Overview of Injections for Optometry (Part I)

Dr. Landgraf's FOSD II Lecture UMSL School of Optometry

1. Intralesional

2. Subconjunctival

What 2 types of injections use this syringe?

chalazion clamp

What is the name of this tool?

Intralesional Kenalog

What type of injection & medication do we use for a chalazion?

1. IV NaFl & ICG

2. IV IM subcutaneous epinephrine, Epipen

3. IM Benadryl

4. IV IM promethazine

What 4 injections are used for IVFA & anaphylaxis? (Medication & Type of injection)

IV IM subcutaneous epinephrine, Epipen

What type of injection & medication is used for IVFA anaphylaxis?

1. Gentamycin

2. Cefazolin

3. Vancomycin

4. Penicillin G

5. Tobramycin

6. Erythromycin

7. Polymixin B

What are the 7 types of subconjunctival antibiotic injections used to treat uveitis & corneal ulcers?

1. Kenalog

2. Methylprednisone

What are the 2 types of subconjunctival steroids used to treat uveitis & corneal ulcers?

subcutaneous

Xylocaine ± epinephrine

What type of injection is given for local anesthesia? What type of local anesthesia is given in this form of injection?

1. TB

2. HIV

3. HBV

4. HCV

What 4 pathogens are under increased awareness in OSHA control?

TB

What pathogen under increased awareness with OSHA is NOT bloodborne?

7 days

How long can Hepatitis B survive in dried up blood?

60-150 days

How long does it take to develop symptoms if exposed to Hepatitis B?

Within 24 hours

If exposed to Hep B, how soon should you receive a vaccine for it to be effective at preventing disease?

False—very fragile; < 24 hours

True/False: HIV is very durable and will survive outside the body for 7 days.

True

True/False: OSHA Exposure to Blood Borne Pathogens Standards are concerned with employees, not the patients.

Exposure Control Plan

What type of plan is required by OSHA in work environments that has controls in place for pathogen exposures?

1. Engineering

2. Work Practice

3. Preventative

What are the 3 types of controls in place in the Exposure Control Plan required by OSHA in the workplace?

1. Needlestick injuries

2. Mucous membrane contact

3. Non-intact skin contact

What are the 3 easiest exposure concerns for bloodborne pathogens?

1. Sharps containers

2. New sharps

3. “no touch” techniques

What are 3 engineering methods utilized for controlling bloodborne pathogens?

1. Hand washing

2. Do not recap needles

What are 2 work practice methods for controlling bloodborne pathogen spread?

1. Gloves

2. Wash hands before & after gloving

What are 2 personal protective equipment methods used to control bloodborne pathogen spread?

1. Labels (biohazard bags for gloves, band-aids, gauze, etc.)

2. Training

3. Education on Universal Precautions

What are 3 communication methods used to control bloodborne pathogens?

Universal precautions

Assumption that every patient has HIV, HBV, or HCV

1. HBV

2. HAV

3. Influenza

What are the 3 main vaccines made available to at-risk employees?

TB screening

What screening method is made available to at-risk employees of bloodborne pathogens?

phlyctenule

What type of eye manifestation can occurs from undiagnosed TB as shown in the image?

1. Autoclaving

2. 2% gluteraldehyde

3. 3% hydrogen peroxide

4. 1:10 bleach

What are the 4 ways in which we can properly sanitize surgical instruments?

Contact with mucous membranes

What exposure to instruments requires high levels of disinfection?

1. 20 minutes

2. 15 minutes

3. 10 minutes

Identify the amount of time required to properly disinfect instruments in the following solutions.

a. 2% gluteraldehyde
b. 1:10 bleach
c. 3% hydrogen peroxide

Needlestick Safety & Prevention Act

From 1991-2001, there was a large number of percutaneous injuries involving contaminated sharps by healthcare workers. Half of these were not reported. What did this prompt within public health?

Needlestick Safety & Prevention Act

Act effective & adopted in 2001; Controls that isolate or remove the bloodborne pathogens hazard from the workplace; Solicitation of input from non-managerial employees; requires sharps injury log

CNV Retinitis

What ocular manifestation shown in the image is caused by the HIV virus?

Sharps with Engineered Sharps Injury Protections (SESIP)

Built-in safety feature or mechanism that effectively reduces the risk of an exposure incorporated into the needlestick safety and prevention act (ex. protective sleeve pushed onto a needle)

IV injection; Subcutaneous

What injection moves the fastest through the blood stream? Slowest?

Ask about allergies

What is important to ask about prior to giving an injection?

SC

What type of injection is the shallowest—IM, IV, or SC?

IM

What type of injection is the deepest—IM, IV, or SC?

Type I Hypersensitivity

What type of hypersensitivity is correlated with anaphylaxis from IV NaFl?

Take a great history

What is the best way to avoid anaphylaxis from IVFA IV?

1. Asthma

2. Atopic

3. Allergies

What 3 conditions should you inquire about during your history before an NaFl IV injection?

1. Hives

2. Itching

3. Angioedema

What are the cutaneous signs associated with anaphylaxis to IV NaFl? (3)

1. Wheezing

2. Tachypnea

3. Cyanosis

4. Tightness in throat

5. Shortness of Breath

What are the respiratory signs associated with anaphylaxis to IV NaFl (5)?

Respiratory signs

What type of signs would signal you to call EMS and inject epinephrine?

Trendelenberg position

What position should you put a patient in that is having signs of anaphylaxis from NaFl IV?

1/1000 epinephrine IM

What is the dosage and injection type used in an Epi-Pen?

IM diphenhydramine ± epinephrine

What allergy injection can be used for urticaria and itching during an allergic reaction?

Gauge

Diameter of a needle

18g

Which is the larger needle—18g or 30g?

30g; 18-25g

What gauge of needle is used for ocular injections? What gauges are used for IM/IV?

Bevel Down

How should the bevel of a needle be oriented for a subconjunctival injection?

1”

What length of needle should be utilized for IM injections?

1. 3/8”

2. 1/2”

3. 1”

What are the 3 lengths of needles available for injections?

cubic centimeters (cc)

What units are syringes measured in?

1 cc

What volume of syringe is used for TB injections, as well as ocular, subconjunctival, and intralesional injections?

1. 3 cc

2. 5 cc

3. 10 cc

What volumes of syringes are used for IM injections? (3)

Informed consent

What form should be filled out by the patient prior to every procedure done in office?

1. Procedure explanation

2. Potential side effects

3. Alternative treatments

What 3 things are discussed in Informed Consent forms?