Parenteral Medication Administration

Why would you administer meds via injection?

• Patient is NPO

• Only form med is available in

• Increase efficacy of med

Preventing Infection: What is sterile/aseptic technique?

• Always used when preparing + administering meds by injection

• Injections are invasive

• Pierced skin is a portal of entry for microorganisms

Preventing Infection: How do you prevent needle contamination?

Avoid letting needle touch any surface

Preventing Infection: How do you prevent syringe contamination?

• Avoid touching length of plunger

• Avoid touching inner part of barrel

• Keep tip of syringe covered with needle

Preventing Infection: How do you prevent medication vial contamination?

Clean vial

Preventing Infection: How do you prepare the skin properly?

• If soiled, wash w soap + water

• Use circular motions while cleaning w alcohol swab (friction)

• Swab from center of site and move outward

• Let the skin dry after swabbing

What equipment is needed?

• MAR Alcohol swabs

• Syringe

• Safety needle

• Med

• Non-sterile gloves

Syringes: What is a Luer-lock?

• Needle locks into place by twisting the needle onto the syringe

• Most common for injections

Syringes: What is a non-luer-lock?

• Needles can be pulled straight off

• Small volume syringes

• Some insulin syringes

Syringes: What are non-removable?

• Some insulin

• Tuberculin syringes

What are the parts of a syringe?

• Plunger

• Barrel

• Tips

What are the parts of a needle?

• Gauge number

• Hub

• Shaft

• Bevel

What parts of the syringe/needle stay sterile?

• Tip of barrel

• Inside of barrel

• Hub

• Shaft

• Needle

What are the types of syringes?

• HYPODERMIC, tenths of mL

• INSULIN, units

• SMALL VOLUME (1mL), hundredths of mL

What are syringe sizes?

• 0.5 - 60 mL

• 3 mL is a standard maximum amount for IM injections

  • Average-sized adult can tolerate 3 mL

  • Larger volumes are harder to tolerate; Cause pain + discomfort

What is gauge?

• DIAMETER, how big around

• 16-27 gauge

• The larger the gauge, the smaller the diameter

What is length?

• How long

• Determined by size + weight of patient and route of administration (ID, SQ, IM)

• 1/4” - 3”

Average Needle Gauges & Lengths: Describe ID.

• Gauge: 25 - 27

• Length: 1/4” - 1/2”

Average Needle Gauges & Lengths: Describe subQ.

• Gauge: 25 - 27

• Length: 1/2” - 5/8”

Average Needle Gauges & Lengths: Describe insulin.

• Gauge: 29 - 31

• Length: 1/2”

Average Needle Gauges & Lengths: Describe IM.

• Gauge: 19-25

• Length: 1” - 1 1/2”

• Locations: Deltoid, vastus lateralis, ventrogluteal

What are safety needles?

• Required by law

• Protects against needle sticks

• HCPs have a responsibility to use equipment + correctly

Why should you label syringes?

• Patient safety

• If NOT labeled, risk for med errors

• All syringes must be labeled w name of drug + dosage during preparation

What are the universal steps for administering any injectable med?

• Review MAR

• Note where last injection was given

• 3 safety checks w 5 rights

• Patient assessment

  • Inspect skin; Avoid scars, bruises, inflammation, edema, etc.

  • Select appropriate injection site

What are the routes for parenteral med administration?

• ID

• SubQ

• IM

• IV

Volume per Route: Describe ID.

0.01 - 0.1 mL

Volume per Route: Describe subQ.

1 - 2 mL

Volume per Route: Describe IM.

• NO greater than 5 mL

• If greater than 3 mL, pls divide into 2 doses

• Deltoid: Up to 1 mL only

• Vastus lateralis + ventrogluteal: 3 mL, no more than 5 mL

Administration: Describe ID.

• Just below skin, into dermis.

• Absorbed slowly due to lack of vasculature

• Location:

  • Forearm

  • Inner aspect of forearm

  • 3-4 finger-widths below antecubital space

  • One hand-width above wrists

• Relax arm w elbow + forearm extended on a flat surface

Injection: Describe ID.

• Use non-dominant hand

• Stretch skin

• Keep bevel up

• Insert needle at 5-15 degree angle

• Insert until resistance is felt

• Insert no more than 1/8” below skin, do not aspirate

• Slowly inject med

  • Small bleb should form under skin

    • If does NOT form: Injection is too deep

• Do NOT massage area

Administration: Describe subQ.

• Under loose connective tissue under dermis

• Absorbed faster than ID, but slower than IM

  • Limited vasculature

• Locations:

  • Outer, posterior aspect of upper arm

  • Abdomen

  • Anterior surface of thigh

  • Alternative: Upper back

Injection: Describe subQ.

• Lift (pinch) skin 1'“, raise skin + fat away from muscle

• Keep bevel up

• Insert needle at 45-90 degree angle

Injections: Describe subQ with anticoagulants.

• Location: Abdomen, 2” away from umbilicus

• Do NOT massage

Injections: Describe subQ and insulin.

• Locations: Arm, abdomen, anterior thigh

  • Rotate locations

• Always use insulin syringe

  • Do NOT run or massage area

Injection: Describe subQ and older adults.

• Thinning of epidermis

• Dermal atrophy

• Decreased blood flow, subQ fat

• Difficult to maintain skin lift

Administration: Describe IM.

• Into muscle

• Quicker absorption of med

  • Increased vasculature

• Location:

  • Deltoid

  • Vastus lateralis

  • Ventrogluteal

    • Less vasculature, but well-developed muscle

Injections: Describe IM and ventrogluteal.

Landmarks:

• Fewer nerves + less vasculature

• Muscle well-developed

• Greater trochanter

• Groin

• Anterior, superior iliac spine

• Buttock

Injections: Describe IM and vastus lateralis.

Landmarks:

• Greater trochanter

• Knee

Injections: Describe IM and deltoid.

Landmarks:

• Acromion process

• Axilla

Administration: Describe IM and Z-track.

• Prevents leakage of med once administered

• Minimizes skin irritation

Injections: Describe IM and older adults.

• Women have larger amounts of subQ tissue in deltoid area

• Insert needle at correct angle

How do you dispose of needles?

• Engage safety device

• Do NOT recap

• Always used needless devices if possible

• Dispose in sharps container

What are potential complications of parenteral injections?

• Nerve damage or paralysis of extremity

• LIPOTROPHY, subQ tissue breakdown at location of injection

• Infection or abscess formation at location (indicates contamination)

• Damage to blood vessels