name the parts of a syringe
syringe sizes
0.5 mL to 60 mL
What is a commonly used size for syringes?
3 cc
How are insulin syringes calibrated?
in units, usually U-100
How are tuberculin syringes calibrated?
hundredths of a milliliter
What volumes can a tuberculin syringe be used for?
< 1 mL
How many doses can prefilled syringes be used for?
one
luer lock
needle is twisted to lock in place
non luer lock
needle slips into tip
carpuject
holds prefilled cartridge-needle units
name the parts of a needle
range of needle lengths
1/4 to 3 inches
the smaller the gauge number, the ________ the needle opening
larger
after injection, should you recap needle after injection?
no
What safety measures should you take when administering medications via syringe?
label syringe
carefully locate size
use appropriate volume
monitor patient
vials
plastic or glass containers that hold one or more doses of medication in powder or liquid form
When administering an injection, what should you do first and throughout?
perform six rights and three checks, and six essential steps
Before administering the ampule, what should you do to make sure the medicine is ready?
lightly and quickly tap the top of the ampule until the fluid moves out of the neck
How should you open an ampule?
place a small gauze pad or unopened alcohol pad around the the neck of the ampule and snap it firmly away from you.
how should you dispose of the ampule top?
in a sharps container
What kind of a needle should you use to get medication out of an ampule?
a filter needle long enough to reach the bottom
How should the ampule be positioned when you draw up medication from an ampule?
it should be resting on a flat surface or held upside down
how should the filter needle be inserted into the ampule?
without touching the rim
how should medication be drawn into the ampule?
pull back on plunger to aspirate medication, and tilt ampule as needed to keep tip under surface of medication
How should you expel bubbles from the ampule?
remove needle from ampule, hold syringe with needle up, tap side of syringe to make bubbles rise toward needle. Draw back slightly on plunger and then push to eject air. Do not eject any fluid
What should you do if the syringe holds excess fluid?
hold the syringe with the needle up and slanted slightly towards the sink. Slowly eject fluid into sink.
How should you recheck fluid level?
by holding syringe at eye level vertically
Is the filter needle used to administer medication to the patient?
no, it is NEVER used to administer medication into the patient. You must change the needle to the appropriate size
what are the appropriate sites for intradermal injections?
inner forearm and upper back
what type of syringe is used for intradermal injections?
inner forearm and upper back
what length needle should be used for intradermal injections?
1/2 inch
What is the appropriate gauge for intradermal injections?
27-30
What is the angle of insertion for intradermal injections?
5-15 degrees
What types of syringes are used for subcutaneous injections?
hypdermic, tuberculin
What is the length of subcutaneous needles?
5/8 in to 1/2 inch
What gauge are subcutaneous needles?
27-25 gauge
What is the maximum volume of subcutaneous needles?
children 0.5 mL adults 1.5 mL
what is the insertion angle of subcutaneous needles if 2 in of skin can be pinched?
90 degrees
what is the insertion angle of subcutaneous needles if 1 inch of skin can be pinched?
45 degrees
When injecting from a vial, what should you do to ensure asepsis from the vial?
firmly and briskly wipe the rubber seal
What should you do before you start to draw up medication from a vial?
inject air into the vial's airspace by pressing firmly to overcome the pressure in the vial
what are intradermal injections typically used for?
skin testing
Where are intradermal medications injected?
into the dermis
Where can intradermal injections be administered?
inner forearm and upper back
What are the six essential steps in administering parenteral medications?
1. identify patient
2. inform the patient
3. perform 3rd check
4. administer drug
5. document administration
6. Evaluate for effectiveness and side effects
What equipment do you need for a subcutaneous injection?
medication (first check)
syringe
needle
alcohol wipes
gloves
What needs to be labeled on syringe?
patient name, medication and dose
what must be recorded in the appropriate place on the mar?
name of drug
dosage
route
site
time
nurse's name
What should you avoid to make it easier to interpret skin reactions in intradermal injections?
areas with bruises, inflammation or edema
What is the ideal site for intradermal injections?
