NRSG 110 Med Lab Quiz #2

Gauges in needle

As the gauge becomes larger the diameter of the needle becomes smaller ex.  a 24-gauge needle is smaller than an 18-gauge needle

Viscosity of medication determines

choice of gauge (diameter of the needle)

Length of needle

• Second number on package

• Varies from ½ inch to 2 inch

• Choose length according to client’s muscle mass, weight, and type of injection

Needle Bevel

• Used for injections

• Longer bevels are sharper

• Short bevels used for intradermal injections

Size of syringe is directed by

the amount of medication to be administered

Angles for intramuscular injections

72 to 90 degrees

Angles for subcutanous injections

45 to 90 degrees

Angles for intradermal injections

5 to 15 degrees

Supplies needed to draw up from a vial

Vial, Syringe with needle, Alcohol Swaps

Method to draw up from a vial

Read your label, Ensure sterility, Practice Coordination

Frequently used SQ medications

• Insulin

• Heparin

• Low-Molecular Weight Heparins

• Allergy Shots

• Vaccines

Pre-filled Syringes

• Most likely: Lovenox (enoxaparin), a low molecular weight heparin.

• Important not to express the air bubble prior to Injection.

Sites to give SQ injections

abdomen, thigh, and outer arm, ensuring proper rotation of injection sites.

Syringe type for SQ injections

1 mL or less

Needle length for SQ injections

3/8 to 1 inch

Gauge for SQ injections

25 to 30 gauge

Considerations for SQ injections

• Consider amount of SQ tissue, Bunch up SQ tissue before insertion- don’t let go!

• Site rotation – with insulin best to rotate within one area- say upper abdomen, still want to go at least 1 inch away from previous sites even if rotating within 1 body part

• Stay 2 inches away from umbilicus

• Give over 10 seconds to avoid discomfort/give tissue time to adjust to medication intrusion

Drawing up from Ampules

• Made of glass so Safety is an important concept

  • Do not want glass in nurses finger

  • Do not want glass in patient- use a filter

  • Do not want to contaminate needle on side of ampule opening

Types of Insulin

• Scheduled (Basal)

• Prandial

• Sliding scale

• Correction

Rapid Acting Insulin

Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)

Onset: 10-30 min

Peak: 30 min to 3 hour

Duration: 3-5 hour

Short Acting Insulin

Regular insulin (Humulin R, Novolin R)

Onset: 30 min to 1 hour

Peak: 2-5 hours

Duration: 5-8 hours

Intermediate Acting Insulin

NPH (Humulin N, Novolin N)

Onset: 1.5- 4 hours

Peak: 4-12 hours

Duration: 12-18 hours

Long Acting Insulin

Insulin glargine (Lantus), insulin detemir (Levemir), degludec (Tresiba)

Onset: 0.8 - 4 hour

No pronounced peak

Duration: 16-24 hour

Inhaled Insulin

Afrezza

Onset: 12-15 minutes

Peak: 60 minutes

Duration: 2.5 to 3 hours

Insulin Pens

• Only used for 1 patient

• Clean tip of reservoir with alcohol

• Invert the pen 20 times to mix if using an insulin suspension

• Attach the needle

• Prime the pen: Dial the dose selector to 2 units and depress the button

• Once prepared give according to SQ principles

• Keep the button depressed and count to 6 before removing from skin

Parenteral Medications Supplied in Powdered Form

• Must be reconstituted

  • Powder in vial must be diluted with liquid (diluent or solvent)

• Most commonly used diluents are 0.9% sodium chloride and sterile water for injection

Parenteral Medications Supplied in Powdered Form

• Clearly label vial

• Date and time of preparation

• Strength of solution

• Date and time that reconstituted solution will expire

• Storage directions

• Your initials

What is the 70 in Novolin 70/30

NPH

What is the 30 in Novolin 70/30

Regular insulin

IM Injection Method

• Per MCC policy always aspirate with IM injections

  • Inject IM needle into muscle

  • pullback on plunger, ensure no blood in syringe

    • if no blood inject medication

    • if blood noted pull out and prepare another dose of medication for administration in another site

Z-track method for IM

• Pullback skin about 2.5 - 3.75 cm to dispace underlying tissue

• Whild holding back skin, administer injection

• Allow skin to return to its normal position

IM Injection Landmarks

Deltoid, vastus lateralis, and ventrogluteal muscles.

IM Deltoid Injection

Needle Gauge: 18-25

Needle Length: Adults 1-1 ½ in, Weight and adipose tissue influence selection needle length

Maximum volume: 1-2 mL

Preferred site for vaccines

IM Ventrogluteal Injection

Gauge: 18-25

Needle Length: Adults 1-1 ½ in, Weight and adipose tissue influence needle length selection

Maximum volume: 4-5 mL

Preferred site for IM injections in adults

IM Dorsogluteal Injection

Gauge: 18-25

Needle Length:  Adults 1 ½ in, Weight and adipose tissue influence needle length selection

Maximum volume: 4-5 mL

NOT a preferred site, Rarely Used due to Risk of Sciatic Nerve Injury

IM Vastus Lateralis Injection

Gauge: 18-25

Needle Length: Adults 5/8 to 1 1/2 in, Weight and adipose tissue influence needle length selection

Maximum volume: 4-5 mL 

Preferred site: Infants & children