CPSS E1 -Injections, I&D

What is an ampule?

small bottle that contains a drug (especially a sealed sterile container for injection by needle)

What is a gauge?

diameter of a slender object, such as hypodermic needle (the higher the number the smaller the diameter)

What is a hub?

enlarged base by which a hollow needle may be attached to a device (as a syringe)

What is a vial?

small container, usually with a closure, used especially for liquids

What size needle is used for venipuncture?

18g

What size needle is used for IM injections?

18-25g

What size needle is used for SQ injections?

23-25g

What size needle is used for ID injection?

27g 1/2’’

What size needle is used for IM injections in infants & children?

22-25g

What size needle is used for SQ injections in infants?

25-27g

What are contraindications for IM injections?

dermatitis, cellulitis, deep tissue infection

What are the principle sites of IM injection?

deltoid, vastus lateralis, gluteal

What technique is used for IM injection in the deltoid?

position arm to pt's side and inject 3-4 cm below acromion

What technique is used for IM injection in the vastus lateralis?

inject into antero-lateral upper thigh

What IM injection site is preferred in infants and kids < 3 y/o?

Vastus lateralis -its the largest muscle at that age

What nerve is at risk when performing an IM injection in the deltoid of a kid?

Radial nerve

What site of IM injection is preferred in children > 2 y/o?

Gluteal

What is the technique for IM injection in the gluteal region?

Inject in the upper outer quadrant of the buttock

-beware of the sciatic nerve

What angle should the needle be inserted at for an IM injection?

90 degrees

What are benefits of using the Z-track method when doing IM injections?

- prevents leakage of irritating or discoloring meds into the SQ tissue

- seals the drug into the muscle

What method of IM injection is preferred in elderly patients who have decreased muscle mass?

Z-track method

What is the rule of thumb when selecting a needle for IM injection?

2’’ needle for 200+ lb pt

1.25-1.5’’ needle for a 100 lb pt

What are the principle sites of SQ injections?

Upper outer arm, Upper back, Anterior thigh, Lower portion of the abdomen

What angle should the needle be inserted at for a SQ injection?

45 degrees

How should you mix insulin?

roll vial between palms (do not shake)

What are the principle sites of intradermal injections?

ventral surface of forearm, back

What angle should the needle be inserted at for an ID injection?

10-15 degrees

What are you measuring when reading a PPD test?

area of induration (not erythema)

For what pts is a 5mm PPD considered +?

HIV+, organ transplant pts, immunosuppressed

close contact with active TB

hx of +CXR for TB

For what pts is a 10mm PPD considered +?

pts with DM, kidney failure; IVDU, children < 4yo

healthcare workers & high risk groups (prisons, nursing homes, homeless shelters)

immigrants who moved from an endemic country within the past 5 years

infants/children who are exposed to high-risk adults

For what pts is a 15mm PPD considered +?

no known risk factors (everyone)

T/F: You should recap your needles after injections to avoid needle sticks

FALSE

T/F: Do NOT massage Z-track injections

True

T/F: When injecting heparin, you should aspirate to ensure you are not in a vessel, then massage the heparin after injection

False

What are clinical features of an abscess?

erythema, induration, tenderness, fluctuance

*must differentiate from cellulitis

What is folliculitis?

infection that forms in a hair follicle

What is a furuncle?

well-circumscribed, firm, tender, inflamed nodule that forms in moist areas, hair follicle, or other high friction areas

What is a carbuncle?

purulent skin infection involving a group of hair follicles

What is a pilonidal abscess?

infected cyst located at the natal cleft

What are contraindications of an I&D?

-large, deep abscess

-pulsatile mass at infection site

-close proximity to neurovascular bundle

-certain anatomic locations (Perirectal and periareolar may be associated with fistulas)

What size blade do you use for an I&D?

#11 or #15 blade