Ch. 37 Parenteral Medications (unit 3)
a regular syringe is
(standard), most frequently used for IM or subcut injections
how many mL of PPD do you do for a TB test?
0.1 mL injection
maximum volume for an IM injection in deltoid in small children through adults
0.5 to 1 mL
maximum volume for an IM injection in small muscles in infants and small children
0.5 to 1 mL
according to most facility polices, the max volume for a subcut injection is
1 to 2 mL
according to most facility policies the max volume for a subcut injection if
1 to 2 mL
maximum volume for an IM in the ventrogluetal and vastus lateralis (average size)
1-2 mL
What sizes can syringes come in? What is the most common size ?
1. 0.3 to 60 ml 2. most common sizes being between 1 mL and 3 mL
a syringe has 3 main parts, which are
1. a barrel 2. a plunger with a flange on the end 3. a tip that connects to the needle
What are the advantages of administration of medications by injection?
1. bypass of the GI tract; preventing GI irritation 2. rapid onset time compared to the oral route 3. ease of administration to uncooperative/unconscious patients 4. better absorption of drugs that are poorly absorbed via the oral route
disadvantages of parenteral administration?
1. invasive and uncomfortable for patient 2. expensive 3. requires additional supplies and equipment 4. requires qualified personnel to administer 5. carries a risk of infection and nervy injury
What are the two types of tips that a syringe may have?
1. luer-lok tip---> has threaded grooves that screw onto the need hub and lock into place 2. slip-tip --> has a smooth, slightly tapered tip that inserts into the needle hib, requiring a slight twist of the syringe
The 4 major types of syringes are
1. regular syringe 2. tuberculin syringe 3. insulin syringe 4. prefilled syringes
Choice of needle gauge depends on
1. viscosity (thickness) of the medication 2. route of administration 3. size of patient and muscle mass
maximum volume for an IM injection in the large ventrogluteal site or large vastus lateralis
2-3 mL
normal range for APTT (activated partial thrombolastin time)
30 to 40 seconds
therapeutic range for APTT (activated partial thrombolastin time)
45 to 100 seconds
you will administer a subcut injection at a _______________angle
45-90 degree; depending on amount of fat and size of patient
when does a patient return to get their TB test read?
48 - 72 hours
how do you want to hold the need when doing a ID (TB) injection?
5-15 degree angle
normal time for PT (partial thromboplastin)
60 to 70 seconds
what angle do you do an IM injection
90 degree angle
therapeutic range for PT (partial thromboplastin)
90 to 175 seconds
The bevel should face?
ALWAYS face upward when piercing the skin
(T/F) redness is a positive result for a skin TB test
FALSE. redness is not a positive result of TB in a skin test
The parenteral routes of administration include
ID (intradermal) subcut (subcutaneous) IM (Intramuscular) IV (intravenous)
what lab results do you monitor when administering heparin?
PTT (partial thromboplastin time) APTT (activated partial thromboplastin tme) INR (international normalized ratio) assess the patients system of blood clot formation
(T/F) Do not recap needle (for prefilled syringes)
True
to maintain asepsis when handling syringes what should you always do?
Wash your hands, clean the work surface where you will be preparing the injection, keep a facility-approved cleaning agent near the medication cart or counter where you routinely prepare medications
a vial is
a glass or plastic container of medication with a rubber stopper that must be punctured with a needle for medication removal
The plunger of a syringe is
a piston-like rod that fits into the barrel and slides up and down the barrel to either draw up medication or push it out of the barrel
a hypodermic needle consists of
a plastic hub (used to attach the needle to the syringe) , the bevel, the cannula, or shaft and, a safety guard to cover the used needle as soon as it is withdrawn from the patients body
a subcut injection, which is intended into the layers of the subcutaneous fat of an adult is administered with what length of needle?
