Date post: | 23-Dec-2015 |
Category: |
Documents |
Upload: | jason-owens |
View: | 228 times |
Download: | 1 times |
GOAL:
-After this session student will be able to confidently :
-Perform giving IM injections. -Demonstrate correct technique for
giving IM injections. -Identify equipment used for giving IM
injections. -Demonstrate correct disposal of used
needle. -Explain and be able to identify how
the patient tolerated the IM injection.
THE SIX RIGHTS OF DRUG ADMINISTRATION
Right PersonRight DrugRight DoseRight TimeRight RouteRight Documentation
-CHOOSING THE SITE TO ADMINISTER MEDICATION-
-There are several different sites an IM injectionSite determination-
-Stage of patients development. -Body build -Physical condition -Amount of the medication to be given
INTRAMUSCULAR INJECTION SITES• Deltoid• Dorsogluteal• Ventroglutea
l• Vastus
lateralis• Rectus
femoris
LANDMARKS: 2-3 FINGER WIDTHS DOWN FROM THE ACROMION PROCESS; BOTTOM EDGE IS AT AN IMAGINARY LINE DRAWN FROM THE AXILLA.
Deltoid
DELTOID
The deltoid site may be used on a child that is one year old and walking, depending on the child’s muscle mass
Assess the deltoid muscle of the adult to determine if it has sufficient mass for the injection
Bunching of the muscle may be needed with smaller muscle mass
DORSALGLUTEAL
Watch out for the sciatic Have patient stand or lay face
down with toes pointing inward. (relaxes muscle)
Divide the buttocks into 4 quadrants; give the injection in the outer, upper quadrant toward the hip.
DO NOT give to children who are not walking yet. (Muscles are not developed enough)
VENTROGLUTEAL
Good for adults and small children.
Find the upper part of the hip.
Place palm on hip (greater trochanter), with fingers point to the ground, and make a very large “V” with your pointer finger and middle finger.
In the middle of the “V” is where the injection can be done.
Vastus Lateralis
Landmarks: Place one hand below the greater trochanter and one hand above the lateral femoral condyle, mid-lateral thigh
THE MUSCLE OF CHOICE FOR IM INJECTIONS IN A CHILD LESS THAN 12 MONTHS OF AGE
Vastus Lateralis in Infants
RECTUS FEMORIS
On the anterior thigh, above the knee.
Used mostly by people who have to get themselves injections.
This is painful, because the muscles in the anterior thigh are tense when given.
INJECTION SITE ASSESSMENT
Do not use a site with any of the following:Muscle atrophyInflammationEdemaScarring, tattoo, mole, or lesionIV port/ accessSurgery in the limb/lymph node
problems
NEEDLES
Made of 3 parts - hub, shaft, bevel or slanted tip Range in length from l/4 to 3 inches Choose needle based on: client's size, weight,
type of tissue
Length: IM’s = I – 1 ½ inchesSC'S = 3/8 – 5/8 inches
NEEDLE GAUGE
Determine appropriate needle gauge IM: 19 - 25 gauge
Lower gauge number = bigger needle Use for more viscous
medications
Usual needle length/gauge for IM vaccines is 19 - 25 G 1”
USE THE CORRECT NEEDLE LENGTH FOR IM INJECTIONS
1” minimum needle recommended
1½” to 2” needle for larger arm
Longer needles: Hurt less Cause fewer local
reactions Assures proper route and
a valid dose of vaccine
-EQUIPMENT NEEDED TO PERFORM AN IM INJECTION-
-Syringe with needle -Medication to be administered. -Gloves -Band-Aid -Alcohol swab
TECHNIQUE OF GIVING AN INTRAMUSCULAR INJECTION
Check the 6 rights of medication administration.
Choose the site for IM injection. Check the patient for any allergies. Gather the supplies needed to perform IM
injection. Wash your hands. Put on gloves. Open alcohol swab and in a circular motion,
clean area in a 2 inch diameter at the site of the intended IM injection.
Let fully dry.
CONTINUED…
Pull skin around the clean site taut. take needle in dominate hand between the thumb
and the index finger. At a 90 degree angle, plunge the needle into the
skin in a dart like motion. Depending on the site and the condition of the
patient, determine how far the needle is going to have to go into the skin to be in the muscle.
pull back on the plunger and aspirate or blood. If there is blood aspirated back into the needle, remove and dispose in a sharps container. start from the beginning.)
Push the medication at a slow and steady pace. Remember to hold the needle as steady as possible.
CONTINUED..
To take the needle out, quickly pull up at a 90 degree angle.
Apply some pressure at the site with the alcohol swab that was used to clean the site.
Massage the site to help disperse the medication that was just given.
