ADMINISTERING PARENTERAL MEDICATION

Question 1

Parenteral administration

Answer 1

administration of medications by injection.

Question 2

What is the difference between Luer-Lok and non - Luer Lok

Answer 2

Syringes are classified as being Luer-Lok or non-LuerLok. Luer-Lok syringes requires special needles, which are twisted onto the tip and lock in place. This design prevents the inadvertent removal of the needle. NonLuer-Lok syringes require needles that slip onto the tip.

Question 3

What type of syringe is used for a subcutaneous or IM injection?

Answer 3

1-3 ml

Question 4

What are insulin syringes used for and what is the size range?

Answer 4

0.3ml to 1ml and are caliberated in units.
Insulin syringes that hold 0.3mL are known as low-dose syringes.
Most insulin syringes are known as u-100 and are designed to be used with insulin that has a strength of U-100
- each ml of U-100 insulin contains 100 units of insulin

Question 5

What is a tuberculin syringe

Answer 5

long, thin barrel with a pre-attatched thin needle. The syringe is caliberated in sixteenths of a minim and in hundreth of a ml and has a cpacity of 1ml. To prepare small amounts of medication

Question 6

parts of a needle

Answer 6

hub- fits onto tip of syringe
shaft - connects to hub
bevel/slanted tip

Question 7

Why are long bevelled tips used for subcutaneous and IM injection

Answer 7

they vary from 0.6 to 7.6 cm and minimize discomfort when entering tissue

Question 8

how to choose the needle length according to patient size and weight

Answer 8

child/slender adult - shorter needle
longer needles (2.5-3.8 cm) for IM injection and use a shorter needle (1 to 1.6) for subcutaneous injections

Question 9

Gauge and needle diameter

Answer 9

gauge becomes smaller, the needle diameter becomes larger
- Gauge selection depends on the visccoscity of fluid to be injected/infused
- iIM injection requires an 18-27 gauge needle
- subcu injection requres small diameter needles, such as 25-gauge needle.

Question 10

In an ampule preparation, why do you tap the top with your finger?

Answer 10

dislodges any fluid that collect at the neck of ampule and all solution moves into lower chamber of ampule

Question 11

on drawing medication from an ampule, filter needle is used that reaches the bottom of the ampule. Why filter needle?

Answer 11

Filter needles are used to sift out any fragments of glass and access the medication

Question 12

why do we aspirate medication into the syringe by pulling back on the plunger?

Answer 12

Withdrawal of the plunger creates negative pressure within the syringe barrel, which pulls the fluid into the syringe.

Question 13

why do we tip the ampule to bring all fluid within reach of needle

Answer 13

Keeping the needle tip under the surface of the liquid prevents the aspiration of air bubbles.

Question 14

If air bubbles are aspirated, do not expel the air into the ampule.

Answer 14

Expelling air into the ampule may force fluid out of the ampule, which could lead to loss of the medication.

Question 15

what do you do to expell excess air bubbles

Answer 15

remove the needle from the ampule. Hold the syringe with the needle pointing up. Tap the side of the syringe to cause bubbles to rise toward needle. Draw back slightly on plunger and push upward to eject the air. Do not eject any fuid

Question 16

can filters be used for an injection

Answer 16

No

Question 17

What is a vial

Answer 17

single dose or multidose container with a rubber seal at the top. Normal saline and sterile distilled water are solutions commonly used to dissolve medication. Air must be injected into the vial to permit easy withdrawal of the solution.

Question 18

what would happen if you dont inject air into vial

Answer 18

creates a vaccum within the vial makes withdrawal difficult

Question 19

principles when mixing medication from two vials

Answer 19

1. do not contaminate one medication from 2 vials
2. ensure the final dose is accurate
3. maintain an aseptic technique

Question 20

how to mix medication from 2 vials

Answer 20

Aspirate a volume of air equivalent to the first medication’s dose (vial A). Inject the air into vial A, ensuring the needle does not touch the solution. Withdraw the needle and aspirate a volume of air equivalent to the second medication’s dose (vial B). Inject the air into vial B. Immediately withdraw the medication from vial B into the syringe, then insert the needle back into vial A. Withdraw the desired amount of medication from vial A into the syringe. Insert into the syringe a new needle or a needleless access device suitable for injection.

