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IM 2 Exam 2 > Parenteral Injections > Flashcards

Parenteral Injections Flashcards

1
Q

Parental Equipment (6)

A
  1. Exam Gloves
  2. Medication (vial/ampule)
  3. Alcohol Swabs
  4. Appropriate syringe and needle(s)
  5. Medication Labels
  6. Clean medication drawer
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2
Q

How many needles do you need for a parental injection?

A

2 separate needles
- A needle to withdraw
- A needle to Inject

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3
Q

How do you determine the appropriate syringe and needle to use during the injection?

A

Site, Route, and Volume of medication for appropriate needle & syringe

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4
Q

Whats the difference between a single and multi-dose medication vial?

A

Single-dose: one and done
Multi-dose: multiple uses or draws can be taken out of the vial (EX: lidocaine)

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5
Q

What must you ALWAYS do after you’ve drawn out a med from a multi-dose vial?

A

Date and Initial because they expire

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6
Q

What part of the vial must be cleaned with a alcohol swab before use?

A

There is a sealed top either metal or plastic, under both there is a secure rubber injection port that must be cleaned.

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7
Q

The smaller the number/ gauge (18g) :
The bigger the number/ gauge (23g) :

A

The bigger the diameter of the needle : this is an inverse relation ship.
The smaller the diameter of the needle.

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8
Q

When choosing a parental needle, you want to make sure it is?

A

Long enough to reach the TARGETED tissue of the patient respective to age, muscle/ tissue mass, and weight.

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9
Q

Parental Needle Sizes
Dermis (ID) :
Subcut (SQ) Anticoagulants:
Subcut (SQ) Insulin:
Muscle (IM) :

A

ID: 1/2” - 5/8”
SQ Anticoagulants: 3/8” - 5/8”
SQ Insulin: 1/2” - 5/16”
IM: 1/2” - 1 1/2” Most common in adults

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10
Q

Gauge (Diameter) of the needle should be large enough to deliver viscosity (thickness) of Medication:

A

Smaller Gauge Needles = thinner solutions (27-20g)
Larger Gauge Needles = thicker solutions (21-18g)

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11
Q

Non- Parental Needles are used when?

A

Used for withdrawing meds

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12
Q

1.Filter needle is used with what med container?
2.What is a filter needles purpose?
3. If filter needle unavailable use?

A
  1. ALWAYS use w/ AMPULES
  2. Small filter in the hub catches debris
  3. Use the smallest gauge (diameter) needle (23g).
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13
Q
  1. Blunt fill needle is used with what med container?
  2. If not available use?
A
  1. Typically used with vials (rubber stopper)
  2. Use the smallest gauge (diameter) needle (23g)
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14
Q

After using either the filter needle or Blunt fill needle to draw up a med you must?

A

REMOVE and Replace with sterile needle for administration.
Never use either of these to inject into the patient due to tissue damage and painful to pt.

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15
Q

If you chose to recap your blunt or filter needle before placing in sharps container, you must?

A

Always use the one-handed recap technique and then apply new sterile needle before placing syringe in med tray.

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16
Q

When is the only time a blunt/filter needle allowed to be in a patients room?

A

Only when used for blood withdraw
(OSHA Guideline)

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17
Q

Choose what type of syringe needed to administer rx’d volume of medication ordered?

A

The smallest syringe appropriate

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18
Q

When will you always use >1ml syringe?
When might you use a <1ml syringe?

A

> 1ml : DEEP IM due to the need to aspirate for possible blood return
<1ml : SQ,ID,DELTOID ex: vaccinations

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19
Q

1st Check:
2nd Check:
Check 2 things on actual med:

A

Acknowledge HCP orders is 1st check
Remove meds from pyxis & verify against eMAR on computer screen is 2nd check
Check expiration date and package integrity

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20
Q

What will you put on the blue label?

A

Med, Dose, Time, Initial, and Room # ( room # is optional)

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21
Q

Will you take insulin Vial into a patients room?

A

No, Insulin remains in the med room. You will take other med vials into the room to verify against pt eMAR.

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22
Q

Single Dose: After you clean the top of the vial you will…

A

inject air equal to the amount of medication to be withdrawn : this is called charging.

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23
Q

Do you charge a multi-dose vial/med?

A

No often times it can over-charge the medication.

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24
Q

Withdraw the entire amount of med from the vial whether you need it or not why?

A

It cannot be used again and you cannot put vials of meds that still have meds in them, into the sharps container.

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25
Q

Prepare to deliver the exact amount of the medication ordered, How?

A

draw the entire volume of med out of the vial and then waste what you don’t need.

