Transcript INJECTIONS
IM, ID, Subcutaneous, (i.e., Insulin, Heparin) Page 435-456 – Wilkinson/Treas Fundamentals Volume 2 (SF) INJECTION TYPES TYPES OF VIALS AMPULES PRE-FILLED MEDICATION WHAT’S IN A NEEDLE?! NEEDLES-LENGTH/GAGE/TYPES SAFETY MECHANISMS SAFETY MECHANISM (CONTD) LEUR LOCK VS. NON LEUR LOCK SYRINGE INCREMENTS ANGLES OF ADMINISTRATION INTRADERMAL INJECTIONS Usually only a small amount of the drug is given. Used for allergy, TB tests. Common sites: Inner lower arm Upper chest Back beneath scapula INTRADERMAL INJECTIONS Administration Use small syringe with a short needle (#25-27, 1/4 to 5/8 long) Hold at a 5-15° angle with bevel up. Drug produces a small bleb just under the skin. Do not massage area of injection site. SUBCUTANEOUS INJECTIONS Usually a small amount of drug - up to 1 mL. Absorption is slower & drug action usually takes longer than IM/IV routes. Verify drug is labeled for SQ route Used for vaccines, insulin, heparin as well as other drugs. SUBCUTANEOUS SITE SUBCUTANEOUS INJECTIONS Common Sites: Outer aspect of the upper arm Anterior aspect of the thigh Abdomen Scapular area of the back Upper ventrogluteal & dorsogluteal areas SUBCUTANEOUS INJECTIONS PG 448/SF Administration: Type of syringe Needle size & length Heparin is usually 1 mL=25-27G with 3/8 to 5/8 inch needle Insulin with insulin syringe 28-31G with 3/16 to 1 inch needle Determine length of needle by pinch test Determine angle of insertion by pinch test ½ width of pinched skinfold 1 inch = 45 degree / 2 inch = 90 degree No aspiration Rotate injection sites Avoid areas of lumps, bumps & bruises. INTRAMUSCULAR INJECTIONS Drugs injected into the muscle are more quickly absorbed because of a greater blood supply to muscle tissue. The muscle can take a larger volume of drug without discomfort. Amount varies based on muscle size and condition. INTRAMUSCULAR ANGLE IM INJECTION SITES Deltoid Dorsogluteal DO NOT USE Ventrogluteal Vastus lateralis INTRAMUSCULAR INJECTIONS PG 451-SF Adults can tolerate up to 5 mL of medication in the ventrogluteal muscles. Recommended amount for the deltoid muscle is no more than 1 mL. Labeled for IM use. May be used for all types of medications: analgesics, etc.. DELTOID MUSCLE GLUTEUS MAXIMUS (NOT RECOMMENDED) VENTROGLUTEAL VASTUS LATERALIS INTRAMUSCULAR INJECTIONS Common sites: Ventrogluteal site Vastus lateralis site Dorsogluteal site-Do Not Use Deltoid site Rectus femoris site INTRAMUSCULAR INJECTIONS Administration 2 - 5mL syringe Size & length of needle #21-22, 1 1/2 in / adults /gluteal #23-25, 1 in / adults / deltoid Large for viscous drugs Longer for obese/ shorter for emaciated #22-25, 5/8 - 1 in, infants/child INSULIN - ADMINISTRATION Medication supplied in units U - 100 - means 100 units/mL U - 500 means 500 units/mL Specialized Insulin syringe Given SQ or IV Only use orange tipped syringes Do not aspirate or massage site INSULIN - TYPES OF SYRINGES 30 unit 50 unit 100 unit Insulin pens INSULIN - TYPES Rapid-acting : Humalog Fast Acting : Lispro Short-acting: Regular Intermediate acting: NPH, Lente Long-acting: Ultra Lente Sustained: Glargine (Lantus) Premixed: Intermediate & short acting mixtures (70/30 or 50/50) INSULIN - TYPICAL ORDER Name of Insulin Type of Insulin Number of units to be given Time to be given Route of administration INSULIN - GUIDELINES Read orders thoroughly Use an insulin syringe Read labels carefully Regular insulin is clear Should always be drawn up first Check with another RN-High Risk Drug orders, label & amount INSULIN - MIXING Regular insulin should be drawn up first Clear before cloudy (i.e., NPH) Draw up exactly as ordered Sliding - scale insulin based on BS levels HEPARIN Administration Supplied in units Must be given IV or SQ Various strengths available Fast – acting, short half life Antidote - protamine sulfate Dose based on lab values Incompatible with other drugs DO not interrupt or delay administration HEPARIN - GUIDELINES Small, short needle, SQ Change needle (avoid bruising) 0.2 mL SQ dose not to exceed 1 mL Double check order, dose, vial, & amount Use TB syringe (mL side) Know symptoms of overdose DO NOT aspirate or massage ENGINEERING CONTROLS - ALWAYS