Question 21

how to mix medications from one vial and one ampule

Answer 21

When mixing medication from a vial and an ampule, prepare medication from the vial first and then use the same syringe and filter needle to withdraw medication from the ampule.

Question 22

mixing 2 kinds of insulin in one syringe

Answer 22

1. If the insulin is cloudy, roll the bottle of insulin between your hands to resuspend the insulin preparation.
2. Wipe the tops of both insulin vials with the alcohol swabs.
3. If mixing rapid (short) acting insulin with intermediate or long-acting insulin, take the insulin syringe and aspirate a volume of air equivalent to the dose of insulin syringe to be withdrawn from the intermediate or long -acting insulin first. If two intermediate or long-acting insulins are mixed, either vial can be prepared first.
4. Insert the needle and inject air into the vial of the intermediate or long-acting insulin. Do not let the tip of the needle touch the insulin.
5. Remove the syringe from the vial of the intermediate or long-acting insulin without aspirating the insulin.
6. With the same syringe, inject a volume of air that is equivalent to the dose of insulin. Withdraw the correct dose into the syringe.
7. Remove the syringe from the rapid-acting insulin vial after carefully removing air bubbles in the syringe to ensure the correct dose.
8. After verifying the insulin dosage with the MAR, a third time, show the insulin preparation in the syringe to another nurse to verify that the correct dose of insulin was prepared. Determine which point on the syringe scale represents the total of the combined units of insulin by adding the number of units of both insulins together (e.g., 3 units regular insulin + 10 units NPH insulin = 13 units total insulin).
9. Place the needle of the syringe back into the vial of the intermediate- or long-acting insulin. 10. Invert the vial and withdraw the desired amount of insulin into the syringe.
10. Withdraw the needle and check the fluid level in the syringe. Keep the needle of the prepared syringe sheathed or capped until you are ready to administer the medication. Show the syringe to another nurse to verify the correct dose was prepared.
11. Dispose of soiled medication supplies in the proper receptacle and perform hand hygiene. 13. Because rapid- or short-acting insulin binds with intermediate- or long-acting insulin, which reduces the action of the faster-acting insulin, administer the mixture within 5 minutes of preparing it.

Question 23

proper size syringe and needle

Answer 23

Subcutaneous: Syringe (1–3 mL) and needle (25–27 gauge, 1–1.6 cm)
- Subcutaneous U-100 insulin: Insulin syringe (0.3, 0.5, or 1 mL) with pre-attached needle (28–31 gauge)
- IM: Syringe 2–3 mL for adult, 0.5–1 mL for infants and small children
-Needle, with length corresponding to the site of injection and the age of the patient according to the following guidelines.
-Any site (children): 1.6–3.2 cm (depending on the size of the child)
- Vastus lateralis (adults): 2.5–3.8 cm
- Deltoid (adults): 2.5–3.8 cm
- Ventrogluteal (adults): 3.8 cm

Question 24

Contraindications for subcutaneous and intramuscular

Answer 24

A. For subcutaneous Injections: Assess the patient for factors such as circulatory shock and reduced local tissue prefusion. Assess the adequacy of the patient’s adipose tissue.
- Reduced tissue perfusion interferes with medication absorption and distribution. The amount of subcutaneous tissue influences the methods chosen for administering injections.
B. For Intramuscular Injections: Assess the patient for muscle atrophy, reduced blood flow, and circulatory shock.
- Atrophied muscles absorb medication poorly. – Factors that interfere with blood flow to muscles will impair the medication’s absorption.

Question 25

how to administer subutaneous injection

Answer 25

Palpate the injection site for masses or tenderness. Avoid these areas. For patients who require daily insulin, rotate the injection site daily. Ensure the needle is the correct size by grasping a skin fold at the injection site with your thumb and forefinger. Measure across the skin fold. The needle should be one-half the distance across the fold to give it at a 90-degree angle.

