NURS121B insulin syringe/pen admin

Insulin Syringi and Administration

Insulin Syringe Calibration

  • Calibration: It is crucial to ensure that the insulin syringe is calibrated to the insulin vial. The common concentrations for insulin vials are:
    • U-30: 30 units per milliliter (ml).
    • U-100: 100 units per ml.
    • U-500: 500 units per ml.
  • Example: The provided insulin is NovoLog, which has a concentration of U-100.

Matching Syringe with Insulin Vials

  • The syringe used for drawing up the insulin must match the concentration of the insulin vial (in this case, U-100).
  • Visual Check: Participants should take a look at the U-100 syringe being passed around for familiarity.

Preparing to Draw Up Insulin

  • Before using the insulin, check:
    • The insulin integrity (color and clarity): Mixed insulin (e.g., NPH) should appear cloudy, while regular insulins should be clear without any sediment.
    • Ensure the insulin is not expired.
  • Antiseptic wipe: Scrub the top of the insulin vial with an antiseptic wipe prior to withdrawing insulin.

Drawing Up Insulin Process

  1. Aspirating Air: Aspirate air into the syringe equal to the number of units to be drawn up (e.g., for six units of insulin, aspirate six units of air).
  2. Inject Air into Vial: Inject the aspirated air into the inverted vial to maintain pressure.
  3. Withdraw Insulin: Flip the vial back upright and withdraw the correct amount of insulin (e.g., six units). Tap the syringe to remove any air bubbles.
    • If air bubbles are present, reintroduce air into the vial and re-draw up the insulin.
  4. Safety: Use a one-handed scoop method to cap the needle safely after preparing the syringe.

Medication Check and Patient Verification

  • Double Check Procedure: Verify prepared medication with another nurse:
    • Patient Details: Provide the patient's name, date of birth, and confirm allergies.
    • Medication Order: State the patient's blood sugar and the corresponding medication order (in this case, six units of regular insulin based on a blood sugar level of 245).

Client Education and Side Effects

  • Insulin Function: Inform the patient that insulin lowers elevated blood glucose levels.
  • Potential Side Effects: Importance of educating the patient about hypoglycemia and its symptoms:
    • Anxiety
    • Sweating (diaphoresis)
  • Response Protocol: Advise to call for help upon experiencing symptoms of hypoglycemia.

Injection Sites for Subcutaneous Administration

  • Acceptable injection sites include:
    • Upper arms
    • Abdomen
    • Thighs
  • Site Rotation: It is imperative to rotate injection sites to avoid the development of scar tissue (lipodystrophy) which can lead to ineffective insulin absorption.
    • Long-term Consequence: Permanent scar tissue can limit the capability for proper insulin administration.

Injection Technique

  • Angle of Injection: Various angles can be used based on the amount of subcutaneous tissue available:
    • Standard angles include 45 degrees or 90 degrees.
    • Emergency Technique: In cases of very skinny patients, pinching the skin helps to concentrate fat, allowing for a more appropriate angle of injection.
  • Injection Process:
    1. Clean the area of injection with antiseptic.
    2. Insert the needle at the chosen angle once the area is prepared.
    3. Inject the insulin.
    4. Safe disposal of the needle after use (deploying the safety mechanism).

Introduction to Insulin Pens

  • Insulin Pen Advantages: The use of insulin pens offers convenience, especially for patients with visual impairments or arthritis due to larger numbers and ease of use.
  • Hospital Protocol: Long-acting insulins are generally supplemented with insulin pens for safety purposes in hospital settings to aid in preventing mix-ups with short-acting and rapid-acting insulins.

Using Insulin Pens

  1. Initial Checks: Verify the pen's label, check expiration, and clean the needle cap with an antiseptic.
  2. Assembly: Remove the protective needle cap carefully.
  3. Priming the Pen:
    • Hold the pen upright, dial to 2 units, and dispense until liquid appears at the needle tip to avoid air being injected.
  4. Administration:
    • Hold the pen like a syringe and inject in a swift motion until a click is heard or felt.
    • Count to 10 after injection to ensure full medication absorption, preventing residual drops.
  5. Sharps Disposal: After use, dispose of used needles in the sharps container following safety protocols.

Practice and Application Scenario

  • The practice scenario involves calculating the insulin dose for a patient with a blood sugar of 375, showcasing teamwork in determining the correct dosage and preparation for administration.
  • Patient Assessment: Check abdomen integrity and rotate the injection sites to ensure they are appropriate for subcutaneous injections.

Implementing Insulin Education for Patients

  • Importance of the patient understanding their insulin administration and the methods by which they can accurately manage and control their blood sugar levels through self-injection or using pens.