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26
Q

After you remove the BF needle you will:

A

Attach the appropriate sterile needle for actual administration into pt.

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27
Q

If an order is written to administer 2 medications: Vial A and Vial B must be?

A

Must be compatible

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28
Q

Mixing two meds you cannot exceed:

A

Acceptable volume for intended site/syringe

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29
Q

What time of needle will be used to draw and mix a med?

A

A Blunt Fill (BF)

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30
Q

Combining two meds:
A vial and Ampule you must:

A

You must use either a BF and A filter needle or simply use a filter needle to avoid confusion.

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31
Q

Ampules can only be drawn up with what needle?

A

FN or Filter Needle

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32
Q

Combining two meds:
Vial and Ampule…
What do you prepare first?

A

prepare from the vial first cause you have to add the air so you’ll have to charge, then ampule second.

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33
Q

Trouble shooting (Air or Bubbles) has 2 general techniques, what are they?

A
  1. Make sure the needle is below fluid level
  2. Withdraw the med slowly
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34
Q

(Air and Bubbles)
Single-Dose Vials: 2

A
  1. Withdraw entire volume from vial - expect air to follow
  2. Expel the air and medication, if more than required is in the syringe, to ensure exact dose
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35
Q

(Air and Bubbles)
Multi-Dose Vials: 2

A

1.Withdraw more med than you need, leaving needle in vial, then push med back into the vial via plunger to exact dose
2.If still having issues, can tap or thump syringe gently to move air to top of syringe then purge air back into vial

36
Q

Why a filter needle and not a blunt-fill needle?
(for a AMPULE)

A

To make sure there is no debris from breaking open the ampule in the med.

37
Q

Are ampules multi-dose or single-dose?

A

Single-dose

38
Q

How do you break the ampule?

A

place barrier ( plastic caps that go past the ring ) around neck and break away from you

39
Q

Reconstitution:

A

Is the process of adding a liquid diluent to a dry, crystals or liquid concentrated ingredient solute to make a specific concentration of liquid

40
Q

Drugs in powder form retain potency only for a short period of time once reconstituted-

A

They have a short shelf life

41
Q

Reconstituted volumes do not always equal the amount of diluent because the medication itself has volume, so no matter what you will:

A

give all of the med always don’t get rid of it, if the volumes a little off.

42
Q

The medication label or package insert dictates which diluent to use- typically :

A

NS or Sterile Water

43
Q

Read the med label carefully whether IM or IV is a choice in reconstitution, why ?

A

May differ in the amount of Diluent

44
Q

Scan medication barcode, then?

A

always look at the screen to acknowledge and address all pop-ups! This occurs with almost every injection.

45
Q

Prior to Administration, select appropriate site for medication – Why? How?

A

Location/Site: Targeted Tissue
How: Landmarks
VISUAL AND TACTILE

46
Q

After Injection is complete you need to?

A

Discharge safety mechanism IMMEDIATELY after injection
Away from You and the Patient!
Dispose of in Sharps – one needle, one time

47
Q

“Donts at the bedside”

A

DO not place trash or items on the bed
DO not leave used equipment/items on the pt food tray or bedside table after med administration

48
Q

What is your indicator that you med documentation has been saved?

A

Once a med has been scanned, the screen automatically will say “Given” which means your documentation has been saved

49
Q

3 Spots of IM injections:

A

Deltoid
Ventrogluteal
Vastus Lateralis

50
Q

(IM) Select Appropriate Syringe and Needle
Based on:

A

Medication, Volume, Injection Site & the patient

51
Q

(IM) Inject at a rate of 1 mL/10 sec –wait 3-5 sec before removing needle - Why?

A

allows the muscle tissue time to expand to accommodate the medication and the 3-5 sec is to make sure it stays deposited into the targeted tissue

52
Q

(IM) Post injection, do not rub or massage – Why?

A

displacement of the medication

53
Q

Angle for IM injections is:

A

90 Degrees

54
Q

Choose the Deltoid for:

A

For Smaller Volumes, Less Irritating Medications (ie: Vaccines, B-12, etc.)

55
Q

(DELTOID) Max Volume Recommended:
Recommended Needle length:

A
  1. 1mL
  2. 1” inch
56
Q

Recommended syringe for deltoid site:

A

depends on what you are going to give and how much control that you have (3ml might be useful to have greater control)

57
Q

How do you landmark the deltoid?

A

Chromium process then 3 finger down

58
Q

For Deep IM which site is 1st choice?-why
Which is 2nd choice?