Question 26

how to administer intramuscular injection

Answer 26

Note the integrity and size of the muscle and palpate for tenderness or hardness. Avoid these areas. If injections are given frequently, rotate the injection sites. Use the ventrogluteal site if possible.

Question 27

how to administer intradermal injection

Answer 27

Note any lesions or discolorations of the patient’s forearm. Select an injection site three to four finger widths below the antecubital space and a hand width above the wrist. If the forearm cannot be used, inspect the patient’s upper back. If necessary, sites for subcutaneous injections may be used.

Question 28

patient positioning for different types of injecting

Answer 28

A. Subcutaneous Injection: Have the patient relax the arm, leg, or abdomen, depending on the site chosen for injection. Relaxation minimizes the patient’s discomfort.
B. Intramuscular Injection: Position the patient depending on the site chosen (e.g., have the patient sit, lie flat, lie on one side, or lie prone). C. Intradermal Injection: Have the patient extend the elbow and support the elbow and forearm on a flat surface.

Question 29

on cleaning the injection site why do we swab the centre of site and rotate outward in a circular direction for about 5cm

Answer 29

The mechanical action of the swab removes secretions containing microorganisms.

Question 30

how do you hold the syringe

Answer 30

between thumb and forefinger of your domnant hand

Question 31

subcutaneous administration

Answer 31

For an average-sized patient, spread the skin tightly across the injection site or pinch the skin with your nondominant hand. The needle penetrates tight skin easier than loose skin. Pinching the skin elevates the subcutaneous tissue and may desensitize the area.
- Inject the needle quickly and firmly at a 45-to 90- degree angle. Hold the skin fold until the needle has been withdrawn from the skin.
- For an obese patient, pinch the skin at the injection site and insert the needle at a 90-degree angle below the tissue fold.
- Inject the medication slowly.

Question 32

intramuscular administeration

Answer 32

 Position your nondominant hand at the proper anatomical landmarks and pull the skin down approximately 2.5 -3.5 cm or laterally with the ulnar side of your hand to administer the injection in a Z-neck.
- Hold this position until the medication is injected. Use your dominant hand to insert the needle quickly at a 90-degree angle into the muscle. The Z-track create a zigzag path through the tissues to seal the needle track and avoid tracking of the medication. The Z-track should be used for all IM injections.
- If the patient’s muscle mass is small, grasp a body of muscle between your thumb and fingers.
- After the needle pierces the skin, grasp the lower end of the syringe barrel with your nondominant to stabilize the syringe. Continue to hold the skin tightly with your nondominant hand. Move your dominant hand to the end of the plunger. Do not move the syringe.
- Wait 10 seconds and then smoothly and steadily withdraw the needle and release the skin. Apply gentle pressure with dry gauze if desired.

Question 33

intradermal administeration

Answer 33

 With your nondominant hand, stretch the skin over the injection site with your forefinger or thumb.
- With the needle almost against the patient’s skin, insert it slowly with the bevel pointed up at a 5- to 15- degree angle until resistance is felt. Advance the needle through the epidermis to approximately 3 mm below the skin surface. The needle tip can be seen through skin.
- Inject the medication slowly. Normally, resistance is felt. If resistance is not felt, the needle is in too deep; remove and begin again. Your nondominant hand can stabilize the needle during the injection.
- While injecting medication, notice that a small bleb of approximately 6 mm in diameter (resembling a mosquito bite) appears on the skin’s surface. Instruct the patient that this bleb is a normal finding. The bleb indicates the medication is deposited in the dermis. - Withdraw the needle while wiping an alcohol swab or gauze gently over the injection site. Apply gentle pressure, do not massage the injection site because the intradermal site may disperse the medication into underlying tissue layers. Put on a bandage if needed.
- Use a skin pencil and draw a circle around the perimeter of the injection site. Read the site within an appropriate amount of time, which is determined by the type of medication or skin test administered.

