Transcript What You Need to Know To Administer an Injection - AAEC

Animal Science
Mr. McGuire
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Describe proper techniques for
administering injectable drugs
Describe precautions to take when
administering injectable products
Appreciate pharmacist role in
administering injectable medications
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Passive Immunity
◦ Antibody produced by one human or other
animal is transferred to another
◦ Temporary protection
 Example: Immunity an infant receives from its mother
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Active Immunity
◦ Immune system is stimulated to produce
cellular and humoral immunity
◦ Lasting protection
 Example: Survive infection from the disease causing
organism
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Vaccinations produce active immunity.
Immune response and immunologic
memory produced is similar to that caused
by natural infection.
Comes without the risks of the actual
disease and associated complications.
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Live attenuated
◦ Attenuated or weakened form of diseasecausing bacterium or virus
◦ Must replicate to be effective
 Uncontrolled replication of the vaccine virus can
cause severe reactions - only occurs in patients
with immunodeficiency
◦ Immune response is cellular & humoral
◦ Circulating antibodies interfere
◦ Usually produce immunity after one dose
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Inactivated
◦ Inactivated form of bacterium or virus
◦ Can’t replicate
 Can’t cause disease, even in immunodeficient
patients
◦ Immune response primarily humoral
◦ Less affected by circulating antibody than live
vaccines
◦ Always requires more than one dose
◦ Antibody titer decline over time
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Standard Questions
◦ Do you have any drug/food allergies?
◦ Do you have any chronic diseases?
◦ What medications do you take?
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Are you sick today?
Are you allergic to latex?
Do you have any allergies to any vaccine or
vaccine components?
◦ Ex: Eggs, gelatin
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Have you ever had a serious reaction after
receiving a vaccine?
Have you had Guillian-Barre Syndrome in the
past?
Is it possible that you could be pregnant?
Breastfeeding?
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Do you have cancer, leukemia, AIDs, or any
other immune system problem?
Do you take cortisone, prednisone, other
steroids, anticancer drugs, or have you had
radiation treatments?
In the past year, have you received a transfusion
of blood or blood products or been given
immune globulin or an antiviral medication?
Have you received any vaccinations in the past 4
weeks?
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Answer any questions patient may have
Patient needs to understand benefits and
risks of getting immunized and consent to
vaccine administration.
◦ If it is a child under 18, then parent or guardian
consent should be obtained
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Patient education sheets developed by the
CDC
◦ Helps to explain the risks and benefits of receiving
a particular vaccine
 Federal law requires that VISs be used for most
vaccines when vaccinating patients
◦ Should be given before vaccine administered
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Choose correct SYRINGE size
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Maximum volumes
◦ If <0.5ml need low-dose syringe (1mL, 3mL)
◦ Finely graduated syringe will ensure accurate
amount
◦ Fluzone (influenza) is 0.5mL dose
◦ Pneumovax (pneumonia) is 0.5mL dose
◦ Deltoid – No more than 0.5-1mL
◦ Large muscle (gluteus medius)
 Adult – no more than 4mL
 Child – no more than 1-2mL
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Choose correct needle LENGTH and
GAUGE
Minimize tissue injury and SQ leakage
Allow easy passage (23 vs. 25 gauge)
Needle length depends on injection
site
◦ Adults 5/8” vs. 1” vs. 1.5”
◦ Children 5/8” vs. 1”
◦ If less SQ fat, use smaller needle
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Get all supplies ready in advance
◦ ex: Band-Aid, alcohol pad, cotton ball, VIS
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Double Check
◦ Correct vaccine, dose, & expiration date
◦ Go over screening/consent form with patient
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Record
◦ Vaccine name, manufacturer, lot number,
expiration date
◦ Location of administration (L/R deltoid)
◦ Provider administering the vaccine
◦ Vaccine Information Sheet publication date
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Cleanse area with alcohol swab
◦ Allow alcohol to dry
Target
◦ C technique and shoot (IM)
◦ Bunch skin (SQ)
Inject – DO NOT Aspirate
◦ Dart-like motion with steady pressure
◦ Inject at:
 90° angle for IM
 45° angle for SQ
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Do not recap needle
Dispose of needle properly
Apply pressure to injection site with cotton
ball (if necessary)
Apply adhesive bandage
Provide patient with immunization record &
Vaccine Information Statement (VIS)
Record all necessary information
Have patient remain under surveillance for
~15 minutes
Advise patients to wash hands
 Have patient confirm type of insulin on bottle label
 Roll vial or pen in palms, if appropriate
 Show patients in counseling where to read dose on
syringe and appropriate amount to draw
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◦ Ensure using best syringe for dose
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Inject at 90° angle for SQ insulin
Injecting into the subcutaneous fat of the belly most
common
◦ Site should be approximately 2 inches from belly button
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Rotate sites
◦ avoid formation of fatty deposits or scarring
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Alternate sites include the back of the
arms, thighs, and buttocks
◦ Slower onset with alternate sites
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Go over insulin storage
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Discard dates
◦ Generally insulin not in use should not be stored
in fridge
◦ Extreme temperatures and excess agitation
should be avoided
◦ Important to go over how long insulin can be
stored at room temperature
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Insulin inspection
Mixing of Insulins
Proper disposal of sharps
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Pen devices/ insulin cartridges:
◦ Deliver insulin subcutaneously through a
needle.
