CH 21

How is the needle gauge determined?

Based on the viscosity (thickness) of the medication. The thicker the medication, the smaller the gauge (larger the lumen)

Disposable injection units

Single dose- prefilled syringes. Ex: morphine sulfate or enoxaparin sodium (Lovenox)

Needleless devices

Special syringes designed w/ a sheath or guard that can cover the needle after it is withdrawn from the skin. Reduces the chances of needlestick injury

Z-tract method

Staining or tracking of the medication- medication is sealed deep within the muscle

Gauge

Standard or scale of measurement of the needle. The smaller the gauge, the larger the diameter of the needle is

Lumen

The inside of the hollow shaft of the needle

Three milliliter syringe

Used for giving volumes of medication of 1-3mL. -used MOST for IM injections. Short lines are 0.1mL and long lines are 0.5mL

Tuberculin syringe

Used to give medications of 1mL or less; Small doses of epinephrine, intradermal skin test TB, and subcutaneous medications

Winged type (butterfly needle)

Useful for giving IV fluids on a short-term basis, and in pediatric cases *veins in peds are sometimes hard to find other than in the scalp.

Blood administrations

16-18 gauge needle is appropriate for blood administration do to its viscosity - also used for emergency IV routes, and surgical cases

Parts of a needle

Hub, shaft, beveled tip

PCA (patient controlled analgesia)

IV infusion device that patient controls can deliver a continuous baseline amount & patient controlled bolus as needed usually morphine or hydromorphone

How is a tuberculin syringe measured?

In mL. The long lines are 0.1 (1/10) mL, and short lines are 0.05 (5/100) mL

continuous infusion

Medication added to a bag and IV fluid and infuses with the IV pump

Subcutaneous injection sites and needle size

Thighs, ABD, back of upper arm, scapula— 1/2 to 5/8 inch and 25 gauge

Ventrogluteal

Three landmarks; greater trochanter, anterior iliac spine, and the iliac crest (hip bone) p.599

Insulin syringe

U100 holds 100 units of insulin per 1mL; U50 holds 50 units per 0.5mL. —0.5mL syringe is marked in 1 unit increments —1mL usually marked in 2 increments —U30 holds 0.3mL — either 1 or 0.5 unit increments and typically for pts w/ small insulin amounts

intermittent infusion

small amount of IV solution arranged with or piggybacked to primary large-volume infusion; used to instill adjunct medications

anaphylactic shock

A severe reaction that occurs when an allergen is introduced to the bloodstream of an allergic individual. Characterized by bronchoconstriction, labored breathing, cyanosis- N&V, diarrhea, change in mental status, pruritus.

deltoid muscle

Acromion process of the scapula, 3 fingers down. —about 3-5cm or (1 -2inches) below the acromion process

IM injections

20-22 gauge needle is used for most nonviscous IM injections— 1 to 1 1/2 depending on the amount of muscle tissue the pt has

Electronic IV pump

Pumps regulate the flow rate of infusions

a tuberculin syringe holds up to ____ ml of medication

1 mL

Stylet

Sharp bevel-tipped metal guide that is used to pierce the skin and vein- once the stylet and catheter is in the vein, and blood return occurs, the stylet is removed

Intradermal injections

25-26 gauge needle is used for intradermal injections, and used for infants and children—3/8 to 5/8 inch needle length

Subcutaneous injections

27-28 gauge needles— 1/2 to 5/8 inch needle length depending on the depth of the tissue

Insulin injections

29-30 gauge—1/2 to 5/16 inch needle length

Safety Glide syringes

Cap on the end of the syringe that protects from needle stick injuries. Push cap down on hard surface to lock needle in

Subcutaneous injections

Insulin, heparin, enoxaparin (lovenox) etc.. p.603- all are given subcu. Between the dermis and muscle layer. 45 degree angle. (Can be 90 if pt has obvious subcutaneous tissue) Less blood supply in adipose tissue therefore drug absorption is slower than with IM injections **NO more than 1mL in the sites, and routine injections need to rotate sites to prevent tissue damage**

Injection angles

Intradermal: 15° or less Subcu: 45° or 90* IM: 90°

IM injections

Muscle tissue has a large blood supply, therefore IM medication is absorbed faster than medication administered subcutaneously

intradermal injection

Needle into the dermis- 15 degree angle - small volumes such as 0.01- 0.1 mL are injected to form small bubble-like wheels or a (bleb). **Best route for allergy sensitivity tests, TB screens, desensitization injections, local anesthetic as, and vaccines** Tuberculin syringe is used (25 gauge 3/8 to 5/8 inch needle

Intravenous needles

Over-the-needle catheter and the winged type (butterfly) needle

Over-the-needle catheter

Plastic catheter that fits over a stainless steel needle called a stylet

vastus lateralis

Preferred injection site for giving an IM injection for children younger than 3 because it's free of nerves and blood vessels. Pt may be placed in supine or sitting position. —one hand above pt's knee, and one hand below the greater trochanter

Most common used sites for IM infection

Ventrogluteal site, vastus lateralis, and deltoid muscle of the arm