Question 34

where is LMWH administered

Answer 34

either right or left side of abdomen at least 5 cm from the umbilicus. administer in its prefilled syringe with the attatched needle, do not expel the air bubble in the syringe before giving the medication

Question 35

why should slower injection rate of 30 seconds be used

Answer 35

to reduce bruising and pain

Question 36

site for insulin injections

Answer 36

include the upper arm and the anterior and lateral portions of the thigh, buttocks, and abdomen (rotating injection sites within the same body part) to provide greater consistency in the absorption of insulin. For subcutaneous injections of insulin, pinch the skin and insert the needle at a 90-degree angle; inject the insulin, then release the pinched skin, count 5 to 6 seconds and remove the needle.

Question 37

intramuscular injection

Answer 37

faster route of absorption due to muscles greater vascularity
obese - 7.5cm needle
thin - 1.3-2.5cm nedle
angle of insertion - 90 degrees

Question 38

vastus lateralis muscle

Answer 38

Lacks major nerves and blood vessels.  Facilitates rapid drug absorption.  Used frequently with infants (younger than 12 months old) receiving immunizations.  May also be used in older children and toddlers receiving immunizations.

Question 39

location of vastus lateralis

Answer 39

Anterior lateral aspect of the thigh and extends in an adult from a handbreadth above the knee to a handbreadth below the greater trochanter of the femur. Use the middle third of the muscle for injection. Young children or cachectic patients, grasp the body of the muscle during injection to ensure the medication is deposited in the muscle tissue. To help relax the muscle, ask the patient to assume a sitting position or to lie flat with leg extended.

Question 40

ventrogluteal muscle

Answer 40

Offers a deep site, situated away from major nerves and blood vessels, which involves the gluteus medius.  Safe site for all patients because it is a large muscle.  Offers less chance of contamination in incontinent patients and infants.  Identified easily by prominent bony landmarks.  Is preferred site for medications (e.g., antibiotics) that are larger in volume, more viscous, and irritating for adults, children, and infants.

Question 41

location of ventrogluteal muscle

Answer 41

Place the heel of your hand over the greater trochanter of the patient’s hip with the wrist perpendicular to the femur. Use your right hand for the left hip, and your left hand for the right hip. Point your thumb toward the patient’s groin and point your fingers toward the patient’s head; point your index finger to the anterior superior iliac spine and extend your middle finger back along the iliac crest toward the buttocks. The index finger, the middle finger, and the iliac crest from a V-shaped triangle; the injection site is the centre of the triangle. The patient may lie on his/her side or back. Flexing of the knee and hip helps the patient to relax this muscle.

Question 42

deltoid muscle

Answer 42

Is easily accessible but the muscle is not well developed in most patients.  May be used for small amounts of medications.  Not used in infants or children with underdeveloped muscles.  Use of the muscle involves potential for injury to the brachial artery and to the radial and ulnar nerves.  May be used for immunizations of toddlers, older children, and adult
- recommenede site for HEP B vaccine and rabies

Question 43

location of deltoid muscle

Answer 43

Have the patient relax the arm at the side and flex the elbow. The patient may sit, stand, or lie down. Palpate the lower edge of the acromion process, which forms the base of a triangle in line with the midpoint of the lateral aspect of the upper arm. The injection site is in the centre of the triangle, approximately 3 to 5 cm below the acromion process. The site can also be located by placing four fingers across the deltoid muscle, with your top finger along the acromion process. The injection site is then three finger widths below the acromion process.

Question 44

technique for intramuscular injection

Answer 44

When administering IM injections, the Z-track method is recommended because it minimizes local skin irritation by sealing the medication in the muscle tissue. For the Z-track technique, select an IM site, preferably in a large, deep muscle, such as the ventrogluteal muscle; smaller needles may need to be used for smaller muscles. Pull the overlying skin and subcutaneous tissues approximately 2.5 to 3.5 cm laterally to the side. Holding the skin taut with the nondominant hand, insert the needle deep into the muscle, and slowly inject the medication. The needle remains inserted for 10 seconds to allow the medication to disperse evenly.