Drug Formulations & patient counseling& IV Drug compatibility Flashcards
There are 3 parts of a needle to be aware of:
the luer lock- where it connects to a syringe.
the hub- where the plastic meets the metal of any needle.
the tip- the sharp part
The bevel of a needle provides many advantages:
- prevents/lessons the amount of coring that can happen when injecting through the top of a metal vial
- less tissue damage to the patient
For (IM) intramuscular injections:
For (SC) subcutaneous injections:
For (ID) intradermal injections:
- inject at a 90-degree angle, must go through dermal & subcutaneous layer to get to the muscle. Longest needle
- inject at a 45-degree angle,
- inject at a 15-degree angle,
The gauge of the needle refers to the __________
This is an important factor when it comes to the viscosity “thickness” of the medication being administered.
diameter of the inside of the hollow part of the needle. “width”
The larger the gauge, the smaller the width.
gauge & diameter are inversely related.
18-gauge needle has a larger diameter than a 27-gauge needle.
Generally, needle with a lower gauge hurt more.
Syringe has 3 parts:
- the Luer-lock, where the needle meets the plastic
- the barrel, where the medication sits in syringe
- the plunger, the mechanism that allows you to push the medication out of the syringe
Choosing syringe size is important:
- choosing the smallest syringe size that can hold the dose of medication
- the dose should in most cases take up at least 20% of the volume in a syringe
- so if we have a 2mL dose of medication to give, we want to make sure the syringe can hold 2 mL but NOT more than 10mL.
What is the most common intradermal injection?
Tuberculin Skin Test, sometimes referred to as a PPD
There are 3 main sites for Subcutaneous injections:
- the back of the arm
- the abdomen
- the thigh
What is the preferred route of administration?
Enteral administration, through the GI tract
When the enteral route is not feasible, then a number of parental routes can be used which include:
(IV) intravenous
(IM) intramuscular
(SC) subcutaneous
transdermal
intra-articular (into the joint)
intrathecal ( into the space under the arachnoid membrane of the brain/ spinal cord.
Drugs with poor oral bioavailability are often given IV, these include:
vancomycin, for conditions other than C.difficile
vasopressors, where fast onset is required to raise cardiac output.
A catheter is __________
a piece of plastic tubing that goes into a part of the body to put fluids in or take fluids out.
The IV route is required in hospitalized patients who are nothing by mouth (unable to take anything by mouth) AND with gastrointestinal conditions when the gut needs to be by passed.
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Peripheral Lines
Central Lines
Percutaneous means __________ & peripheral refers to __________
through the skin.
locations away from the body’s central compartment, including the arms and legs.
Most IV drugs can be delivered through percutaneous, ___________ that are inserted into __________.
Common veins used for peripheral venous catheters are the _____________ and the ___________
peripheral venous catheters
smaller veins
cephalic vein in the arm
saphenous vein near the ankle
Peripheral lines are simpler and less expensive to insert than Central lines, but they have limitations.
This includes:
because we are administering drugs into a smaller vein, this can cause Phlebitis (vein irritation), venous thrombosis (clots), and interstitial fluid extravasation; this is when the catheter becomes dislodged from the vein and the infusion contents enter surrounding tissue.
A Central line empties into ____________.
Central lines provide secure, long-term vascular access and are required for administration of:
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Additional benefits with a central line include the ability to administer higher volumes and use faster infusion rates.
a larger vein AND the contents are quickly diluted.
- Highly concentrated drugs (eg potassium chloride > 20mEq/100mL)
- Long term antibiotics
- Toxic drugs that would cause severe phlebitis [ chemotherapy, especially with vesicants]
- Drugs with a pH or Osmolality that is not close to blood pH or osmolality (parenteral nutrition)
To be considered a central venous catheter, also called a central line, the catheter tip must be located in a large vessel ( _________, _____________, ___________)
The catheter can reach one of these locations by being inserted into a proximal central vein or a peripheral vein. A line inserted in a proximal central vein can be placed in ________, _________, __________.
These are in close proximity to the large vessels and do not require long catheters.
superior vena cava
right atrium
inferior vena cava
internal jugular vein (near the top of the chest)
subclavian vein (under the collarbone)
femoral vein (in the groin)
(PICC) Peripherally inserted central catheters, are inserted by placing the line into a peripheral vein and advancing (pushing) the catheter through the vein until the tip ends ____________
in the superior vena cana (where the infusion contents will be released)
Does the patient have a line?
What is a line?
meaning, can the patient get this drug via IV administration.
a line is an open port that is going into patients’ body somewhere.
Vesicants are safer with a ________
a vesicant is a drug that will ________
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-
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-central line
- cause severe tissue damage if the catheter tip comes out of the vein, allowing the drug to seep into the surrounding tissues (extravasate). Vesicants are preferentially administered through a central line because the line is less likely to become dislodged from the vein.
- VASOPRESSORS (dopamine, norepinephrine),
- ANTHRACYCLINES (doxorubicin),
- VINKA ALKALOIDS (vincristine, vinblastine),
others: digoxin, foscarnet, nafcillin, mannitol, mitomycin and promethazine.
