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Chapter 35
Administering Intradermal, Subcutaneous, and Intramuscular Injections
| Question | Answer |
|---|---|
| Ampules | all-glass containers containing medication |
| Anaphylactic Shock | circulatory failure from an allergic reaction |
| Bevel | the slanted part of the needle tip |
| Bleb | bump, visible elevation of the epidermis |
| Core | circular cutout piece |
| Diluent | specified fluid to dissolve the solute |
| Fibrosis | formation of fibrous tissue |
| Gauge | scale of measurement |
| Gluteal | pertaining to the buttocks |
| Induration | quality of being hard |
| Injection | forcing fluid into a part of the body |
| Intradermal (ID) | into the dermis |
| Intramuscular (IM) | into the muscle |
| Lumen | opening or interior diameter |
| Parenteral | not delivered via the gastrointestinal tract |
| Solute | solid material |
| Subcutaneous | beneath the skin layers |
| Tuberculin Syringe | syringe with graduated measurements to 1 mL |
| Urticaria | a reaction characterized by reddened, slightly elevated patches known as wheels |
| vials | small bottles |
| Viscous | thick and sticky |
| Z-track Technique | causing a needle track, or pathway, in the shape of a 'z' |
| When are parenteral injections used? | -patient is NPO -digestive juices counteract oral drugs |
| What are parenteral injections used for? | -hasten the action of the drug -ensure the delivered dose is accurate |
| What is the appropriate size needle for intradermal injections? | 24, 27, 29 gauge |
| What is the appropriate size needle for subcutaneous injections? | 27 gauge 3/8 - 1/2 or 25 gauge, 5/8 |
| What is the appropriate size needle for intramuscular injections? | 1-3 inch |
| What would you do if a 5-year old child refuses his immunizations? | demonstrate procedure on a doll, let child look at empty vials/syringes, explain that medicine will help them to stay well |
| Why is it important to rotate injection sites? | it is best to rotate injection sites to promote the best absorption of the medication and to decrease tissue irritation or fibrosis |
| What information must be on the syringe label? | patient's name, name of the drug, and the dose |
| Select an injection site that is relatively free of: | hair, lesions, inflammation, rashes, moles, and freckles -avoid major nerves, blood vessels, & underlying organs |
| What must the nurse be aware of when administering medications? | -purpose of medication -side effects of the drug |
| How soon after a new medication is given should the nurse assess for side effects? | 30 minutes |
| Epidermis | contains cells that produce pigment and protect immune system |
| Dermis | contains nerve endings, oil and sweat glands, and hair follicles |
| Subcutaneous Tissue | made up of fat, connective tissue, and larger blood vessels |
| Intradermal injection: | -medication is deposited into layers of skin -typically TB test, skin tests, allergy testing -small needle; 15-degree angle of insertion -tuberculin syringe -forms skin bleb |
| Is a 29 gauge needle bigger or smaller than a 24 gauge needle? | smaller - the larger the number of the gauge, the smaller the needle |
| You have issued a tuberculin test intradermally. When should the patient return to assess the injection site? | 48-72 hours after the test |
| Subcutaneous injection: | -0.5-1 mL of medication into tissue below dermal layer into subQ fat -usual sites: upper outer portion of arm, anterior surface of thigh, abdomen -insulin or tuberculin syringe -45 or 90 degree angle |
| Name two medications that can be given subcutaneously: | -heparin -insulin -allergy extract |
| Why is the abdomen a good place to administer certain subcutaneous medications? | The abdomen provides the most reliable, steady absorption |
| How do you give a subcutaneous injection? | -gently pinch skin and insert the needle 45 to 90 degree angle -after inserting the needle completely, release grasp on skin -inject all solution by steadily/gently pushing down the plunger |
| Intramuscular injections: | -injected in muscle layer at 90-degree angle -common sites: deltoid, dorsogluteal, ventrogluteal, vastus lateralis, rectus femoris -19-23 gauge, volume up to 3 mL -aspirate for blood prior to injection to avoid blood vessel |
| Which intramuscular site is the best side for administering medication to infants and the elderly? | infants: vastus lateralis elderly: ventrogluteal and vastus lateralis |
| Which injection site can cause sciatic nerve injury if medication is administered incorrectly? | dorsogluteal |
