Week 4 - subcutaneous, intramuscular injections and subcutaneous device Flashcards
what do syringes have?
- tip
- barrel
- plunger
What can syringes have?
luer lok - they are threaded
non-luer lok - slip tip
what are the normal ranges for syringes?
0.5mL-60mL
What do nurses usually use for subcut and IM injections?
1-3mL
What do small syringes have?
non-removable needle
ex. insulin, TB
What can syringes measure medication doses in?
- units
- decimals (tenths)
- fractions
What must syringes containing medication be labelled with?
- 2 client identifiers
- name of medication
- dose/ volume
- route
What are needles made of?
stainless steel
What do needles consist of?
- hub
- cannula or shaft
- bevel
describe the gauge of needles
- diameter of shaft
- varies from #16-#28
- larger the gauge the smaller the diameter of shaft
how is the length of the needle chosen?
according to the route of the injection and the client
What color are blunt ad filtered blunt needles?
blunt - red
blunt filtered - lilac
if an ampules has a dot where should it be located when opening?
- dot located on side furthest away from you
- index finger should be covering it
what sizes do ampules come in?
1mL-10mLs or more
Why can’t you touch the sides the ampule while pulling up medication?
side of ampule could be contaminated
what does subcut stand for?
into the subcutaneous tissue
What is the dose for a subcut?
usually <1mL but some institutional policies may state up to 2mL
what syringe/needle size is usually used for subcut?
1-3mL with a 25G and 5/8in long needle
What angle should a subcut be administered at?
45 degrees if 2.5cm tissue can be grabbed at site
90 degree if 5cm tissue can be grasped at site
Why do subcutaneous injection sites need to be rotated in an orderly fashion?
- minimize tissue damage
- maintain absorption
- avoid discomfort
What are some things to consider when injecting heparin?
- injected at least 5cm away from umbilicus
- low molecular weight heparin comes refilled in syringe
- administered slowly over 10-20 seconds
- assess abdomen for trauma prior to selecting injection site
- swab prior to injecting
Where is the best place to administer heparin? Where else can you administer it?
can be administered in arms but abdomen preferred
describe insulin syringes
come in variety of sizes
- 30 units
- 50 units
- 100 units
describe insulin needles
usually 26-31 gauge and 1/4 to 1/2 in long
where is insulin absorbed more quickly?
abdomen then arms then thighs and butt
how are patients supposed to rotate sites when injecting insulin?
- in the same anatomical site approx. 2.5cm apart rather than between anatomical sites
- limits variations in BG levels
what angel should insulin be injected at?
90 degrees
once insulin is injected how long should the needle be held at the site for?
10 seconds
What are the steps for setting up at subcutaneous butterfly?
- prepare meds including any if priming line
- select site for injection(arms, chest, legs)
- swab area
- insert device at 45-90 degrees c pebbled side facing client
- remove needle by securing wings at site/ pull end of device
- apply tegaderm to cover insertion site
What needs to be on the tegaderm label thats covering the subcutaneous butterfly?
- date
- name of medication
- concentration
when assessing a subcutaneous butterfly site what are you looking for?
- redness
- swelling
- pain
How long can a subcutaneous butterfly stay in place for?
2-7 days
What can subcutaneous butterflies be used for?
- specified medication/ concentration that is on the label
- if concentration changes device must be changed
what do you need to document in regards to subcutaneous butterflies?
- nursing notes
- insertion of device
- where its inserted
- how client tolerated process - sometimes wanted documented in the Kardex
what kind of injection is faster in regards to drug absorption?
muscle tissue is faster than subcut or ID
describe the onset of drugs once administered via IM
faster onset of action
What group can accept larger volumes of medication?
muscles accept larger volumes of medication vs. subcut or ID
what kind of medication can muscles accept?
some irritating medications that should not be administered by subcut or ID
what do muscle injections lead to?
good immune response with vaccines
describe the syringe and gauge size needed for IM injections
1-3mL syringe
21-23 gauge and 1/2-1 1/2in long
obese clients may need longer needle (up to 3in)
When administering an IM injections what do you need to select?
