Parenteral Medications

Topics: Syringe, Hypodermic needle, Insulin Pages: 11 (3345 words) Published: February 10, 2013
Skills Notes (3/10/11)
Parenteral Medications
*absorbed more quickly than oral meds
*b/c injections are invasive; aseptic technique must be used! Injections:
1. Intradermally- ID
2. Intramuscularly- IM
3. Intravenously- IV
4. Subcutaneously- SubQ

1. Intradermal Injections(ID)- the administration of a drug into the dermal layer of the skin just beneath the epidermis. * Frequently used for allergy testing and tuberculosis (TB, aka PPD) screening. * Common Sites:

* Inner lower arm
* Upper chest
* Back beneath the scapulae
* Left arm is commonly used for TB screening and right for everything else * Small doses; max amount is 0.1 cc
* Needle length: 3/8” – 1/2” ; gauge: 25-27
* Most common length: 25 and gauge: 1/2”
* Needle inserted at 5-15 degree angle
* Just under skin; can still see needle under skin
* Not whole shaft is inserted
* Do not rub or scratch the injection because it can disperse deeper into the tissue or out thru the needle site. 2. Subcutaneous Injections(SubQ)- beneath the layers of the skin; hypodermic * Common sites:

* Outer aspect of the upper arms
* Anterior aspect of the thighs
* Abdomen (umbilicus 1-2 inches away)
* Scapular areas of the upper back
* Upper ventrogluteal area
* Upper dorsogluteal area
* Upper arms and thighs are used b/c they usually have good blood circulation * Used for vaccines, insulin, and heparin
* Things about insulin:
* Orange is universal color
* Uses insulin syringe
* Typical meds to mix
* Newer insulins can’t be mixed, i.e. Lantus is never mixed * “Clear to Cloudy” Method only on Regular and NPH
* All syringes are based on 100 units (1cc)
* Ensure at least one person who can inject in an emergency * Often refrigerated and one vial is used for many patients * If open new bottle, include time and date (must be used within 30 days) * Things about heparin

* Site is abdomen 2inches away from umbilicus and above the level of iliac crest * Uses tuberculin syringe
* Needle is 3/8” and #25 or #26 or smaller gauge
* Inserted at 90 degree angle
* DON”T aspirate or massage b/c cause damage to surrounding tissue and cause bleeding and ecchymoses (bruising); also hastens drug absorption * Small doses; max amount 1cc
* Needle length: 3/8” – 5/8” ; gauge: 25-30
* Most common length: 5/8” and gauge: 25
* Needle inserted at 45 degree angle
* NO aspiration!
* Needle length and size is based on pt’s body mass, intended angle of insertion, and planned site. * Rotate sites to minimize tissue damage, aid absorption, and avoid discomfort. Also to prevent lipoatrpohy and lipohyperatrophy * Absorbed slowly; Produces sustained effect

3. Intramuscular Injections(IM)- injections into muscle tissue * absorbed more quickly than Subcutaneous injections b/c of the greater blood supply to the body muscles * larger fluid volume without discomfort

* several factors indicate length and gauge of needle to be used: muscle, solution type, adipose tissue covering muscle, age of client * major consideration: away from large blood vessels, nerves, and bones * Z-track technique recommended for all IM injections

* Less painful and decreases leakage of irritating and discoloring(stain) meds into the SubQ tissue. * Be sure to aspirate 0.5 mL air whenever using a Z-track * Be sure to aspirate for blood to; if find blood withdraw and dispose of syringe then start over * Pull skin over using side of hand

* After give the meds, hold for 10 seconds to ensure all of the med is delivered * Let go of skin as pull needle out
* Common sites:
* Ventrogluteal Site
* Preferred site; safest site
* Suitable for kids over 1 year and adults
* In the gluteus medius muscle over the gluteus minimus
* Back, prone, or Side lying position, with knee bent to chest *...
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