| How to find the ventrogluteal site? | -palm over greater trochanter -index finger on anterior superior iliac spine -middle fingers by posterior iliac creat -injection site in 'V' formation |
| Z-Track Method IM route: | -may be used anytime IM is given -deep IM injections of drugs like iron dextran/Vistaril -reduces pain from drugs leaking into subQ tissue -seals medication in muscular layer |
| What needle size and length would you use when administering a medication using the Z-track method? What if the patient is morbidly obese? | -airlock method should be used with the Z-track method because it prevents medication leakage |
| What are the two materials used for syringes? | -glass - can be sterilized/reused -plastic - disposable -some syringes are refilled with medication |
| Syringe composition: | composed of barrel and plunger with a needle tip made of plastic or glass |
| 3 mL syringe | -popular because large enough for subcutaneous and most IM injections |
| U-100 syringe | used with U-100 strength insulin -calibrated in units |
| Tuberculin syringes | -1 mL in size -calibrated to measure as small as 0.01 mL drug doses |
| Unit-dose cartridge | -requires a special holder for the cartridge and needle |
| Most 3mL syringes have two scales, which are: | -tenths of a milliliter (o.1mL) -minim scale |
| Needle | metal tube through which liquid medication flows |
| Needle gauge/length | -standard sizes from 13-30 -larger the number, smaller the needle -consists of hub fitting on end of syringe, hollow shaft (cannula), a bevel |
| Filter needles: | -medications drawn from ampule may have glass in them from breaking of ampule -used when medication is withdrawn from ampule to trap glass particles -filter is discarded & new needle attached to syringe for injecting medication into the patient |
| Preventing needle sticks: | -HIV, Hep B, Hep C -safety syringes prevent needle sticks (used when available) -needle must be disposed of in sharps container -report all needle sticks |
| What increases your risk of a needle stick injury, and blood borne pathogens? | recapping or trying to recap needles |
| Preparing syringe for use: | -aseptic technique -needle, tip, inner barrel, plunger must remain sterile -discard if contaminated |
| Parenteral solutions: | -available in ampules/vials (single dose/multidose) -Mix -O-vials - meds in powder form, diluent present in 2 halves of vial separated by rubber stopper -unit-dose cartridges - carpuject/tubex holders |
| What type of needle must be used when withdrawing medications from an ampule? | filter needle |
| Name a medication that is supplied in an ampule: | digoxin |
| If you do not use all the medication in an ampule, can the remainder be saved for the next dose? | no |
| Ampules: | -made of glass/polyurethane -consist of body, neck, stem - typically single dose -all meds must be in ampule body before neck is broken -before open, meds must be removed from neck/stem -tap/flick stem with finger to free trapped solution |
| What are two ways to check drug compatibility? | -check a compatibility chart -ask the pharmacist |
| Vials: | -single or multidose -1 - 50mL -powder form needing reconstitution (label/package insert with instructions) -check compatibility before mixing |
| Reconstituting a drug: | -drugs that are unstable in liquid form, prepared in powdered form -solute mixed with diluent prior to injection -diluents - sterile water/saline |
| Compatibility of medications: | -reaction occurs when drug combines with an incompatible drug -range from color change, precipitation, clouding to invisible chemical changes making drug inactive -charts often available that outline compatible drugs |
| When drugs are compatible, you inject what into the vials? | -amount of air equal to desired dose of each drug into the respective vials |
| What are symptoms of anaphylactic shock? | -urticaria, bronchiolar constriction, edema, finally circulatory collapse |
| Things to remember: | -check for allergies -know possible/expected side effects -date multidose vials when opened -question order that don't make sense -follow 6 rights/ 5 rules -know landmarks/injection techniques |
| What is not an appropriate site for an intramuscular injection? | Dermal |
| Darlene is about to give her patient an intramuscular injection. What angle should the injection be given? | -90 degrees |
| Sylvie is going to give her 1 yr old patient an IM injection. What is the preferred IM site? | -vastus laeralis |
| Michael is going to give his patient an injection of iron. To help minimize the pain, what can Michael do? | use the z-track method |
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ahoyyitbeaddi
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