Module 13: Administration of Medication via ID, SC, or IM Route

Question 1

IM Injections

Answer 1

• Intramuscular
• Patients with developed muscles can tolerate 3 mL
• 0.5 - 1 mL recommended for less developed muscle

Question 2

Factors to consider for IM injections

Answer 2

• Body weight
• Amount of adipose tissue
• Type of solution
• Supplies
• Landmarking
• Comfort

Question 3

Needles and Syringes for IM

Answer 3

Length – 1.3cm to 7.5cm
Gauge - 18G to 27G
Angle – 90 degrees
-Needles need to be long enough to penetrate past subcutaneous tissue, but short enough to not penetrate underlying blood vessels or bone
-Syringes need to be large enough for the solution but easy to manage

Question 4

Proper Landmarking

Answer 4

Avoid sites with:

• Large blood vessels
• Nerves
• Bone

Question 5

Common IM Locations

Answer 5

• Deltoid
• Ventrogluteal
• Vastus Lateralis
• Rectus Femoris

Question 6

Ventrogluteal Site

Answer 6

Advantages:
-Away from large nerves or blood vessels
-Large developed muscle
Landmarking:
-Heel of hand over greater trochanter, thumb pointed to groin, index finger to anterior superior iliac spine, middle finger extended along iliac crest.

Question 7

Vastus Lateralis Site

Answer 7

Advantages

• Site of choice in infants, toddlers, and children
• Anterolateral aspect of the thigh

Question 8

Rectus Femoris Site

Answer 8

• Occaisonally used
• Self-admin
• More painful

Question 9

Deltoid Site

Answer 9

• Small muscle
• Common for immunizations
• Max volume 1mL
• Use with caution

Question 10

IM Contraindications

Answer 10

• Nodules
• Lumps
• Abscesses
• Tenderness

Question 11

Technique Considerations

Answer 11

• Z-track
• Hold skin taut
• 1mL every 10 seconds
• Wait 10 seconds post
• Do not aspirate (as per policy & protocol)
• Remove within same track
• Gentle pressure, do not massage
• Discard in sharps container STAT

Question 12

Reconstitution

Answer 12

Some drugs may be stored in a powder form because they become inactivated after a prolonged amount of time when mixed in a solution

Question 13

Reconstitution- Diluent

Answer 13

• Sterile water, sodium chloride
• Check with Parenteral Drug Monograph or Medication Vial
• Must do 3 checks

Question 14

Subcutaneous Butterfly Catheters

Answer 14

A device which provides access for subcutaneous medication administration and hypodermoclysis

Question 15

Hypodermoclysis

Answer 15

• The subcutaneous infusion of fluid
• Limited IV access
• Palliative care patients (with caution)
• Mild dehydration

Question 16

Subcutaneous Butterfly Catheters- Recommended Sites

Answer 16

• Abdomen (preferred)
• Upper arms
• Upper back (scapular area)
• Anterior thighs
• Anterior upper chest

Question 17

Subcutaneous Butterfly Catheter- Safe Site Considerations

Answer 17

• Lesions
• Erythema
• Swelling
• Ecchymosis
• Inflammation
• Tissue Damage

Question 18

Subcutaneous Butterfly Catheter-Preparing Medication

Answer 18

• Obtain correct medication
• Obtain syringe and blunt fill needle/ blunt filter needle and alcohol swabs
• Draw up correct amount of medication

Question 19

Subcutaneous Butterfly Catheter-Technique Consideration

Answer 19

-For needless systems:
=>Additional medication is required to prime tubing and injection cap with FIRST dose
+>Note: Priming amount may change with different sets.
-Only insert subcutaneous butterflies when medication is needed (nurse discretion)
-Don gloves
-Cleanse skin and let dry
-Ensure bevel up and wing bubbles are toward the patient (squeezing wings locks the bevel)
-Insert SC 20-40 degree angle (or as per policy) ***
-Secure with transparent drsg (ie Tegaderm)

Question 20

Subcutaneous Butterfly Catheter- Safety Considerations

Answer 20

• One medication per site
• Each site to be labeled with Medication, Concentration, Date
• Can remain in site up to 7 days
• Assess site EVERY shift
• Infusion bags good for 24 hours (continuous HDC)
• Sol’n admin sets good for 72 hrs (continuous HDC)

Question 21

Subcutaneous Butterfly Catheter- Documentation

Answer 21

• Date & Time
• Discipline & -Focus
• Site of Insertion
• Gauge
• Primed with ?
• Tolerated ?
• Signature

Question 22

Ampules

Answer 22

• Single doses of medication
• Open system
• Glass vial with colored ring to indicate weak spot
• Filter needle required to draw up medication

Question 23

Vials

Answer 23

• Single dose or multidose container with rubber seal
• Contain liquids or powdered forms of medications
• Closed system, air must be injected into vial prior to withdrawal

Question 24

Mixing medications from two vials

Answer 24

1. Do not contaminate one medication with another
2. Ensure final dose is accurate
3. Maintain aseptic technique

Question 25

Mixing from a vial and an ampule

Answer 25

1. Prepare med from vial first | 2. Use same filter needle to draw up med from ampule

Question 26

Subcutaneous Injections

Answer 26

Administering medication into loose connective tissue under the dermis - Is absorbed slower than IM as it is not as rich with blood vessels - Is absorbed completely if circulatory status is normal - May experience discomfort as tissue contains pain receptors

Question 27

Subcutaneous Injection- Sites

Answer 27

- Back of arms (outer posterior aspect of upper arms) - Abdomen, below costal margins to iliac crests - Anterior aspects of thighs

Question 28

Intradermal Injections

Answer 28

- Commonly performed for skin testing - Medications are potent and administered into the dermis - Blood supply is reduced so absorption is slower

Question 29

Intradermal Injection- Sites

Answer 29

- Inner forearm - Upper back - Site must be lightly pigmented, free of lesions, relatively hairless