NUR 117: Unit 2

Injections and IVs

What are the no touch parts on a syringe?

The bevel, tip, shaft, inside of barrel, hub, and flange

What is the needle gauge for Intradermal (ID) Injections?

25-27 G

What is the needle length for intradermal (ID) injections?

3/8”-5/8”

What is the angle for intradermal (ID) injections?

5-15 degrees

What is the nursing implications for Intradermal (ID) Injections?

Used for diagnostic tests, TB, or allergy testing. Do NOT massage

What is the effect of intradermal (ID) injections?

Local effect

What is the effect of subcutaneous (SUBQ) injections?

Systemic effect

What is the needle gauge of subcutaneous (SUBQ) injections?

25-31 G

What is the needle length of subcutaneous (SUBQ) injections?

1/2”-5/8”

What is the angle for subcutaneous (SUBQ) injections?

45-90 degrees

What are the nursing implications for subcutaneous (SUBQ) injections?

Bunch skin, usually 1 mL or less, do NOT aspirate

What is the effect of intramuscular (IM) injections?

Systemic effect

What is the needle gauge for intramuscular (IM) injections?

18-25 G

What is the needle length for intramuscular (IM) injections?

1/2”-1 and 1/2”

What is the angle for intramuscular (IM) injections?

90 degrees

What are the nursing implications for intramuscular (IM) injections?

Pull skin taut, may z-track, may need to aspirate

Insulin info

Use insulin syringe only! and rotate injection sites

Heparin info

Administer in abdomen at least 2” away from umbilicus. Do not aspirate or massage

Enoxaparin (Lovenox) and fondaparinux (Arixtra) info

use the anterior-lateral abdomen or “love-handles”, do not expel air bubble, do not aspirate or massage

Deltoid

IM site. Palpate the acromion process. Injection site is 2-3 finger-widths below the acromion process but above deltoid groove. 1mL or less.

Vastus Lateralis

IM Site. One hand-width above the patella and one hand-width below the greater trochanter. Mentally, divide what’s left into thirds, and use the middle third of the thigh on the anterior, lateral aspect. 3mL max.

Ventrogluteal

Place heel of hand over the greater trochanter with thumb pointing toward the groin and index finger pointing toward iliac crest towards clients buttock. A v-shaped is formed between the index and middle finger. Inject site is in center of V. Up to 3 mL

Recommended IM site for infant (0-2)

Vastus Lateralis

Recommended IM site for Child/Adolescent (3-18)

deltoid (preferred) or vastus lateralis

Recommended IM site for Adults

Deltoid or ventrogluteal

How to recap a needle?

One hand scoop method

What is insulin measured in?

Units

IM Injection Steps (after prepping med)

1. locate site

2. clean site in circular motion

3. z-track skin

4. insert like throwing a dart

5. inject medication slowly, 10 secs per mL

6. wait 10 secs before removing

7. push back skin (z-track)

8. administer safety

9. dispose of needle

SUBQ Injection Steps (after prepping med)

1. locate site

2. clean site in circular motion

3. bunch skin

4. insert like throwing a dart

5. let go of skin

6. inject quickly

7. wait ten seconds before removing needle

8. administer safety

9. dispose of needle

Heparin SUBQ injection difference

Continue bunching skin while injecting medication, let go right before removing the needle

Assessing IV Site- what to look for that’s abnormal

Redness, swelling, tenderness, coolness, warm to touch, IV fluid does not flow, pt reports pain, no blood return, does not flush

Saline Lock

Use of a short extension, no IV fluids running, but still allows IV access

TKO/KVO

“To keep open” or “keep vein open” usually an order for a small hourly rate of an amount of liquid (10mL-20mL) to keep the vein open

Yellow (IV Cannula)

24 G

Max flow rate: 13 mL/min

Blue (IV Cannula)

22 G

Max flow rate: 31 mL/min

Pink (IV Cannula)

20 G

Max flow rate: 67 mL/min

Green (IV Cannula)

18 G

Max flow rate: 103 mL/min

Gray (IV Cannula)

16 G

Max flow rate: 236 mL/min

Orange

14 G

Max flow rate: 270 mL/min

How often do IVs need to be assessed if pt is on continuous fluids?

Every 3-4hrs

IVPB

IV Piggy Back, a secondary bag, check compatibility with primary bag. Use back priming to get ready. Remember your stopping the primary bag flow when setting up IVPB

IVP

IV Push medication, flush before and after pushing medication. Make sure it’s compatible with IV Fluid. Stop medication before pushing! Clean hub before, after and during process with alcohol pads. Check how long to push meds over what length of time.

Primary IV Bag Set Up

Don’t touch the spike when open. Clean hub before connecting to IV site. Close roller clamp before starting process. Make sure no air bubbles in tubing. Check compatibility if there is another primary bag hanging.

Phlebitis

Warmth, redness, cord-like vein

Infiltration

Skin cool, edema and leaking at the site

Extravasation

Blistering, pain

IVP steps

1. Assess IV for any complications

2. Pause/Stop primary fluids

3. Select injection port closest to the pt

4. Use saline flush syringe to assess patency and flush line

5. Safely administer medication

6. Use saline flush syringe to flush line

7. Unclamp primary IV and restart infusion