A

1st: Ventrogluteal is the first choice bc the muscle is more dense
2nd: Vastus Lateralis

59
Q

Choose Ventrogluteal or Vastus Lateralis for :

A

thicker, painful, or irritating meds (Deep IM)

60
Q

(DEEP IM) Maximum Volume Recommended:
Recommended Needle Length:
Recommended syringe?

A
  1. 3ml
  2. 1” to 1 1/2 (normally)
  3. Must be 3ml in order to aspirate for blood return.
61
Q

Deep IM technique: (3)

A

1.Position patient – hip up bend leg
2.Select VG or VL site – Always Rotate Sites!!
3.Landmark – Must Know How!!

62
Q

Z-track Method
What is the objective/purpose of this method?

A

move subQ, tissue, dermis out of the way .

63
Q

Insert needle quickly __ to hub, __ 3-5 seconds
(DEEP IM)

A
  1. 90 degree to hub
  2. Aspirate 3-5secs
64
Q

If blood returns during aspirating what should you do?

A

DO NOT INJECT start over

65
Q

(DEEP IM)
Inject at rate of 1 mL /10 sec, wait 3-5 sec, withdraw needle then :

A

Then release Z-track
Z track seals the deal and deposits deep into the tissue

66
Q

What muscle do you avoid when doing deep IM?

A

Dorsogluteal Muscle

67
Q

Sub Q Injections: (2)

A

Insulin
Anticoagulants

68
Q

(SUBQ)
Insulin unique property:

A

1.Own unique needle & syringe
2.Needles are very fragile and permanently attached to syringe

69
Q

(SUBQ)
Anticoagulant needle:
Appropriate syringe?

A

3/8-5/8” needle
correct syringe based on the med and the dosage/volume

70
Q

SQ Injection Rule of Thumb:

A

Inject at a 90° angle if you can “bunch” the skin more than 2”; otherwise, inject at a 45° angle

71
Q

Insulins: Mulit-dose Vials: (3)

A

Short Acting
Intermediate Acting
Long Acting

72
Q

(SQ Insulin Guidelines)
Site of injection:

A

Administered to the adipose “fatty” areas of arms, abdomen, back or thighs

73
Q

What is Lipodystrophy? What causes this? How can prevent this from occurring?

A

For diabetics, repeated use of the small needles and insulin often develops hard knots ( lipodystrophy) repeated injections. YOU MUST ROTATE THE SITE OR ALTERNATE BY 1 INCH

74
Q

(SQ Insulin) Avoid Linea Alba and umbilicus by at least:

A

By at least 2 inches

75
Q

(SQ Insulin Administration)
Draw dose based on:

A

verified BS or standing order and attach insulin label to syringe – leave insulin vial in pyxis

76
Q

(SQ Insulin Administration)
Specific parts of actual injection technique:

A

bunch site after assessed and cleaned , inject 90 degrees , release bunch, release med into body, wait 3-5 sec and then withdraw at the same angle

77
Q

SQ Enoxaparin Injection is ALWAYS injected at which site?

A

ALWAYS ABDOMINAL ADMINISTRATION

78
Q

(SQ Enoxaparin)
How do you position pt?

A

reclining/supine is always best

79
Q

(SQ Enoxaparin)
Assess abdominal “Love Handle” region:
Administer:

A

1.Greater than or equal to 4 inches from umbilicus
2.DEEP SQ this is gonna have a longer length needle ( prepackaged ) - 90 degree angle is recommended unless what?
45 degree angle is for when you ABSOLUTELY HAVE TO

80
Q

(SQ Enoxaparin)
Do you bunch the skin during injection?

A

YES DURING THE ENTIRE INJECTION

81
Q

DO NOT aspirate or expel nitrogen bubble, why?

A

nitrogen bubble follows and seals the med deep into the sub q

82
Q

When are intradermal injections used?
When selecting site be mindful of:

A

Allergy testing and TB testing
Select site (free of tattoos (if possible), blemishes, hair, scarring, bruises, etc.)

83
Q

(Intradermal)
Site preparation:

A

stretch middle ⅓ of forearm relatively taut, you want that skin tight

84
Q

(Intradermal)
Angle of administration:

A

Inject at almost parallel angle (5-15 degree) until bevel of needle barely disappears under the skin- direction of the bevel matters
BEVEL NEEDS TO BE UP

85
Q

Inject and ensure a “ bleb or wheal “ - A MUST WHY?

A

INTRADERMAL is target spot to elicit a response of the medication in order to read the results of it.

86
Q

Rate of Absorption:
1st, 2nd, 3rd and 4th

A

what is the fastest? IV
second: IM
third: SUBQ
fourth: Intradermal
Depends on how fast the medication is going to act, exceptions fast acting insulin.

IM 2 Exam 2 (2 decks)

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