HTEC94 T#2: I.M. p459-465,469-471 Flashcards
(25 cards)
Why are shots given into the muscle layer?
absorption is more rapid than by SC because more blood vessels in muscle tissue. medication that is irritating to SC tissue is oft givn IM cuz fewer nerve endings in deep muscle tissue. more medicine can be injected that into SC
Up to how much medication can be injected (and which sites)?
3 ml into gluteal or vastus lateralis, 2ml if older or very thin
Examples of medications administered through IM route
immunizations, antibiotics, injectable contraceptives, vitamin B12, corticosteroids
How long must needles be to reach muscle tissue? +Guideline lengths
1-3 inches. 1.5 inches average adult. 1 inch for thin/child, 2-3 for obese
Gauge? And what does it depend on?
18-23 G. viscosity of medication
The sites chosen for IM injections are all…
away from large nerves and blood vessels
Sites:
dorsogluteal, deltoid, vastus lateralis, ventrogluteal
Dorsogluteal
patient should lie on abdomen with toes pointed inward. injection into upper outer quadrant of gluteal area, located by palpating GREATER TROCHANTER and POSTERIOR SUPERIOR ILIAC SPINE. injection above and outside line b/w these two pts. OR upper outer quadrant approx 2-3 inches below iliac crest. careful to avoid sciatic nerve or superior gluteal artery
Dorsogluteal injection site
upper outer quadrant of the gluteal area, above and outside line b/w posterior superior iliac spine and greater trochanter. OR upper outer quadrant 2-3 inches betlow the iliac crest
Dorsogluteal landmarks
posterior superior iliac spine, greater trochanter
Deltoid
patient sitting/lying down. SMALL because major nerves and blood vessels surround it (large amts of med–no more than 1 ml–and repeated injections shouldn’t be given here). expose ENTIRE arm (roll up or remove sleeve (tight sleeve constricts arm –> unnecessary bleeding from puncture site). palpate LOWER EDGE OF ACROMION PROCESS, which forms base of triangle in line w mdpt of lateral side of arm, opposite the axilla. ALSO locate by putting 4 fingers horizontally across the deltoid w top finger along acromion process. injection site 2-3 fingerwidths, or 1-2 inches) below AP. avoid radial nerve and deep radial artery
Deltoid injection site
2-3 fingerwidths, or 1-2 inches) below acromion process
Deltoid landmarks
acromion process
Vastus lateralis
NOT NEAR MAJOR NERVES/VESSELS, relatively thick muscle. good for infants/childs <3 yrs old whose gluteal muscles are not well developed. bounded by midanterior thigh (front of leg) and midlateral thigh (side). proximal boundary is handwidth below GREATER TROCHANTER of femur and distal boundary above knee (lateral femur condyle). easier when pat lying down, sitting can also be used.
Vastus lateralis injection site
middle of vastus lateralis
Vastus lateralis landmarks
proximal boundary is handwidth below GREATER TROCHANTER of femur and distal boundary above knee (lateral femur condyle)
Ventrogluteal
SC layer is relatively small and muscle layer is thick here. also away from major nerve/vessels. palpation for GREATER TROCHANTER, ANTERIOR superior iliac spine, and ILIAC CREST. place opposite palm on greater trochanter and index on anterior superior iliac spine, middle finger spread posteriorly as far as possible away from index, to touch iliac crest. triangle formed is injection site. patient lying prone or on one side
Ventrogluteal injection site
triangle formed by index and middle finger. opposite palm on greater trochanter and index on anterior superior iliac spine, middle finger spread posteriorly as far as possible away from index, to touch iliac crest.
Ventrogluteal landmarks
triangle formed by iliac crest, anterior superior iliac spine, and greater trochanter
How do you do the Z-track method and give e.g.
pull skin and sc tissue at injection site to the side, so zigzag path through tissues when needle is removed and skin is released (prevents med from reaching sc layer/skin by sealing off needle track), iron dextran (Imferon)
Check medication when?
removing from storage, before withdrawing into syringe, after preparing medication
Steps for preparing injection
sanitize, assemble equip, work in quiet, well-lit, select proper med and check. CALCULATE correct dose if needed. OPEN syringe and needle pack, assemble if needed. CHECK needle attached firmly to syringe. BREAK SEAL by moving plunger several times. REMOVE soft metal/plastic cap protecting rubber syringe. WIPE and clean rubber stopper with antiseptic. PLACE vial in upright position on flat surface. REMOVE needle guard. PULL BACK plunger to draw in amt of air equal to amt of med to be withdrawn. 90-degree angle, stop at empty space between stopper and fluid level, inject air into vial. INVERT VIAL while holding syringe and plunger. HOLD syringe @ EYE-LEVEL and withdraw proper amt of med. REMOVE AIR BUBBLES by tapping. REMOVE any air remaining at top of syringe slowly while needle is still in vial. REMOVE needle from rubber stopper and REPLACE NEEDLE GUARD. CHECK DRUG LABEL
Steps for preparing injection
sanitize, assemble equip, work in quiet, well-lit, select proper med and check. CALCULATE correct dose if needed. OPEN syringe and needle pack, assemble if needed. CHECK needle attached firmly to syringe. BREAK SEAL by moving plunger several times. REMOVE soft metal/plastic cap protecting rubber syringe. WIPE and clean rubber stopper with antiseptic.
Different procedures for preparing medication from ampule
need to first attach filter needle first. Wipe neck. Tap stem to remove med from neck. Once done withdrawing, remove and discard filter needle and reapply needle for administration. Tap for bubbles, hold vertically up and slanted towards sink and push out air.