a shorter needle: between 3/8 and 7/8 of an inch (depending on patients size)
an ID injection is the injection of
a small amount of fluid into the dermis, or the true skin layer immediately below the epidermis
an ampule is
a small, sealed glass drug container that must be broken to withdraw medication
preferred injection site for insulin is
abdomen because it provides faster and more consistent absorption
what must you do when using a filter needle?
after drawing up the medication you must change the filter needle before administering the injection
multiple-dose vs single dose vials
all multiple dose vials contain bacteriostatic preservatives that reduce the risk of microorganism growth whereas the single does vials do not
What parts do you keep sterile when handling a syringe?
all parts that contact the medication or the patient; syringe tip, inside of the barrel, and the length of the plunger from the rubber tip inside the barrel to 1 inch from the flange end
what is heparin
anticoagulant to reduce and prevent blood clot formation
when removing the needle during a subcut injection what do you do? What are the exceptions to this?
apply gentle pressure to the site after removal of needle and gently massage to distribute the medication into the tissue for better absorption UNLESS you are administering insulin or heparin
one of the liver's most important function is metabolizing and detoxifying potentially harmful agents in the blood. How does this affect oral medications?
as the liver metabolizes the drug, it decreases the amount of drug remaining in the blood after it leaves the liver to enter the systemic circulation
tips for safe administration for heparin
asses lab results-prothrombin time have a second nurse verify you have correct strength do not aspirate before do not massage monitor patient for bleeding gums, rbc in urine, blood in stools, excessive bruising
intramuscular size of needle
average adult 1-1.5 inches 20-22 G
sites for a subcut injection include
back of the upper arms, abdomen (stay a minimum of 2 in away from the umbilicus ), the anterior thighs, the area of the back just below the scapulae, and the upper buttocks
why is the dosogluteal site no longer used for IM injections unless it is the only option
because it is near the sciatic nerve
needle stick injuries provide the perfect mode of transmission for
blood borne infectious diseases such as HIV, hepatitis B, and hepatitis C
benzyl alcohol 0.9%, the bacteriostatic preservative used in multiple-dose vials of sterile water for injection and sodium chloride 0.9% for injection is
contradicted in newborns
an IM injection is administered into the
deep muscle tissue below the subcutaneous layer of tissue
ID injections are commonly used as a ________________ _____________, such as testing for _______________or___________________
diagnostic tool allergies tuberculosis
before an oral medication can begin to work, it must
first be absorbed from the GI tract into the portal circulation that transports the medication to the liver
before administering insulin how should you warm it up
gently roll the vial between both hands
when using an ampule attach a filter needle which,
has a device for filtering debris such as glass shards from ampules or rubber cores from vials, to the syringe you will use to draw up medication
how should you position a patient when doing a ventrogluteal IM injection?
have the patient assume a side-lying position with the foot on the top of the leg inverted to relax hip muscles
a syringe is used to
hold and introduce the medication into the need, which will direct the medication into the body tissue
hyperglycemia s/s
hot, dry , flushed skin thirst fatigue or weakness sleepiness sweet or acetone odor to breath
If a needle stick injury occurs what should you do?
immediately wash the punctured area with soap and water, which encourages bleeding from the site. Follow facility protocol and seek medical attention
what is a positive TB skin test?
induration-palpable raised and hardened area, blisters may be present
the most commons parenteral routes are classified as
intradermal, subcutaneous , and intramuscular
chemical incompatibility
involves the degradation of the drug resulting from a chemical reaction
the Z-track method of IM injections prevents
irritating and dark colored medications from leaking out of the injection site (to subcut/sensitive tissue)
incompatibility
is an unwanted reaction that occurs between the drug and the solution, container, or another drug
What is the barrel of the syringe?
is the hollow cylindrical chamber that holds the medication. One end had a tip that connects to the needle and the other end of the barrel is open and has a plunger inserted into it
what knowledge should you know about each drug?
