med administration 3: IM INJECTIONS

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Ampules:

- lightly flick top to remove any medication

- note the colored neck, this is where it will break

- use a protective padding between your fingers and the ampule

- pull back firmly on the top to snap the ampule away from your body

- dispose in sharps container

- you MUST use a filter needle

- withdraw either upside down, or if right side up, use an adequately long needle

- do not touch rim of the ampule with the tip or the shaft of the needle

- if air is aspirated:

- remove needle from ampule

- hold needle upright and tap to move air to top of syringe

- pull plunger back to remove medication from needle

- carefully eject air and reinsert needle thru ampule opening and resume withdrawal

- discard any excess medication into a sink or waste bin.

- hold needle lower than syringe to avoid contamination or spilling

- remove filter needle and replace with appropriate needle for injection

Vials

- may be single dose

- if preservative is added, may be multi-dose

- discard multi-dose vial after one month or according to policy

- check date on vial and check label with the MAR two times while preparing

- pressurize the vial by drawing air into syringe that equals the amount of medication you wish to withdrawal

- clean rubber stopper with alcohol swab and allow do dry

- insert needle into stopper and inject air space

- invert vial, keep needle below fluid, gently draw up solution

- tap or flick syringe so that you can move and eject bubbles/air

- this also ensures accurate measurement of medication

- avoid bending needle

- return bottle to upright position and withdraw the needle from vial

- recap needle with one hand

- if injecting large amounts of air

- resistance may occur, inject a portion of the air, allow air pressure to fill the syringe slowly by keeping your thumb firmly on the plunger

- once filling stops, inject the rest of the air and draw up the remainder of the solution you need.

- if mixing medications:

- draw up air for medication vial A, inject air and withdrawal needle

- draw up air for medication vial B, inject air, invert vial and withdrawal proper amount of medication

- do not expel medication in vial B

- if one vial is single-dose, it should be used as vial A in this scenario

Reconstituting medication:

- remove protective cap of medication vial and diluent vial

- cleanse both stoppers and allow to dry

- pressurize diluent and withdraw appropriate volume of diluent to dissolve medication

- allow diluent to dissolve medication

- roll vial to ensure thorough mixing DO NOT SHAKE.

- concentration determines the amount to be given, read medication label calculate dosage.

Syringes:

- up to 60 mL, but you typically use 1-5 mL for injections

- some are packaged with a needle preattached, make sure it is securely attached before use

- the needle may need to be changed depending on the route of administration and patient size

- read the calibration of the syringe to assure proper measurement.

- prefilled syringe system

- Carpuject uses prefilled syringes along with reusable plastic or metal syringe holder where it is loaded to administer the medication

- load syringe into holder, needle end first, turn blue lock a half turn, rotate plunger rod until it is fully screwed onto plunger.

- uncap needle, eject air and excess medication by holding needle lower than syringe

- after administration, dispose in sharps container: position holder so that it is cradling the syringe, unscrew plunger rod, rotate blue lock a half turn, invert holder over sharps container and dispose of syringe and needle.

- TB syringes (are usually the gray tops..but in your tote bag they have a yellow syringe attached on a 1 ml vial).

- The Intramuscular injections you can use between a 1 to 3 mL syringe to give the injection (most often 3 ml is used and with either a 1 inch to 1.5 inch needle 22 to 25 g)

Needles

- filter needles are NEVER used to administer an injection

- some needles are equipped with safety devices to reduce needlestick (automatic or may need to be activated) use a needleless system whenever possible to prevent injury

- gauge: diameter of needle, the lower the gauge, the narrower or smaller the diameter of needle

- you must keep the bevel, shaft and hub sterile as you prepare

- if recap is needed and it hasn't been used on a patient, do not contaminate, use the one-handed scoop technique

- if unused DO NOT use safety mechanism to cover needle, it will render it useless and create unnecessary waste

- NEVER recap a needle that has been in contact with a patient.

Appropriate needle size for injection

1. Intradermal: 25- to 27-gauge, 1/2- to 5/8-inch long, hold at 5- to 15-degrees

2. subcutaneous: 25- to 27-gauge, 3/8- to 5/8-inch long, hold at 45- to 90-degrees.

