Lesson 2: Injections, Venipuncture, IV Insertion, ABG

Question 1

Parenteral?

Answer 1

The administration of medical therapy is in a manner not involving GI or alimentary tract.
Can be intradermal, subcutaneous, intramuscular, or IV.

Question 2

Indications for injections?

Answer 2

Therapeutic treatment/Maintenance (giving medications).
Disease Prevention (immunizations).
Diagnosis of medical conditions  (allergen response, tuberculosis).

Question 3

Contraindications to injections?

Answer 3

Allergies to any component of injected substance.
Coagulopathy (especially for IM injections).
Pregnancy (should not have live virus vaccines such as MMR, varicella).
Active infection at the site.

Question 4

Potential Complications of Injections?

Answer 4

Pain, burning, and erythema at the injection site.
Infection.
Lipodystrophy: atrophy of subcutaneous fat.
Allergic reaction.

Question 5

How to Avoid Potential Complications?

Answer 5

To Decrease Pain:
Have patient relax arm/muscle.
Allow antiseptic to dry completely.
Gentle massage the area after injection.

Decrease infection risk:
Proper aseptic technique

Decrease lipodystrophy
Rotate injection site

Question 6

Intradermal Site?

Answer 6

ventral forearm, approx. 10cm from the antecubital fossa.

Question 7

Subcutaneous Site?

Answer 7

adipose regions of the lower abdomen, anterior or posterior thigh, upper buttocks, lateral lower back, and lateral upper extremities.

Question 8

Intramuscular site?

Answer 8

deltoid, ventro-gluteal, vastus lateralis.

Question 9

Rights of Medication Administration?

Answer 9

1. Right patient (name, DOB, MRN)
2. Right drug
3. Right dose
4. Right time (hour during day and expiration date*)
5. Right route (med comes in injectable form)
6. Right site (look for active infection at site)
7. Right documentation ( if vaccine, must hand patient a Vaccine Information Statement (VIS)

Question 10

What not to forget to say?

Answer 10

Introduce yourselves.
Explain procedure – Do not say “it will not hurt”, instead say “small pinch”.
Ask if patient gives consent.
Any allergies to meds – allergic to latex?
Any bleeding disorders or taking any blood thinning meds?

Question 11

IM Needle?

Answer 11

At least 1 inch length, usually 18-22 gauge.

The larger the gauge the smaller the diameter.

Question 12

How to draw fluid from vial?

Answer 12

Inject air into vial (amount of air similar to amount going to withdraw).
Inject air above the fluid surface line, withdraw meds below the fluid surface line.

Question 13

What to do after injection?

Answer 13

“you may feel a little sore”, - If IM
“be sure to return in 48-72 hours” ppd read
Return/call office if any concerns for infection or other concerns.

Question 14

Indications for venipuncture?

Answer 14

To obtain a venous blood sample.

Question 15

Contraindications for venipuncture?

Answer 15

Site has active infection, scarring, hematoma.
Ipsilateral side of mastectomy.
Arm with IV in place.

Question 16

Complications of venipuncture?

Answer 16

Hematoma/hemorrhage.
Local skin infection (cellulitis), infection of vein (phlebitis).
Thrombosis.
Laceration of the vein.
Vasovagal episode.

Question 17

Best vein for venipuncture and why is it the best?

Answer 17

Median cubital vein.

Easily palpated.
Well anchored.
Least painful.
Least likely to bruise.
Usually largest vein in antecubital space.

Question 18

Tips for venipuncture?

Answer 18

Prepare all the materials needed!
Double check test ordered/test tubes.
Look over patient anatomy (before tourniquet) .
Don’t rely only on vision – find good vein (doesn’t roll)
Can’t find vein? Warm washcloth, BP cuff, tap or rub area – gently.
Apply tourniquet 3-4 inches above intended site.
Do not leave tourniquet on for > 2 minutes!

Question 19

Venipuncture procedure?

Answer 19

Site Preparation: 2-3 alcohol pads, circular motion, start inside then outwards.
Allow to dry since alcohol lyses blood and causes pain!
Use opposite hand to traction vein.
Insert BEVEL UP at 15-30 degree angle, and lower when skin punctured.
Can use vacutainers/or syringe to draw blood.
Fill tubes – keeping needle steady (invert tube gently after each).
Release tourniquet before removing needle*, have gauze ready to hold over puncture site. Apply pressure/or tell patient to apply pressure at least 3-4 minutes.

Question 20

Venipuncture after procedure?

Answer 20

Throw away your needles in sharps container. MUST DO.
Label tubes.
Properly dispose of contaminated materials in biohazardous waste containers.
Make sure patient feeling ok.
Remove gloves, wash hands.
Return to office if….