UNIT 3

1. UNIT 3

2. FORMS FOR PACKAGING PARENTERAL MEDICATIONS • Ampule • Small glass container/ holds single dose of sterile solution • Vial • Single dose or multi dose container /sealed with rubber stopper • Cartridge injection • Single dose in container / fits into a particular syringe • Prefilled syringe • Aqueous solution • Sterile water base • Viscous solution • Oil base

3. Syringe & Needle PartsRefer to Handouts

4. Injection Guidelines Selecting needle size Gauge: Diameter of the lumen (inside of the shaft) Higher the number = finer (smaller) the needle 28 gauge smallest; 15 gauge largest Based on viscosity (thickness) of solution 25 gauge for subq; 20 – 22 gauge for IM Length Vary from 3/8 inch to 2 inches 3/8 for intradermal; 5/8 for subq; up to 2” for IM

5. Syringe Types Standard (Hypodermic) Used for subcutaneous or IM Marked in mL 0.5 – 2 mL per injection site Most common is 3 mL size for > 1 mL dose Use 1 mL syringe when < 1 mL

6. Syringe Types • Tuberculin • Intradermal injections of small amounts of substances • Calibrated in tenths & hundrethsof a mL; holds 1mL • Insulin • Calibrated in units; 1mL amount • Most common size U-100 which means 100 units = 1 mL

7. Intramuscular (IM) Injections Deposits medication deep into muscle Rapid systemic absorption & action Not administered at inflamed, edematous, or irritated sites or sites that contain moles, birthmarks, scar tissue or other lesions

8. IM Injection Sites Dorsogluteal--------------------- Upper outer quadrant of buttocks DO NOT USE AREA– high risk of sciatic nerve or major blood vessel injury Ventrogluteal Above the outside of buttock on hip Preferred site for adults & children but not for children ≤ age 3

9. IM Injection Sites Deltoid Upper outer arm above axilla Vastuslateralis Front of thigh toward outside of leg Preferred site for infants Rectus femoris Front of thigh toward midline of leg Preferred site for self injections

10. IM Guidelines Check med for color, clarity & expiration Choose appropriate equipment Draw up medication from vial or ampule per procedure

12. Z-track Method Prevent leakage of medication into subcutaneous tissue Use for medications that irritate or discolor tissue Follow usual method of drawing up medication. Then, draw up 0.2 – 0.5mL of air Follow IM procedure except displace skin laterally. Wait 10 seconds after injection. Then, release skin & withdraw needle at same time. DO NOT massage

14. Subcutaneous Injections Injection into adipose tissue below skin Slower onset than IM Minimal tissue trauma & little risk of striking major vessel 0.5 – 2mL Fat pads of abdomen, upper hips, upper back, lateral & upper arm & thighs

15. Subcutaneous Injections Insulin – arms, abdomen, thighs preferred Heparin – lower abdomen preferred 45 - 90° angle

16. Intradermal Injections Little systemic absorption Primarily used to produce a local effect 0.5 or less volume into outer layers of skin Ventral forearm most common site 10 – 15° angle with bevel up Only go 1/8th inch below epidermis Inject slowly; wheal form Do not massage

18. Administering Medications to Young Child or Infant Injections Praise When giving <1mL, use TB syringe Shorter needles Get HELP to administer Vastuslateralis site

19. Medication Documentation START WITH SIX RIGHTS Must Document: • Medication given • Effectiveness • Signature • If refused – why? • Education / Teaching

20. Documentation Tips • Write legibly / Spell correctly • Be complete • Be prompt but not premature • Follow facility procedures for late entries or correcting errors • Be objective & descriptive

21. Responsibility & Controlled Substances

22. Controlled Substances • Accurate records for storage, use & waste • Inventory record • Patient • Date & time • Med with amount • Dr. ordering med • Person administering • Amount remaining • Wastage (if any) with reason • Requires witness

23. Reconstitution Principles • Reconstituting • Adding a diluent or solvent (a liquid) to powdered med to dissolve it & form a liquid • Solute • Powdered med or liquid concentrate • Solution • Resulting liquid

24. Let’s Reconstitute…

25. Insulin • Different concentrations • Different sources • Recombinant insulin (human source) - rDNA • Different action speeds • Rapid acting (regular) – signified by “R” • Intermediate acting (NPH) – signified by “N” • Long acting • Know onset, peak, duration • Inspect / Read label • Double check

26. Insulin • Clear Insulin appearance ---Rapid & Regular acting ---Long acting • Cloudy Insulin appearance ---Intermediate acting ---Mixtures • Combination insulins • Indicates % of NPH & % of regular insulin • Larger % will be NPH

27. Insulin • Administer subcutaneous or IV, never IM • Only rapid acting regular insulin given IV • Measured in units • Administer in corresponding syringes to insulin strength • Sliding scale insulin

28. Insulin Preparation • Do NOT shake vial • Roll vial between palms of hands • Lantus may NOT be mixed with others

29. Insulin Combined Dosages

30. Pediatric Dose Calculations • Based on mg per kg per day • Reference will state recommended/safe dosage • Sequence • Determine child’s weight in kg • Calculate total daily dosage • Divide daily dosage by number doses to give • Decide if dosage is safe by comparing to source • Use ratio : proportion for amount of tablets or liquid to administer