Medication Administration Week 3
Subcutaneous injections 1. Where are they administered? What are some examples of drugs that would require this route? 2. What sites? 3.What needle length? what guage? 4. What angle? when would you use different angles?
1.are administered into the adipose tissue layer just below the epidermis and dermis. This tissue has few blood vessels, thus drugs administered here have a slow, sustained rate of absorption into the capillaries. This route is used to administer drugs such as insulin and heparin 2.Various sites may be used for subcutaneous injections, including the outer aspect of the upper arm, the abdomen(FASTEST ABSORPION)(from below the costal margin to the iliac crests), the anterior aspects of the thigh, the upper back, and the upper ventral or dorsogluteal area 3.A 25- to 30-gauge, 3/8″ to 1″ needle can be used. The 3/8″ and 5/8″ needles are most commonly used. Choose the needle length based on the amount of subcutaneous tissue present, which is based on the patient's body weight and build. No more than 1ml given. 4.Subcutaneous injections are administered at a 45- to 90-degree angle. Choose the angle of needle insertion based on the amount of subcutaneous tissue present and the length of the needle. Generally, the shorter, 3/8″ needle should be inserted at a 90-degree angle, and the longer, 5/8″ needle is inserted at a 45-degree angle. Recommendations differ regarding pinching or bunching of a skin fold for administration. Pinching is advised for thinner patients and when a longer needle is used to lift the adipose tissue away from underlying muscle and tissue. If pinching is used, once the needle is inserted, release the skin to avoid injecting into compressed tissue. take needle out after inserting.
Intradermal injections 1. Where are they administered? is it a fast absorption time? 2.When would someone might have an intradermal injection? 3. What are the sites commonly used? 4. what is the length of the needle? and guage? 5. what angle is it administered?
1.are administered into the dermis, just below the epidermis. The intradermal route has the longest absorption time of all the parenteral routes 2.For this reason, intradermal injections are used for sensitivity tests, such as tuberculin and allergy tests, and local anesthesia 3.Sites commonly used are the inner surface of the forearm and the upper back, under the scapula. 4. Equipment used for an intradermal injection includes a tuberculin syringe calibrated in tenths and hundredths of a milliliter. A 1/4″ to 1/2″, 25- or 27-gauge needle is used. The dosage given intradermally is small, usually less than 0.5 mL. 5.The angle of administration for an intradermal injection is 5 to 15 degrees (almost parallel to skin). Pulling the skin tight when administering. BEVEL OF NEEDLE HAS TO BE UP. INSERT ABOUT 1/8 OF AN INCH. ADMINISTER SLOWLY. WATCH FOR WHEEL TO APPEAR (bump). do not do anything else to site (no rubbing) Pt. has to come back btw 48-96hrs.. usually will be measured in cm (diameter)
Intramuscular injections 1. where do they deliver medication? 2. What types of meds. require this site?
1.deliver medication through the skin and subcutaneous tissues into certain muscles. Muscles have larger and a greater number of blood vessels than does subcutaneous tissue, allowing faster onset of action than with subcutaneous injections 2.This route is used to administer drugs such as antibiotics, hormones, and vaccines, such as the pneumococcal and hepatitis vaccines
inject 1ml for how long
10 SECONDS
howl long do you leave needle after injecting?
10 seconds.
1.What is selection of IM injection equipment base on ? 2.How much medication should be drawn up? 3. at what angle is it administered?
1Needle length should be based on: A.. the site for injection and B.the patient's age. Patients who are obese may require a longer needle 2.1-4mL. no more than 1mL for deltoid. 1-2 mls is standard 3.Administer the intramuscular injection so that the needle is perpendicular to the patient's body. This should ensure that it is given using an angle of injection between 72 to 90 degrees. inject 1ml for 10 seconds. leave for 10 seonds after administering.
