  1. Use a blunt fill needle
  2. Pull medication into a syringe
  3. Remove and discard the blunt filtered needle
  4. replace with desired needle for injection + prime
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21
Q

Syringes must be labelled with?

A

2 client identifies
Name of medication
Dose/volume
route

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22
Q

How much is administered via subcut route?

A

<1mL

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23
Q

What is the needle size usually used for subcut?

A

25 gauge and 5/8” long

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24
Q

when should a 45 degree angle be administered?

A

if 2.5cm tissue can be grasped at the site

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25
Q

When should a 90 degree angle be administered?

A

if 5cm tissue can be grasped at the site

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26
Q

Why rotate injection sites?

A

minimize tissue damage
maintain absorption
avoid discomfort

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27
Q

How far away should the injection be from the umbilicus

A

at least 5cm

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28
Q

Steps to administer heparin?

A
  1. Swab with alcohol
  2. Pinch and hold skin
  3. Administer very slowly 10 to 20 seconds
  4. remove and apply pressure
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29
Q

what does heparin require?

A

An IDC

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30
Q

What are the various insulin syringe sizes?

A

30, 50 and 100 units

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31
Q

Insulin needles usual gauge and length?

A

26-31 gauge and 1/4 to 1/2 inches long

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32
Q

what must be done with cloudy insulin before withdrawing?

A

Rolled between hands to mix

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33
Q

Steps to mixing 2 types of insulin?

A
  1. Mix cloudy
  2. swab both
  3. draw up air + insert into cloudy first
  4. Insert air into second vial + draw up insulin
  5. Draw up cloudy insulin
  6. Final IDC
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34
Q

SCBF Supplies

A
  1. Saf T Device (the insertion needle)
  2. Chlorhexidine wipe
  3. MicroClave clear needless cap
  4. Tegaderm
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35
Q

When initiating a SCBF,

A

The line and needless cap must be primed after insertion

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36
Q

What is the initial priming volume

A

Saf T Intima device line: 0.17mL
MicroClave Needless cap: 0.04mL
Priming total: 0.21mL

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37
Q

SCBF Insertion Steps

A
  1. Prepare and label
  2. swab with chlorhexidine
  3. Use thumb and index finger and pinch site
  4. Grasp textured size of wings and pinch together
  5. Insert at 30-45 degree angle
  6. Pull white end out of deice
  7. Apply tegaderm + administer priming and initial dose
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38
Q

What gets charted in SCBF Insertion

A

insertion of the device, location, and how the client tolerated the process, document in Kardex

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39
Q

Subcutaneous devices can only be used for

A

The specific medication and concentration that is on the label

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40
Q

How long can a SCBF be used

A

7 days (IH usually 4 days)

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41
Q

IM injections onset

A

faster onset of action

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42
Q

Why is IM sometimes used over Subcut

A

Muscles can accept some irritating medications

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43
Q

what is the usual IM syringe size, gauge, and length

A

1-3mL, 21-23G and 1/2 1 1/2” long

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44
Q

IM needles should be long enough to

A

Reach the muscle but not long enough to reach blood vessels or bone

45
Q

Syringe size is determined by

A

the medication and volume

46
Q

IM volume administered is determined by

A

muscle development and mass

47
Q

Ventrogluteal is

A

side of the glutes
preferred site in adults

48
Q

What is the typical amount administered into Ventrogluteal

A

Up to 3mL (some cases up to 5mL)

49
Q

What is the ventrogluteal landmark identifiers

A

Greater Trochanter
Iliac Crest
Anterior superior iliac spine

50
Q

Deltoid

A

lateral aspect of the arm

51
Q

Volume into deltoid

A

up to 2 mL

52
Q

Landmark identifiers

A

Acromion process - inject into muscle approx 3-5cm below acromion process
axilla (deltoid narrows)

53
Q

Vastus Lateralis

A

thick well developed muscle - side of thigh

54
Q

Volume into vistas laterals

A

up to 3mL (in some cases 5mL)

55
Q

Vastus lateralis landmark identifiers

A

anterior lateral aspect of thigh
greater trochanter
lateral femoral condyle

56
Q

Rectus Femoris

A

anterior aspect of thigh

57
Q

Rectus Femoris volume

A

up to 3mL (max 5mL)

58
Q

Rectus Femoris landmark identifiers

A

Anterior aspect of the thigh
anterior superior iliac crest
patella

59
Q

Dorsogluteal

A

No longer recommended in acute care
risk for sciatic nerve damage
often ends up in subcut tissue and not muscle

60
Q

Risks of IM injections

A

Pain
Bleeding
Abcess
Cellulitis
Tissue necrosis
Granuloma
Muscle fibrosis
Contractures
Hematoma
Injury to blood vessels, bone, nerves

61
Q

Is aspiration recommended for subcut injections?