is the patient allergic? what is its classification? what does it do? how does it work? why does the patient need this? is the ordered does within the safe dose parameters for this patients age, size and condition? what assessments should you make before/after administering the medication? is the route appropriate ? how quick is the onset of drug action? compatible with other meds the patient is taking?
to prevent irritation and tissue damage (during a subcut injection) the medication must be
isotonic and must be the same pH as the tissue
put pressure/gently massage the site after an IM injection unless
it is a Z-track
never push on the end of the cap of the needle because
it is possible for a large needle to go through the end of the cap and into your finger.
which size of gauge needle is used for thinner medications?
larger gauges --> 21 G (0.8 mm) to 30 G (0.3 mm), have smaller diameters
to find your site for a deltoid injection
locate the acromion process, place your little finger on the process and measure 3 finger breadths down. Inject into the fullest part of the deltoid
Medical syringes vs Glass syringes
medical syringes are usually disposable and made of plastic whereas glass syringes are more prevalent in research settings
the powder form of injectable medications is used for
medications that are not stable for very long once they are in a solution
tips for safe administration of insulin
monitor finger stick blood levels use a syringe matching strength of insulin do not aspirate before injecting do not massage after monitor patient for s/s of hypo/hyperglycemia
to prevent accidental needle sticks with contaminated needles never do what?
recap a used needle
when administering a subcut injection the abdomen provides _________________ absorption and is the preferred site for _____________,_______________and _______________
more rapid insulin, Lovenox , anticoagulant
the needle size when doing an intradermal injection?
needle 1/4 to 5/8 inch small diameter 25-30 G
with a subcut injection what size needle do you want?
needle between 3/8 and 7/8 diameter between 24 and 29 G
What does parenteral route mean?
not through the GI tract
therapeutic incompatibility
occurs within the patient as the result of 2 concurrently administered drugs that interact
what route is the most common and safest ?
oral administration
hypoglycemia s/s
pale, cool clammy skin tremors or palpitations hunger or nausea increased irrability fatigue difficulty concentrating
when preparing the syringe you should
peel the package open an lay package down with the syringe still resting in one side of the package until you are ready to attach the needle
needle-stick injuries are also called
percutaneous injuries
when doing a subcut injection how do you ensure that it is subcutaneous tissue and not muscle?
pinch or bunch up the skin and underlying fat layer into a fold between your finger and thumb. This helps lift the subcutaneous layer off the muscle
to locate the vastus lateralis injection site
place one of your hands across the thigh next to the femoral crease and your other hand just above the patella. The midpoint between your hands is the middle third of the thigh, inject into the fullest portion of the muscle
how do you perform a Z-track injection?
place the lateral aspect of your nondominant hand on the patients skin and pull the skin between 1 and 2 inches to one side while your dominant hand pierces the skin
to locate the ventrogluteal site
place the palm of you hand on the patient's greater trochanter with index finger on the anterior superior iliac spine and your middle finger pointing toward the iliac crest. The "V" formed by your index finger/middle finger marks your injection site. insert needle center in the V
Reconstitution
process of dissolving powdered drugs using a liquid or diluent such as sterile normal saline or sterile water
physical incompatibility
produce visible reactions such as color changes, precipitate formation, cloudiness, gas formation or haze
coring is
punching out a circular piece of skin when inserting the needle
what are things you need to do to "Get ready" for preparing a syringe?
review health-care providers orders, assess patients age and size, site you will use, the amount of muscle mass or subcutaneous tissue at the site.
you should gather all supplies you will need before beginning the preparation of the injection because it will
save you time and energy, make you more efficient and enable you to be productive and maintain sterility
the insulin syringe is
similar in size and shape to a TB syringe, but it is calibrated in "units" of insulin and used ONLY for injecting insulin.
a prefilled syringe are
single-dose, ready to use, disposable syringe cartridges, some with an attached needle and some to which you must attach a needle that contains the specific dosage of medication.