Insulin syringes
Insulin is specifically drawn up with these Insulin syringes are available with 28- to 30-gauge, 5/16″ and 1/2″ length needles, and in 3/10-mL to 1-mL sizes. The shorter needles (5/16″) are becoming the more common length used. .
What is reconstituting powder medications?
Occasionally, a drug is supplied as a powder in a vial. A liquid, or diluent, must be added to the powder before it is administered as a solution. The technique of adding a diluent to a powdered drug is called reconstitution. .
what are the sites for IM injections how do you find each.
The ventrogluteal site (see Fig. 28-13A) involves the gluteus medius and gluteus minimus muscles in the hip area. This site offers a large muscle mass that is relatively free from major nerves and blood vessels, the area is clean (fecal contamination is rare at this site), and the patient can be on the back, abdomen, or side for the injection (depending on what side of pt. use opposite hand to place on hip) 1. find greater trochnater-place palm on that. find iliac crest with index and insert needle. The vastus lateralis (see Fig. 28-13B) involves the quadriceps femoris muscle and is located along the anterolateral aspect of the thigh. There are no large nerves or vessels in its proximity, and it does not cover a joint. To locate the site, divide the thigh into thirds horizontally and vertically and administer the injection in the outer middle third. The deltoid muscle is located in the lateral aspect of the upper arm (see Fig. 28-13C). It is the recommended site for vaccines for adults and may be used for children between 1 and 18 years of age for vaccine administration (CDC, 2012). The deltoid muscle is not developed enough in infants to absorb medication adequately.. Find acromion process. Go three finger lengths down. Should be in line with axilla. The dorsogluteal site has been previously identified as a possible site to be used for intramuscular medication administration. However, this site has been associated with inadvertent injection into subcutaneous tissue because the area is covered with subcutaneous tissue in many people; injection into subcutaneous tissue alters drug absorption and causes tissue irritation
Age/site and needle length
Vastus lateralis 5/8″ to 1″ Deltoid (children) 5/8″ to 1¼″ Deltoid (adults) 5/8″ to 1½″ Ventrogluteal (adults)1½″ 18-25 gauge (oil based) 20-25 gauge (biomaterial)
breakining ampule
flick lid, to make sure med is down break with guaze or plastic ampule breaker AWAY FROM YOU. USE FILTER NEEDLE TO FILTER OUT GLASS. DO NOT INJECT WITH THIS
When choosing a site
choose the site based on age amount to be given if med burns put in larger muscle.
Age of patient and recommended site for IM infant child/toddler adult
infant: vastus lateralis child/toddler: vastus lateralis and deltoid (rec. for immunizations in years 1-18) adult: ventrogluteal and deltoid
what is lovanox
low molecular weight heparin. comes in prefilled syringe inserted in outer aspects of abdomen.
What does parenteral mean?
means outside the intestines or alimentary canal
Aspiration
not required.
Z track method for IM
use it so medication doesn't come back out. Pull skin to one side with hand laying on side ( use non dominant hand). Make skin taut. While holding skin, inject. As pulling needle out slowly let go of skin.
When mixing insulin
you have to make sure they compatable. if they are fast acting slowing acting. normal insulin- unmodified, fast acting and clear modified- put air into first, this is usually long acting, and cloudy. 1. put air into modified .1st, then put air into unmodified, and then draw up unmodified, then draw up modified (because modified can change action of unmodified) cap. and then inject (not able to change needles) Lantis does mix with any insulin.
Choose equipment needed for an injection based on the following cirteria (5)
•Route of administration: A longer needle is required for an intramuscular injection than for an intradermal or a subcutaneous injection. .•Viscosity of the solution: Some medications are more viscous than others and require a large-lumen needle to inject the drug. •Quantity to be administered: The larger the amount of medication to be injected, the greater the capacity of the syringe .•Body size: An obese person requires a longer needle to reach muscle tissue than does a thin person. A thin person or an older adult with decreased muscle mass requires a shorter needle. •Type of medication: There are special syringes for certain uses. An example is the insulin syringe used to inject insulin.
