CMA- Injections and Parenteral Medication

Guidelines for aspiration

*When administering IM and Subcutaneous medications, the CMA should aspirate after inserting the needle and before giving the medication. This is to ensure that you are not in a blood vessel that would turn this medication into an IV med. -CDC recently put out information that deemed aspiration unnecessary. -You will find some facilities that have moved away from aspiration and some that still want their employees to aspirate. As a student, you will follow facility policy

Parenteral Medication containers

-Ampules: Holds a single dose of medication -Cartridge Unit: Disposable, prefilled, single dose that slips into an injection device -Vials: Glass or plastic container that contains either a single or multiple doses

Components of the syringes are

-Calibrated barrel The cylinder holds the medication and contains calibrations for precise measuring. It is calibrated in mL or cc's (Cubic Centimeters). Insulin syringes are calibrated in units -Plunger- plastic rod with a rubber stopper on one end. This seals the medication within the syringe -Flange- used for guiding the plunger -Tip— Slip Tip-needle slips on Luer lock- locks the needle on by twisting.

Measuring medication in a syringe:

-Choose your syringe based on the amt (sometimes the type) of medication needed to administer -Smaller syringes are calibrated in mL's and minims

Needles

-Comes in various sizes, lengths, disposable and non-disposable -Needles size used depends on- *Medication being given *Route of administration *Size of patient

Advantages of Parenteral Delivery:

-Effective when other routes might not be an option (unconscious patient) -No digestive irritation or gastric acid alteration -Exact dose can be delivered to a direct site -Faster relief

Parenternal routes by injections

-Intradermal -Subcutaneous -Intramuscular -Intra-articular

Rate at which medication begins to be effective:

-Intravenous- Instantly to seconds -Intramuscular- 5-15" -Subcutaneous- usually within minutes

Intradermal:

-Pertaining to "within the skin" -The epidermis (outer layer of skin) is for intradermal injections

Parenteral

-Pertaining to the outside of the intestines Taken into the body or administered in a manner other than through the digestive tract. Ex: -Injections -Intravenous (IV)- through vein -Transdermal-through skin -Trans mucosal- through the mucus membrane -Topical - on the skin -Inhalation- through respiratory tract

Parts of the needle:

-Point- sharpened end of the needle -Lumen- the bore hollow of the needle -Bevel- the flat, slanted edge that eases the insertion of the needle into the skin -Shaft- the hollow steel tube which the medication passes into the patient -Hub- the component that attaches the needle to the syringe; color coded for easy recognition of the size. Must remain sterile while attaching to the syringe -Safety Device- a mechanism to shield the needle after use

Syringes

-Predominantly plastic and disposable -Most common sizes 1mL to 5mL -10mL to 60mL are available to irrigate wounds or aspirations -Syringes are packaged in sterile packages

Guidelines for giving parenteral medication:

-Prepare for only one patient and one medication at a time. If more than one injection is needed, prepare one and label it, then make the other -Follow safety precautions when dealing with needles and syringes -Ensure that contamination does not occur to the equipment during preparation or transport -Never allow another health care worker to prepare medication that you will administer, nor should you prepare for someone else. *The medication error falls on the person that administers it!

Gauge

-Refers to the diameter of the needle - Common sizes 20-27g

Reconstituting Medication for Injection—

-Some medication comes in powder form and must be diluted -These medications have a longer shelf life -The liquid used to dilute the medication is called the diluent; it is usually sterile saline (NaCl), sterile water, or lidocaine -Once the liquid as be inserted into the powder vial (use same technique as drawing liquid medication), the two are mixed together by rolling the vial between both hands -Once particles are dissolved, draw up the medication as any other

Medication Administration cont.

