Injections ID SubQ IM

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Injections ID SubQ IM
2012-08-23 20:25:20
Injections ID SubQ IM

Info on ID SubQ and IM Injections
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  1. Intradermal Injection
    Needle Length?
    Needle Guage?
    • Needle Length = 1/4 to 1/2 inch
    • Needle Guage = 26 or 27
    • (See Pg. 180)
  2. Intradermal Injection
    Degree Angle?
    • 10 to 15 degrees
    • (see pg. 182)
  3. Intradermal Injection
    Type of Syringe to use?
    • tuberculin syringe calibrated in tenths and hundredths of a milliliter
    • (p. 179)
  4. Intradermal Injection
    Distance to Insert?
    only about 1/8 inch with bevel side up, and entire bevel under skin (p. 182)
  5. Intradermal Injection
    Absorption Time?
    • longest absorption time of all parenteral routes
    • (p. 179)
  6. Intradermal Injection
    • usually less than 0.5 mL
    • (pg. 179)
  7. Subcutaneous Injection
    Needle Length?
    Needle Guage?
    • Needle Length = 3/8 to 1 inch can be used, 3/8 to 5/8 inch needles are most commonly used. (p.184)
    • Needle Guage = 25-30 (p. 184)
  8. Subcutaneous Injection
    Degree Angle?
    • 45 to 90 degrees
    • Choose the needle length based on the amount of Subcutaneous tissue present, generally insert 3/8 inch needle at 90 degrees, and 5/8 inch needle at 45 degrees.
    • (p. 184)
  9. Subcutaneous Injections
    Appropriate Sites?
    • 1. Outer aspect of upper arm.
    • 2. Abdomen (below costal margin to iliac crest)
    • 3. Anterior aspect of thigh.
    • 4. Upper Back
    • 5. Upper ventral gluteal area.
    • (see. p. 184)

    (Heparin is also administered subQ.  The most common site is the abdomen.  For heparin injections, avoid the area two inches around the umbilicus and the belt line.) p. 189
  10. Subcutaneous Injections
    Absorption Time?
    • Adipose tissue has few blood vessels, so drugs administered here have a slow, sustained rate of absorption into capillaries. The sites for subcutaneous injections listed in order from most rapid absorption to slowest absorption are abdomen, arms, thighs, upper ventral gluteal area.
    • (p. 184)
  11. Subcutaneous Injection
    Amount Given?
    Usually, no more than 1 mL of solution is given Subcutaneously. Giving larger amounts adds to discomfort, and may predispose to poor absorption (p. 185)
  12. Subcutaneous Tissue
    • Pinching is advised for thinner patients and when a longer needle is used, to lift the adipose tissue away from underlying muscle and tissue. If pinching is used, once the needle is inserted, release the skin to avoid injecting into compressed tissue.
    • (p. 184)
  13. Intramuscular Injections
    Needle Length?
    Needle Guage?
    • Needle Length:
    • Vastus Lateralis = 5/8 to 1 inch.
    • Deltoid = 1 to 1.5 inch.
    • Ventrogluteal - 1.5 inch.
    • Child Deltoid = 5/8 to 1.25 inch
    • (p. 192)
  14. Guage:
    • 20-25 for biologic agents and meds in aqueous solutions
    • 18-25 for meds in oil-based solutions
    • (p. 191)
  15. Intramuscular Injections
    Degree Angle?
    Prependicular to patient's body. This insures an angle between 72 & 90 degrees. (p. 196)
  16. Intramuscular Injections
    Appropriate Sites?
    • Ventrogluteal
    • Vastus Lateralis
    • Deltoid
    • (p. 191)
  17. Intramuscular Injections
    Absorption time?
    • Faster than with SubQ injections due to larger blood vessels and greater number of blood vessels within the muscle.
    • (190)
  18. Intramuscular Injections
    Amount Given?
    • 1-4 mL in general
    • 1-2 mL in deltoid
    • 1-2 mL in children and elderly
    • (p. 193)
  19. Intramuscular Injections
    How do you locate the Ventrogluteal Site?
    To locate the ventrogluteal site, place the palm of your hand over the greater trochanter, with your fingers facing the patient's head. (left hand for right hip or right hand for left hip) Place the index finger on the anterosuperior iliac spine and extend the middle finger dorsally, palpating the iliac crest. A triangle is formed, and the injection is given in the center of the triangle. (p. 752 - 753)
  20. Intramuscular Injections
    How do you locate the vastus lateralis site?
    To locate the vastus lateralis site, divide the thigh into thirds horizontally and vertically, and administer the injection in the outer middle third. (This site is particularly desirable for infants and children.)
  21. Intramuscular Injections?
    How do you locate the deltoid site?
    • Locate the deltoid muscle by palpating the lower edge of the acromion process. A triangle is formed at the midpoint in line with the axilla on the lateral aspect of the upper arm, with the base of the triangle at the acromion process.
    • (p. 753)
  22. Name four of the steps that intradermal, subcutaneous, and intramuscular injections have in common.
    • 1. Put on clean gloves.
    • 2. Cleanse the site with an antimicrobial swab.
    • 3. Remove the needle cap.
    • 4. Perform the injection.
  23. At what rate should each type of injection be injected?
    For an intradermal injection, slowly inject the agent while watching for a small wheal or blister to appear.  (p. 182)

    For a subcutaneous injection, inject the medication slowly (at a rate of 10 sec/mL).  (p. 187)

    For an intramuscular injection, inject the solutioin slowly (10 sec/mL).  Once the medication has been instilled, wait 10 seconds before withdrawing the needle.  (p. 196)
  24. For which types of injections might you apply pressure following the injection?
    For an intradermal injection, do not massage the area, apply pressure, or rub the site after removing the needle.  If necessary, gently blot the site with a dry gauze square.  (p. 182)

    For a subcutaneous injection, use a gauze square to apply gentle pressure to the site after the needle is withdrawn.  (p. 188)

    For an intramuscular injection, apply gentle pressure at the site with a dry gauze.  Do not massage the site.  (p. 196)
  25. What type of injection is used to administer heparin?

    What is the most common site?
    Heparin injections are administered subcutaneously.  

    The most common site is the abdomen.  When administering a heparin injection, avoid the area two inches around the umbilicus and the belt line.  (p. 189)
  26. For what type of an injection would you use the Z-track technique?

    How is the Z-track technique performed?
    The Z-track technique can be used for intramuscular injections. 

    • To perform the Z-track technique:
    • 1. Move the skin to one side (about an inch).
    • 2. Insert the needle at 90 degrees.  
    • 3. Aspirate for blood, then inject at the appropriate rate.
    • 4. Leave the needle in for an additional 10 seconds.
    • 5. Withdraw the needle and then allow the displaced tissue to return to its normal position, preventing the solution from escaping from the muscle tissue.
  27. What should the non-dominant hand do to the injection site to position it for an intradermal injection?
    What about for a subcutaneous injection?
    What about for an intramuscular injection?
    For an intradermal injection, use the non-dominant hand to spread the skin taught over the injection site.

    For a subcutaneous injection, grasp and bunch the area surrounding the injection site or spread the skin taut at the site.

    For an intramuscular injection, displace the skin in a Z-track manner by pulling the skin down or to one side about 1 inch with your non-dominant hand.