A

Not typically recommended for subcut

62
Q

What is Parenteral injection?

A

Injection into body tissues

63
Q

4 major sites on injections

A
  1. Intradermal
  2. Subcutaneous
  3. Intramuscular
  4. Intravenous
64
Q

Intradermal Injection

A

Injected into dermis just under epidermis

65
Q

Subcutaneous injection

A

injected into tissues just below dermis

66
Q

Intramuscular injection

A

into a muscle

67
Q

Intravenous injection

A

Into a vein

68
Q

Administering injections is a

A

Invasive procedure that must be performed with aseptic technique

69
Q

What is important for the nurse to understand with parenteral medications?

A

Effects of parenteral medications occur quickly and are often hard to reverse

70
Q

What do syringes consist of?

A

A close fitting plunger and a cylindrical barrel with a tip to fit the hub of a needle

71
Q

What are the 2 types of syringes?

A

Leur Lock and Non Leur Lock

72
Q

Leur Lock

A

Requires special needles, twisted to lock into place

73
Q

Non Leur Lock

A

Requires needle that slips onto the tip

74
Q

What is the range for syringe sizes?

A

0.5mL to 60mL

75
Q

What are the IM syringe sizes most commonly?

A

1-3mL

76
Q

What is an unusual syringe size for IM injections?

A

greater than 5mL

77
Q

What are larger syringes used for?

A

IV medications, adding to IV solutions, irrigating or draining

78
Q

Insulin syringe sizes

A

0.3-1mL & calibrated in units

79
Q

What is a low dose syringe?

A

Holds 0.3mL

80
Q

What is most insulin syringes units?

A

U-100 (100 units per mL)

81
Q

what do tuberculin syringes look like?

A

Long, thin barrel with pre attached needle

82
Q

What are tuberculin syringes capacity?

A

1mL

83
Q

What are tuberculin syringes good for?

A

Small precise doses (e.g infants or young children)

84
Q

How are needles packaged?

A

In individual sheaths to allow flexibility in choosing the right needle

85
Q

What are most needles made of?

A

stainless steel + disposable

86
Q

What are the 3 parts to a needle?

A

The hub
The shaft
The bevel

86
Q

What are the 3 parts to a needle?

A

The hub
The shaft
The bevel

87
Q

What is needle length?

A

0.6 to 7.6cm

87
Q

What is needle length?

A

0.6 to 7.6cm

88
Q

How is needle length determined?

A

By patients weight and size

89
Q

What are the size of long needles + what are they used for?

A

2.5 to 3.8 and used for IM injections

90
Q

What are the size of short needles + what are they used for?

A

1 to 1.6cm and used for subcutaneous injections

91
Q

how is needle diameter measured?

A

By gauge

92
Q

As gauge becomes SMALLER…..

A

needle diameter becomes LARGER

93
Q

what does gauge selection depend on?

A

The viscosity of the fluid

94
Q

Gauge of IM injections

A

18-27

95
Q

Gauge of subcut injections

A

25

96
Q

typical gauge used for intradermal injections

A

26

97
Q

What are disposable injection units

A

Single dose pre-filled syringes

98
Q

Size of ampules?

A

1 to 10 or more mL

99
Q

What must happen to vials?

A

air injected into them to prevent vacuum seal

100
Q

What influences absorption rate

A

Characteristics of the tissues

101
Q

What should the nurse know prior to injections?

A

The volume, characteristics, viscosity, anatomical location

102
Q

What are some complications from incorrect administration?

A

Nerve/bone damage
Pain/tissue damage
injection into artery/vein

103
Q

What are ways to minimize patient discomfort with injections?

A

Smallest needle length/gauge
position comfortably
proper site selection
divert attention
quick smooth insertion
hold syringe steady
inject med slow and steady

104
Q

What kinds of meds are administered into the dermis?

A

Potent medications

105
Q

What is the ideal spot for dermis injections

A

light pigment, no lesions, hairless (mostly) - so nurse can assess

106
Q

how many staff receive needle stick injury

A

1/3 hospital staff

NRSG 202 (8 decks)

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