Procedures

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Author:
ysimon
ID:
184419
Filename:
Procedures
Updated:
2012-11-19 14:25:20
Tags:
Injections SubQ Intradermal IM IV angicath butterfly
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Description:
SIM Lab procedures
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  1. Injection equipment
    • Gloves
    • Alcohol pads/cleaning sol
    • Syringe 
    • Needle 
    • Dressing material/tape
    • Med to be administered 
    • Biohazard sharp container
  2. Syringes
    • Standard
    • Various sizes 3-5+ mL
    • Measured in mL
    • Contains some dead space
    • May come prepackaged with needle

    • Tuberculin
    • Max of 1mL
    • Divided into tenths
    • e.g. 0.1mL, 0.2mL...

    • Insulin:
    • Divided into units 
    • NO dead space
  3. Needles
    • Gauge  measures internal diameter of needle 
    • The LARGER the gauge of the needle, the SMALLER the needle 
    • THICK, CONCENTRATED meds need SMALLER Gauge (LARGE needle)

    • Selection of needle gauge depends on type of injection:
    • Intradermal: 25-26 G, 3/8"-5/8" long, short bevel tip
    • SubQ: 23-25 G, 5/8"-1" long, short-medium bevel tip
    • IM: 18-23 G, 1"-3" long, long bevel tip
    • IV: 14-16 G, 1-3+" long, long bevel tip
  4. Needle Safety
    Sheath device 

    NEVER RECAP A NEEDLE with 2 HANDS -if you must recap (do NOT) use the "one-handed" recap technique
  5. Types of injection
    • Intradermal
    • SubQ
    • IM
    • IV
  6. Intradermal injection
    • Skin testing -PPD test, allergy test
    • Local anesthesia

    • Equipment:
    • Tuberculin syringe
    • Needle: 25-26 G, 3/8"-5/8" long, short bevel tip
    • Alcohol prep, Gauze
    • +/- Bandaid 

    • Tuberculin
    • Max of 1mL
    • Divided into tenthse.g. 0.1mL, 0.2mL...

    • Common injection sites:
    • Ventral forearm
    • Dorsal upper arm 
    • Scapula area 
    • Upper chest 

    • Procedure:
    • Withdraw proper amount of medication
    • Inform pt of procedure
    • Select and clean site -"bull's eye" motion with alcohol prep, inside --> outside
    • Apply gentle traction to stretch skin taut -pull skin wtih thumb
    • Position syringe @ 15angle with needle bevel up
    • Insert needle and gently lift, then inject slowly
    • Form a "wheal"
    • Withdraw needle, dispose in sharp container
    • Gently wipe area
    • Chart injection properly
    • +/- Mark area of injection
    • Pt. education/instructions
    • Intradermal injection
    • Apply gentle traction to stretch skin taut -pull skin wtih thumb
    • Position syringe @ 150 angle with needle bevel up
    • Insert needle and gently lift, then inject slowly
    • Form a "wheal"
    • Withdraw needle, dispose in sharp container
  7. SQ injection
    • For highly soluble, potent meds -Insulin, Heparin, Epi, Antigens
    • For meds that need slow, sustained release
    • Limited drug doses (<1mL)
    • Equipment: 
    • Syringe: 1-3mL 
    • Needle: 23-25 G, 5/8"-1" long, short-medium bevel tip
    • Alcohol, Gauze
    • +/- Bandaid

    • Insulin:
    • Divided into units
    • NO dead space
    • Common sites:
    • Abdomen (good for self-injections, Insulin/fat)
    • Upper back 
    • Laterial thigh
    • Posterior upper arm ("flabby" upper arm)

    • Procedure:
    • Withdraw proper amount of medication (MAX 1mL)
    • Inform pt of procedure
    • Select and clean appropriate site
    • Pinch up 1" skin fold, lifting SQ tissue off of underlying mx
    • Hold syringe like a pencil and inject @ 450 angle into site 
    • Release skin fold
    • ASPIRATE before injecting SLOWLY 
    • Withdraw needle and dispose in sharp container
    • Cleanse site again if needed -blood 
    • Apply dressing and bandage
    • Document injection
    • Monitor pt
    • Pt education/instruction
  8. SQ injection

    • Pinch up 1" skin fold, lifting SQ tissue off of underlying mx
    • Hold syringe like a pencil and inject @ 450 angle into site Release skin fold
    • ASPIRATE before injecting SLOWLY
  9. IM injection
    • Rapid absorption of aqueous sol
    • Prolonged absorption of oil-based sol
    • Larger drug doses (3-5mL)
    • Tetanus shot, PCN

    • Equipment:
    • Syringe: 3-5mL
    • Needle: 18-23 G, 1"-3" long, long bevel tip
    • Alcohol, Gauze
    • Dressing/Bandage material

    • Common sites:
    • Posterior gluteal mx
    • Ventral gluteal mx
    • Deltoid mx
    • Vastus lateralis mx
    • Rectus femoris mx
    • Dorsogluteal site
    • Line from posterior illiac spine to greater trocanter 
    • Go lateral and superior to this line --> Outer -Upper gluteal area 
    • Most convenient for pt/preserves modesty (do NOT have to drop pants all the way)
    • Deltoid site:
    • 2-3 finger-breaths below the acromion process 
    • Into the Deltoid mx (triangle)

    • Procedure:
    • Withdraw proper amount of medication (MAX 3mL)
    • Inform pt of procedure
    • Select and clean injection site
    • Use NON-dominant hand to apply gentle traction to skin to "Z-track"
    • Quickly insert needle at 900 angle
    • ASPIRATE prior to injecting medication
    • Withdraw needle and release tension onskin, trapping medication in mx
    • Apply pressure/bandage for any bleeding +/- massage site 
    • Dispose of needle in sharp container
    • Document injection
    • Monitor pt
    • Pt education




  10. IM injection

    • Use NON-dominant hand to apply gentle traction to skin to "Z-track"
    • Quickly insert needle at 900 angle
    • ASPIRATE prior to injecting medication
    • Withdraw needle and release tension onskin, trapping medication in mx
    • Z-Track Method for IM injections
    • Use to prevent backflow of medication into SQ tissue -traps medication in mx
    • Displace skin to one side (laterally) before inserting needle
    • Insert needle @ 900 angle
    • Aspirate
    • Administer medication
    • Withdraw needle BEFORE releasing skin 
  11. IV
    • Needle: 14-16 G, 1-3+" long, long bevel tip 
    • or 
    • Buttlerfly

    • Site:
    • Vein in dorsal surface of hand

    • Procedure:
    • Tournique 6-8 inches higher to site
    • Little traction to the skin
    • Shallow approach to the vein 
    • Flashback of blood into the needle = you are in the vein
    • Move catheter forward
    • Apply pressure proximal to puncture site before attaching the line
    • Protect insertion site
    • Sign with date and initials 
  12. 5 Rs of Medication Administration
    • Right patient -check pt's name (ask, read bracelet), ask about allergies
    • Right medication -check medication and concentration
    • Right dose -double check dose
    • Right route -ensure proper route of adminitration (ID, SQ, IM, IV)
    • Right time -speed of injection (rapid push, given over set time period)

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