the bevel is the
slanted tip of the needle, designed to facilitate needle insertion and prevent coring
downside to oral adminstration
slowest onset of action of all the routes and provides a lower blood level than all the other routes
The needle is a
small hollow, cylindrical tube with a sharp beveled cutting-edge tip used to pierce the skin
The higher the guage number on the needle the _____ the diameter
smaller
which size of gauge is required for thick, viscous medications?
smaller gauge, from 14 G (2.1 mm) to 20 G (0.9 mm), have a larger diameter
Why is it important to review the health-care providers orders before you prepare a syringe?
so that you know the type and volume of medication that you are to draw up and route of administration.
a subcut injection deposits the medication into the
subcutaneous layer below the skin and above the muscle layer
the routes of administration that escape "first-pass metabolism" include
sublingual, buccal, and parenteral routes, because they all provide absorption directly into the systemic circulation rather than portal circulation of the digestive tract
administration of medication per an inject-able route requires various supplies such as
syringe, needle alcohol prep pads, dry cotton ball or gauze pad, needle disposal container, examination gloves, bandage
if air is present in the syringe...
tap the barrel of the syringe near the hub to move air toward the needle
to prepare the ampule for withdrawal of medication
tap the top of the ampule to distribute the medication to the lower portion of the ampule
when administering an ID injection spread the skin
taunt over the injection site to ease piercing of the skin with the needls
a tuberculin syringe is
the TB syringe, smaller diameter that holds a total of 1 mL...excellent choice for administration of the small and precise volumes of medication required by newborns and infants as well as for the TB skin test (which it was designed for)
an IM injection for an adult (injected into the muscular layer below the subcutaneous layer), is administered in
the body or the largest portion of a muscle and requires a longer needle length, from 1 to 2 inches (2.5 to 5 cm)
the most common site for IM injections of small volumes such as 0.5 to 1 mL is
the deltoid muscle
the gauge (G) of the needle refers to
the diameter of the needle and is indicated by numbers, typically between 14 G (2.1 mm) and 30 G (0.3 mm)
the ID injection deposits the medication into
the epidermis or the outer layers of the skin
It is no longer considered safe to abbreviate the word "Unit" with "U" because.....
the joint commission has included it on the list of "Do Not Use Abbreviations". The word units must always be spelled out
Injections are considered to be administered via
the parenteral route
if injecting PPD (TB test) circle
the site and write the date, time, initials by the circle
compare the absorption time with a subcut injection vs an IM injection
the subcutaneous contains fewer blood vessels than muscle, which produces a slower absorption time compared to IM injections
first pass metabolism
the substance degradation of an orally administered drug caused by metabolism in the liver before the drug reaches the systemic circulation
When withdrawing medication from a vial, pull the plunger back filling
the syringe reservoir with air equal to the amount of solution to be drawn up. example if you are to draw 1.7 mL of medication, pull back on the plunger you fill the syringe 1.7 mL of air
the choice of the length of the needle depends on
the weight, amount of fat, and muscle development of the patient, the site of injection and the route of administration
why might you combine more than one drug in one syringe?
to avoid the discomfort of multiple injections. Crucial to check the compatibility of medications before mixing and injecting them
(T/F) never place needles in the garbage or in a recycling bin
true
(T/F) the outside of the barrel and the flange are the only parts that may be touched
true
what is used to test an individual for the presence of tuberculosis ?
tuberculin purified protein derivative (P.P.D.)
A subcut injection is injected
under the layers of the skin into the subcutaneous tissue layer
the safest and most comfortable IM injection site for all patients older than 7 months is the
ventrogluteal site
When do needle stick injuries commonly happen
when recapping contaminated needles; improper needle disposal
when is the subcut route useful
when slow and continuous absorption is required
how to stabilize the needle during a Z track injection
without moving your non dominant hand close the index finger and thumb of that hand against the syringe
upon opening multiple dose vial do what
write the date, time and initials on the label