◦ All a little different and might require extra
teaching time
◦ In specific patient populations these devices
have been demonstrated to improve:
 accuracy of administration
 adherence
◦ Requires needle to be left embedded in skin
for at least 5 seconds after plunger depressed
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Be aware of patient behavior
Have patient sit before administration
Lay patient down if necessary
Check airway, breathing and vital signs
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Rare but potentially fatal
Occurs within 15 minutes
Call 911
Lay patient down, check airway,
breathing, vital signs
Be prepared and ready to administer
epinephrine (Epipen)
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Child – fever, fussy, crying, injection site
Adult – injection site discomfort
Symptomatic relief
◦ Fluids
◦ Pain medications
 No aspirin for children
 Acetaminophen (Tylenol)
 Ibuprofen (Advil, Motrin)
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Vaccine Adverse
Event Reporting
System (VAERS)
Required for:
- Rare, serious or
unexpected events
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Access to Emergency Medical Services (EMS) –
phone on hand
Be prepared for adverse reactions
◦ CPR trained staff
◦ Necessary medications on hand
◦ Have patient remain under surveillance after
administration
Controlling Infection Transmission
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Control infection transmission
◦ Use universal precautions
◦ Proper cleaning and disposal of waste
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Anticipate adverse effects
 Assure patient safety
◦ Know your equipment
◦ Establish quality procedures
◦ Practice good technique
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Infection control guidelines designed to
protect workers from exposure to diseases
spread by blood and certain body fluids
Assume all patients to be infectious for
blood-borne diseases
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Blood
semen
vaginal secretions
synovial fluid
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cerebrospinal fluid
pleural fluid
peritoneal fluid
pericardial fluid
amniotic fluid
Universal precautions should be applied
to all body fluids when it is difficult to
identify the specific body fluid or when
body fluids are visibly contaminated
with blood.
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feces
nasal secretions
sputum
sweat
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tears
urine
vomit
saliva (except in
the dental setting)
But, you must still be mindful of
transmitting infectious material.
They may not carry blood-borne
illness, but they do carry viruses and
bacteria.
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Wear gloves if likely to touch body substances
or mucous membranes
◦ Latex or non-latex
◦ Monitor for allergies
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Wear eye protection if likely to be splashed
Wear lab coat or gown if likely to be soiled
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Place needles in special
containers (Sharps Container)
Place soiled articles in plastic
bag for disposal
Place soiled linen in laundry
bag
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Dispensing versus administration
Makes sense for:
◦ Vaccinations
◦ Teaching patients to self-inject
 Insulin and glucagon
 Increasing availability of self-injection products
 Allergic reactions, migraine, MS, infertility
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Proper training required
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Profession:
◦ Establishes the role of the pharmacist
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Patients:
◦ Pharmacists are easily accessible
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Population:
◦ Preventing disease
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APhA: Pharmacy-Based Immunization
Delivery Certificate Program
◦ www.pharmacist.com
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Center for Disease Control – Vaccines
◦ http://www.cdc.gov/vaccines
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Vaccine Adverse Event Reporting System
◦ http://vaers.hhs.gov
Rachel Nowak, PharmD
Clinical Instructor, UWSOP
Bartell Drugs Clinical Coordinator
January 29, 2010