3-4 finger widths below antecubital space and one hand above wrist
if you can't use the forearm for an injection, where else can you administer a subcutaneous injection?
site on upper back or subcutaneous injection site
how should the site for an intradermal injection be cleaned?
with an alcohol swipe, beginning at the center and spiraling out for about 2 inches
subcutaneous injection sites
Before injecting air into the vial, what should you do to promote asepsis?
use an alcohol swab to firmly and briskly wipe the rubber seal, and then let it dry
Before drawing up medication from a vial, what should you do first?
inject a volume of air equal to the volume of medicine you want to dispense
What should you do if any air remains at the top of the syringe after you have "tapped out" the bubbles?
you should inject it back into the vial
Six rights
Time Medication Dose Route Client Documentation
Three checks
compare medication with mar before dispensing
compare medication with Mar as medication is being removed from container
check medication one last time at bedside before dispensing
Six essential steps
identify the patient
inform the patient
perform 3rd check
Administer drug
document
evaluate effectiveness, side effects
Which way is the bevel pointing in intradermal injections?
bevel pointing up
What is the ideal site for intradermal injections?
a site three or four finger widths below the antecubital space and one hand above the wrist
If you can't use the forearm for an intradermal injection, where can you inject instead?
upper back, subcutaneous injection site
How much of the needle should enter the patient's skin in giving intradermal injections?
about 1/8th of an inch
After administering a tuberculin skin test, what should you do so that you can identify the patient when you read the test?
circle the injection site
how do you locate the deltoid injection site?
locate site by measuring 2-3 fingerbreadths below the acromion process on the lateral midline of the ar
How do you locate the vastus lateralis injection site?
locate by identifying greater trochanter and lateral femoral condyle. Injection site is middle third and anterior aspect of the thigh
locating ventrogluteal site
Ventrogluteal: Locate site by placing the hand with heel on the greater trochanter and thumb toward umbilicus. Point to the anterior iliac spine with the index finger (forming a "V"). Injection of medication is given within the "V" area.
If the fluid volume of the IM injection is 0.5 to 1.0 mL, which site should you use?
deltoid
What needle length should you use in the deltoid?
1
What gauge should you use when administering an IM in the deltoid?
23
What position should the patient be in for a deltoid muscle injection?
sitting, standing, supine or prone
Which arm should you administer in when giving an IM deltoid injection?
non-dominant arm when possible
What is the safest IM injection site for all adults and children?
Ventrogluteal
What volumes are appropriate for the ventrogluteal site?
1-3 cc
What needle length should you use for a ventrogluteal injection in an average adult?
1.5
If you are giving an injection to a child, what needle lengths should you use for ALL injections?
5/8 to 1 inch
What position should a client be in for a ventrogluteal injection?
supine lateral position
What gage is appropriate for anterolateral thigh (vastus lateralis)
22-25 gauge
What needle length is appropriate for vastus lateralis?
1.5
What position should a client be in for an injection into the vastus lateralis
supine or sitting postion
What size syringe should you use for intramuscular injections?
3 cc
What should you do if the dose ordered for an adult is over 5cc?
divide it
What should you do if the dose ordered for a child is over 3cc?
divide it into smaller doses
What should you do to prepare the skin for an IM injection?
pull it taut
How should you clean the skin before an IM injection?
in a circular motion
What angle should the IM needle be inserted in?
90 degrees
What MUST be done before injecting medication in a patient?
aspirate and observe for blood
After administering IM, what should you do?
remove needle quickly, gently apply pressure to site with a dry, sterile 2x2 gauze
You should NEVER ________ the injection site
massage
Why is the Z-track method used?
used to prevent backflow of medication into subcutaneous tissue
Why should you change the needle between drawing up medication and injecting it into client when using Z-track method?
to prevent tissue staining or irritation
Describe the Z-track method
displace skin laterally to one side before inserting needle, insert at 90 degrees and aspirate, administer if no blood is present, withdraw needle and release skin
In infants and young children you should never give an injection greater than
1 mL
What factors affect which IM site chosen by the nurse?
age
level of activity
frequency of injections
general condition
medication
volume to be given