Transcript 7_ - IS MU

Indications:
 Where IV administration is not available.
 Drugs with specific actions on muscles.
 A longer half life is needed eg. Morphine for
anaesthesia
 Damage to the sciatic nerve. (Upper outer quadrant)
 Injection fibrosis - causes inability to flex muscle drug
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is administered to.
Thrombocytopenia (low platelets) and coagulopathy
(bleeding) can lead to hematomas.
Local sepsis
Arterial/IV injection
Infection
 Check identity of patient and contents and expiry date of drugs
 Insert needle into syringe, and fill with the required amount of
drug. Tap syringe to bring any air bubbles to the top and push the
air out.
 Choose a suitable injection site and inspect for signs of
inflammation, swelling, infections or lesions
 5 main sites:
▪ Upper arm (deltoid) – vaccines
▪ Dorsogluteal (gluteus maximus)
▪ Ventrogluteal(gluteus medius)
▪ Vastus lateralis (quadriceps femoris) outer side of femur
▪ Rectus femoris (anterior quadriceps) – self administration or
infants
 Swab site with alcohol and let it dry (bactericidal and decreases
pain)
 Pull skin laterally and insert needle in one swift motion at 90°,
aspirate to avoid an intravenous placement, if blood is drawn in,
restart with new medication and slowly inject the drug.
 Remove needle and apply a pressure gauze and observe for
signs of an adverse reaction.
Moving the skin may distract from the intended needle
destination, therefore visualise and aim for the
underlying muscle about to receive the injection.
http://www.youtube.com/watch?v=nA8i9eYW0_M
Indications
 When drug is desired to have a slow, sustained
absorption effect
 Local anaesthesia
 Administration of vaccines
and medicines such as
insulin and morphine
 Avoid using the same site repetitively which
can cause lumps or dents (lypodystrophies –
loss or degeneration of fat) from forming.
 Accidental IV, ID, IM injections
 Check identity of patient and contents and expiry date of
drugs
 Insert needle into syringe, and fill with the required amount
of drug. Tap syringe to bring any air bubbles to the top and
push the air out.
 Choose a suitable injection site and inspect for signs of
inflammation, swelling, infections or lesions
 4 main sites:
▪ Upper arm outer area
▪ Abdomen – above and below waist, except around navel
▪ Anterior thigh – midway of outer side
▪ Upper area of butt – behind hip bone
 When repeated injections are needed use a hidden
site to cover bruises – but the same area at the same
time each day to reduce changes in the action of the
insulin
 Swab site with alcohol and let it dry (bactericidal and
decreases pain)
 Gently pinch skin to elevate subcutaneous fat and
separate it from underlying muscle.
 Insert the needle at a 30° angle and inject the drug –
aspiration before injecting the drug is unnecessary as
can increase the risk of local hematoma formation for
heparin.
http://www.youtube.com/watch?v=bxdYGXKz1iA
Contraindications
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Patient refusal – but many can be persuaded
Allergy – rare
DO NOT USE adrenaline containing LA on digits or
penis – vasoconstriction can lead to ischaemia and
necrosis.
Anticoagulated patients have a tendency to bleed if a
vessel is punctured.
Infection at intended site may make it more painful and
spread.
Broken needles
Acute systemic toxicity – CNS, CVS – when plasma
conc., exceeds toxic limit.
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LA block fast sodium channels in nerve axons
preventing propagation of nerve impulse
Pain nerves are usually smaller and non myelinated
fibres so are blocked faster than larger myelinated fibres
(motor, proprioception, touch)
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Injected subcutaneously
Onset of effect is 2 minutes, but duration
varies depending on the drug.
LA solutions are alkaline pH 10/11
therefore are more painful
A less painful approach would be ID
(instant anaesthesia)
Avoid intra vascular injection, so aspirate
first.