- appropriate length
- appropriate gauge
- appropriate site
in regards to IM injections how is the gauge determined?
by the viscosity of the liquid
in regards to IM injections how is the site determined?
by the medication and volume
in regards to IM injections how is the volume administered determined?
by the development and amount of muscle mass
in regards to IM injections how is the length determined?
by the site/ weight of the client
in regards to IM injections needles need to be what?
long enough to reach muscle but not long enough to reach blood vessels or bones
in regards to IM injections what do you need to assess?
clients weight and muscle mass
what is the needle length used at the ventrogluteal site for a child?
1/2-1in
what is the needle length used at the ventrogluteal site for an adult?
1 1/2 in
what is the needle length used at the vastus lateralis site for a child?
5/8-1in
what is the needle length used at the vests lateralis site for an adult?
5/8-1in
what is the needle length used at the deltoid site for a child?
1/2-1in
what is the needle length used at the deltoid site for an adult
1-1 1/2in
What is the needle length used for men and women if they weigh <130lb?
5/8-1in
What is the needle length used for men and women if they weigh 130-152lb?
1in
What is the needle length used for men and women if they weigh 153-260lb?
1-1 1/2in
What is the needle length used for men and women if they weigh 260+lb?
1-1 1/2 in
What is the preferred site for IM injections for adults?
ventrogluteal
How many mLs can be administered in the ventrogluteal site?
up to 3mL
What positions can the client be in when administering an injection at the ventrogluteal site?
- side-lying
- suprine
- prone
What land mark identifiers are used when finding injection site for ventrogluteal?
- greater trochanter
- iliac crest
- anterior superior iliac spine
Where is the deltoid located?
lateral aspect of the arm
How many mLs can be injected into the deltoid muscle?
small amount <1mL
What land mark identifiers are used when finding injection site for deltoid?
- acromion process
- axilla
- 3-5cm below the acromion process
describe the vastus lateralis
thick/ well developed in adult and children
What is the preferred site for IM injections in regards to children 1 year and younger?
vastus lateralis
How many mLs can be administered in the vastus lateralis?
up to 3mL
What position can the client be in when administering an IM injection into the vastus lateralis?
- back-lying
- sitting
What land mark identifiers are used when finding injection site for the vastus lateralis?
- anterior lateral aspect of the thigh into middle third
- greater trochanter
- lateral femoral condyle
What are the advantages to using the vastus lateralis site for IM injections?
- ease of access
- no major blood vessels/ significant nerves
- bulk of muscle non-atrophied reduces chances of injury
What can get damaged at the vastus lateralis site when injecting not landmarking properly?
- femoral nerve
- femoral artery
where is the rectus femoris located?
anterior aspect of the thigh
how many mLs can be adminsteredin the rectus femoris?
- up to 3mL
What position can the client be in when administering an IM injection into the rectus femoris?
- lying
- sitting
What land mark identifiers are used when finding injection site for the rectus femoris?
- anterior aspect of thigh
- anterior-superior iliac spine
- patella
When a client is administering their own medication IM, what site do they use? (not insulin)
rectus femoris
What is the disadvantage of using the rectus femoris site for IM injections?
may cause considerable discomfort
Why is the dorsogluteal site not recommended for IM injections?
- sciatic nerve
- various amount of subcutaneous tissue
- gluteal artery
What are some risk factors associated with IM injections?
- bleeding
- abscess
- cellulitis
- tissue necrosis
- granuloma
- muscle fibrosis
- contractures
- hematoma
- injury to blood vessels, bones, peripheral nerves
- tendonitis
- pain
- infection
if you are required to aspirated during an IM injection how long do you need to pull back on the plunger for? What does this ensure?
- 5-10 seconds
- ensures needle is not in low flow blood vessel
What do you do if blood is aspirated in syringe during an IM injection?
- needle withdrawn
- syringe discarded
- new injection prepared using new equipment
- administered in different location
What are the techniques used for IM injections?
- stretch skin (standard method)
- Z-track
What technique is used that results in reduced pain and fewer injection site lesions?
Z-track
