Week 4 - subcutaneous, intramuscular injections and subcutaneous device Flashcards
1
Q
what do syringes have?
A
- tip
- barrel
- plunger
2
Q
What can syringes have?
A
luer lok - they are threaded
non-luer lok - slip tip
3
Q
what are the normal ranges for syringes?
A
0.5mL-60mL
4
Q
What do nurses usually use for subcut and IM injections?
A
1-3mL
5
Q
What do small syringes have?
A
non-removable needle
ex. insulin, TB
6
Q
What can syringes measure medication doses in?
A
- units
- decimals (tenths)
- fractions
7
Q
What must syringes containing medication be labelled with?
A
- 2 client identifiers
- name of medication
- dose/ volume
- route
8
Q
What are needles made of?
A
stainless steel
9
Q
What do needles consist of?
A
- hub
- cannula or shaft
- bevel
10
Q
describe the gauge of needles
A
- diameter of shaft
- varies from #16-#28
- larger the gauge the smaller the diameter of shaft
11
Q
how is the length of the needle chosen?
A
according to the route of the injection and the client
12
Q
What color are blunt ad filtered blunt needles?
A
blunt - red
blunt filtered - lilac
13
Q
if an ampules has a dot where should it be located when opening?
A
- dot located on side furthest away from you
- index finger should be covering it
14
Q
what sizes do ampules come in?
A
1mL-10mLs or more
15
Q
Why can’t you touch the sides the ampule while pulling up medication?
A
side of ampule could be contaminated
16
Q
what does subcut stand for?
A
into the subcutaneous tissue
17
Q
What is the dose for a subcut?
A
usually <1mL but some institutional policies may state up to 2mL
18
Q
what syringe/needle size is usually used for subcut?
A
1-3mL with a 25G and 5/8in long needle
19
Q
What angle should a subcut be administered at?
A
45 degrees if 2.5cm tissue can be grabbed at site
90 degree if 5cm tissue can be grasped at site
20
Q
Why do subcutaneous injection sites need to be rotated in an orderly fashion?
A
- minimize tissue damage
- maintain absorption
- avoid discomfort
21
Q
What are some things to consider when injecting heparin?
A
- 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
22
Q
Where is the best place to administer heparin? Where else can you administer it?
A
can be administered in arms but abdomen preferred
23
Q
describe insulin syringes
A
come in variety of sizes
- 30 units
- 50 units
- 100 units
24
Q
describe insulin needles
A
usually 26-31 gauge and 1/4 to 1/2 in long
25
where is insulin absorbed more quickly?
abdomen then arms then thighs and butt
26
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
27
what angel should insulin be injected at?
90 degrees
28
once insulin is injected how long should the needle be held at the site for?
10 seconds
29
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
30
What needs to be on the tegaderm label thats covering the subcutaneous butterfly?
- date
- name of medication
- concentration
31
when assessing a subcutaneous butterfly site what are you looking for?
- redness
- swelling
- pain
32
How long can a subcutaneous butterfly stay in place for?
2-7 days
33
What can subcutaneous butterflies be used for?
- specified medication/ concentration that is on the label
| - if concentration changes device must be changed
34
what do you need to document in regards to subcutaneous butterflies?
1. nursing notes
- insertion of device
- where its inserted
- how client tolerated process
2. sometimes wanted documented in the Kardex
35
what kind of injection is faster in regards to drug absorption?
muscle tissue is faster than subcut or ID
36
describe the onset of drugs once administered via IM
faster onset of action
37
What group can accept larger volumes of medication?
muscles accept larger volumes of medication vs. subcut or ID
38
what kind of medication can muscles accept?
some irritating medications that should not be administered by subcut or ID
39
what do muscle injections lead to?
good immune response with vaccines
40
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)
41
When administering an IM injections what do you need to select?
- appropriate length
- appropriate gauge
- appropriate site
42
in regards to IM injections how is the gauge determined?
by the viscosity of the liquid
43
in regards to IM injections how is the site determined?
by the medication and volume
44
in regards to IM injections how is the volume administered determined?
by the development and amount of muscle mass
45
in regards to IM injections how is the length determined?
by the site/ weight of the client
46
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
47
in regards to IM injections what do you need to assess?
clients weight and muscle mass
48
what is the needle length used at the ventrogluteal site for a child?
1/2-1in
49
what is the needle length used at the ventrogluteal site for an adult?
1 1/2 in
50
what is the needle length used at the vastus lateralis site for a child?
5/8-1in
51
what is the needle length used at the vests lateralis site for an adult?
5/8-1in
52
what is the needle length used at the deltoid site for a child?
1/2-1in
53
what is the needle length used at the deltoid site for an adult
1-1 1/2in
54
What is the needle length used for men and women if they weigh <130lb?
5/8-1in
55
What is the needle length used for men and women if they weigh 130-152lb?
1in
56
What is the needle length used for men and women if they weigh 153-260lb?
1-1 1/2in
57
What is the needle length used for men and women if they weigh 260+lb?
1-1 1/2 in
58
What is the preferred site for IM injections for adults?
ventrogluteal
59
How many mLs can be administered in the ventrogluteal site?
up to 3mL
60
What positions can the client be in when administering an injection at the ventrogluteal site?
- side-lying
- suprine
- prone
61
What land mark identifiers are used when finding injection site for ventrogluteal?
- greater trochanter
- iliac crest
- anterior superior iliac spine
62
Where is the deltoid located?
lateral aspect of the arm
63
How many mLs can be injected into the deltoid muscle?
small amount <1mL
64
What land mark identifiers are used when finding injection site for deltoid?
- acromion process
- axilla
- 3-5cm below the acromion process
65
describe the vastus lateralis
thick/ well developed in adult and children
66
What is the preferred site for IM injections in regards to children 1 year and younger?
vastus lateralis
67
How many mLs can be administered in the vastus lateralis?
up to 3mL
68
What position can the client be in when administering an IM injection into the vastus lateralis?
- back-lying
| - sitting
69
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
70
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
71
What can get damaged at the vastus lateralis site when injecting not landmarking properly?
- femoral nerve
| - femoral artery
72
where is the rectus femoris located?
anterior aspect of the thigh
73
how many mLs can be adminsteredin the rectus femoris?
- up to 3mL
74
What position can the client be in when administering an IM injection into the rectus femoris?
- lying
| - sitting
75
What land mark identifiers are used when finding injection site for the rectus femoris?
- anterior aspect of thigh
- anterior-superior iliac spine
- patella
76
When a client is administering their own medication IM, what site do they use? (not insulin)
rectus femoris
77
What is the disadvantage of using the rectus femoris site for IM injections?
may cause considerable discomfort
78
Why is the dorsogluteal site not recommended for IM injections?
- sciatic nerve
- various amount of subcutaneous tissue
- gluteal artery
79
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
80
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
81
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
82
What are the techniques used for IM injections?
- stretch skin (standard method)
| - Z-track
83
What technique is used that results in reduced pain and fewer injection site lesions?
Z-track