3. subcutaneous insulin: 25- to 31-gauge, 5/16- to 1/2-inch long, hold at 45- to 90-degrees

4. intramuscular: 18- to 25-gauge, 5/8- to 1 and 1/2-inch, hold at 90-degrees.

(5/8 is a notch over a half inch, 3/8 is a notch under a half inch, 5/16 is a notch between 1/4 and 3/8)

- consider patient size and age, injection site and type of medication administered.

Contaminated needles

- make sure that a sharps container is within arms reach and at eye level.

- make sure sharps container is functional and not overfilled before administration

- DO NOT carry contaminated needles around in your hand or in your pocket

- NEVER dispose of contaminated sharps in wastebasket or patient's meal tray

- NEVER recap contaminated needle.

IM injections

- allow rapid absorption

- deltoid, vastus lateralis, ventrogluteal muscles are acceptable sites

- examine area to determine that there is adequate muscle tissue.

- avoid lesions, trauma areas, inflammation, or bony prominence

- rotate IM injection site to prevent tissue damage

ZTRACK technique

- prevents tissue irritation caused by medication leaking into subcutaneous tissues.

- displace skin and subcutaneous tissue at site about 1-1 and 1/2 inches with side of non- dominant hand. maintain displacement during injection and release immediately after you withdraw the needle.

- insert at 90 degree angle, use quick, darting motion to insert.

- inject slowly and smoothly and hold the needle in place for 10 seconds to allow dispersion, withdraw needle quickly at a 90 degree angle

- cover site with dry gauze immediately and apply gentle pressure DO NOT MASSAGE THE SITE

Deltoid injection:

landmarks: acromion process and axillary line

- insert needle two- three finger widths below acromion process, above the axillary line, in the midline of the lateral aspect of the arm.

- up to 2 mL of medication, 1 to 1&1/2 inch needle.

- For children use 1/2 to 1 inch needle, still 2 mL

- DO NOT USE FOR INFANTS AND TODDLERS YOUNGER THAN 3 YEARS

Vastus lateralis injection:

landmarks: head of greater trochanter and the knee

- insert needle into middle third of muscle at least one hand width below the greater trochanter and one hand width above the knee in the anterolateral aspect of the leg

- up to 3 mL of medication, 18-25-gauge, 5/8 to 1 inch needle for oil-based or viscous solution.

- 22- 27-gauge, 5/8 to 1 inch needle for aqueous solution.

- for infants: up to 1 mL with 1 inch needle

- small infants: up to 0.5 mL with a 5/8 inch needle.

- PREFERRED SITE FOR INFANTS

Ventrogluteal injection

landmarks: head of greater trochanter anterior superior iliac spine.

- place heel or palm of hand on the head of the greater trochanter with your thumb pointing toward the patient's abdomen. spread fingers along iliac crest, insert the needle in the "V" formed between index and 3rd finger

- up to 3 mL of medication, 18-25-gauge, 1&1/2 inch needle for oil-based or viscous solutions

- 22-27-gauge, 1&1/2 inch needle for aqueous solutions

- for infants, give up to 1 mL, 21-25- gauge,1/2 to 1 inch needle

- for small infants, give up to 0.5 mL with a 21-25- gauge, 5/8 inch needle

- for toddlers, give up to 2 mL with a 21-25-gauge, 1 inch needle

- for children 3 years and older, give up to 2-3 mL with a 21-25 gauge with a 1/2 to 1 inch needle

- for adolescents, give up to 2 mL with a 21-25 gauge, 1- 1&1/2 inch needle.

- this is the preferred site for administering irritating or oily solutions to patients of any age.

determining volume, gauge, and length

- the site, age, size of pt., and medication

- if total volume to be administered exceeds max volume recommended, split injection into two or more injections and give at different sites

IF YOU HAVE USED A NEEDLE TO DRAW UP MEDICATION FOR AN INTRAMUSCULAR INJECTION, CHANGE THE NEEDLE TO A CLEAN, DRY NEEDLE FOR THE INJECTION TO PREVENT TISSUE IRRITATION OR DAMAGE