-Stabilize your hand when holding the needle and syringe. Hand movement may cause a nick in the blood vessel or nerve -Follow the same track bringing needle out that you used going in -Engage the needle safety device on the syringe immediately and dispose in Sharps -Patients should wait 20-30" after injection to monitor for anaphylaxis -Check on the patient at the end of this period and check the injection site for bleeding, local reactions, or swelling. Ask pt about breathing difficulties or other unusual symptoms

Follow the 7 rights of medication administration:

-The right patient (use two identifiers) -The right drug (check label three times) - The right dose -The right route (check the order) - The right time -The right technique -The right documentation

The Length of the Needle is determined by:

-The route of the medication -The site of the injection -The amount of ADIPOSE tissue over the injection site

Examine a TB syringe

-This is measured in increments of hundredths. -Each small line represents 0.01cc The longer lines are 0.1 (total volume is 1 cc)

Disavantages of parenteral

-Unsanitary equipment can lead to infection -Rapid allergic reaction -Improper procedure could cause damage to nerves, tissue, veins, and other vessels -Can't "stop" the medication once given

Medication Administration

-Use two patient identifiers before administering ANY medication -Check the patient's drug allergy status, latex and adhesive allergy status prior ANY medication -Wash your hands and don gloves to protect you against bleeding of patient -Never allow a pt to stand while getting an injection -Sites should be free from scars, wounds, lesions, rashes, moles, or any other tissue growths -Cleanse site with approved skin antiseptic using a circular motion

Descriptions of adipose amounts:

-Very little- can pinch very little tissue (males/females less than 130#) -Average- can pinch an average amt (females 130-200# /males-130-260#) -Large- can pinch large amount (females 200+ lbs/males 260+ lbs)

Fact #4

-Vials have a sterile cap -Remove this without contaminating the rubber stopper -Medication is aspirated out of the vial by pulling back on the plunger

Subcutaneous

-pertaining to "under the dermis" -True layer of skin

Rules for withdrawing medication-(3 Checks)

1. Check name and dose of medication when removing from shelf after obtaining an order (from provider) 2. Check name and dose before preparing the medication 3. Check medication name and dose after preparing it

STEPS (please follow along with a new syringe, needle, and vial)

1. Wash hands 2. Remove the syringe & needle from the package keeping the needle sterile 3. Pull the plunger back to the calibration line that matches the amount of medication to be removed 4. Clean the rubber top with alcohol IF has been previously used 5. With the vial sitting on the table, with one hand holding it secure, insert the needle into the rubber top 6. Push the plunger to push the air in the syringe into the vial 7. Pick up the vial and invert it with the needle in it. Make sure the needle now is below the liquid line 8. Carefully pull back the plunger to the level of the desired medication 9. Gently remove the needle from the rubber stopper 10. Carefully recap the needle 11. Tiny bubbles can be removed by gently flicking the syringe (Large bubbles may change the amount of medication; more may need to be drawn) 12. Change needles for giving the injection

Fact #2

IM or Intramuscular require longer needles because muscles are deeper.

Fun Fact

Needles come in different lengths also.

Parenternal routes by injections cont.

Parenteral medications are delivered into the blood stream much more rapidly than oral medications.

Steps for removing medication from ampule—

Same for a vial EXCEPT: - Some medication can get into neck of ampule; it must be "flicked" into the bottle - The neck is scored and can be broken easily but cover with a gauze and break away from your body/face - Pieces should be placed in a Sharp's container - Syringe filters (remove before injecting the patient)

Examine a 5cc syringe—

Smaller calibrations are measured as 0.2cc and the longer lines represent 1, 2, 3, 4 , 5, 6

Fact #3

Specialty syringes are measured in units (insulin syringes). There are 2 different sizes

The rule about gauges is:

The larger the gauge, the smaller the diameter.

Examine a 3cc syringe

The smaller calibrations are 0.1cc The longer lines are increments of ½, 1, 1 ½, 2, 2 ½, 3

intramuscular

Within the muscle

Guidelines for Massaging the Injection Site

~At the end of the injection for IM and subcutaneous methods, gently massage the site with the alcohol pad or cotton ball to assist with the disbursement of the medication ~There are medications that have a contraindication for massage. Some of those include: -Heparin (anti-coagulant) -Imferon (iron) -Insulin -Lovenox (anti-coagulant) -Z track method injections