Cover site with Band-Aid. Dispose of needle into a sharps container. Dispose gloves and wash hands. Observe the patient for signs of any allergic
reaction, N&V, or any other adverse reactions that may go along with the medication.
Always remember to document.
Z-TRACK TECHNIQUE
It’s pretty simple.
It reduces leakage of medication through subcutaneous tissue and decreases skin lesions at the injection site. So, the patient gets the full dose of medication.
It doesn’t hurt patients quite as much as a regular I.M. injection.
24
Use dry gauze to apply very gentle pressure to the puncture site.
Assess the site immediately after administering the injection and again 2 to 4 hours later.
Properly dispose of all used equipment and supplies.
26
COMFORTING RESTRAINT FOR INFANTS & TODDLERS
Hold the child on parent’s lap1. One of child’s arms embraces
parent’s back and is held under parent’s arm
2. Other arm controlled by parent’s arm and hand--for infants, parents can control both arms with one hand
3. Both legs anchored with the child’s feet held firmly between parent’s thighs, and controlled by parent’s other arm.
COMFORTING RESTRAINT FOR OLDER KIDS
Hold the child on parent’s lap or have the child stand in front of the seated parent
1. Parent’s arms embrace the child
2. Both legs are firmly between parent’s legs
SUBCUTANEOUS INJECTIONS (SC)
Drug absorption is slower than intramuscular (IM) because subcutaneous tissue is not as richly supplied with blood as the muscle.
As the area contains pain receptors, clients may experience discomfort during injection.
Injection site must be free of infection, skin lesions, scars, bony prominence, and large underlying muscles or nerves.
PARENTERAL ADMINISTRATION
Subcutaneous Injections Injections made into the loose connective
tissue between the dermis and the muscle layer
Drug absorption slower than with IM injections
Given at a 45-degree angle if the patient is thin or at a 90-degree angle if the patient has ample subcutaneous tissue
Usual needle length is 1/2 to 5/8 inch and 25 gauge
Used to administer insulin and heparin
SC Inject at 90 degree in the average client - 45
degrees if the client has small amt of subcutaneous tissue
(If you can pinch 2 inches, use 90 degrees, otherwise use 45 degrees)
Heparin - use lower abdominal folds - Arms are moved frequently and are at greater risk for tissue disruption and bruising, do not inject heparin (or “blood thinners” into arms)
Do not massage following the injection of Insulin or Heparin (cause more tissue disruption)
INJECTION SITES
The preferred site for giving a subcutaneous injection of insulin and heparin is the abdomen.
Additional or alternative injection sites for insulin are the outer back area of the upper arm, where it is fleshier, and outer areas of the thigh and upper buttocks
INJECTION SITES
Rotating within one injection site, preferably the abdomen, is recommended rather than rotating to a different area with each injection
The rate of drug absorption at various subcutaneous sites from fastest to slowest is abdomen, arms, thighs, and buttocks.
45
INJECTION TECHNIQUE
To reach subcutaneous tissue in a normal-sized or obese person who has a 2-inch tissue fold when it is bunched, the nurse inserts the needle at a 90-degree angle.
The tissue usually is bunched between the thumb and fingers before administering the injection to avoid instilling insulin within the muscle.
46
INTRADERMAL INJECTIONS
Introduction of a hypodermic needle into the dermis for the purpose of instilling a substance such as a serum, vaccine, or skin test agent
Small volumes (0.1 ml) injected to form a small bubblelike wheal just under the skin
Used for allergy sensitivity tests, TB screening, and local anesthetics
A tuberculin syringe used with a 25-gauge, 3/8- to 5/8-inch needle
INJECTION SITES
A common site for an intradermal injection is
the inner aspect of the forearm. Other areas
that may be used are the back and upper
chest.
50
INJECTION EQUIPMENT
A tuberculin syringe holds 1 mL of fluid and is calibrated in 0.01-mL increments. It is used to administer intradermal injections.
A 26- to 28-gauge needle measuring a half-inch in length commonly is used when administering an intradermal injection.
51
INJECTION TECHNIQUE
When giving an intradermal injection, instill
the medication shallowly at a 10- to 15-
degree angle of entry
REDUCING INJECTION DISCOMFORT Use the smallest-gauge needle that is appropriate. Change the needle before administering a drug
that is irritating to tissue. Select a site that is free of irritation. Rotate injection sites. Numb the skin with an ice pack before the
injection. Insert and withdraw the needle without hesitation. Instill the medication slowly and steadily. Use the Z-track method for intramuscular
injections. Apply pressure to the site during needle
withdrawal. Massage the site afterward, if appropriate.
MEDICATION ADMINISTRATION AND DOCUMENTATION
Record all information concerning the patient and medication including: Indication for drug administration Dosage and route delivered Patient response to the
medication—both positive and negative