Chapter 10 and 11

Parenteral AdministrationEquipmentSyringesSyringe consists of a barrel, a plunger, and a tip.Outside of the barrel is calibrated in milliliters, minims, insulin units, and heparin units.TypesTuberculin syringeInsulin syringeThree-milliliter syringeSafety-Lok syringesDisposable injection units

Figure 23-4Parts of a syringe. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Figure 23-6Calibration of U100 insulin syringe. (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

Figure 23-7Reading the calibrations of a 3-mL syringe.

Figure 23-9Safety-Glide syringe.

Figure 23-11Parts of a needle. (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

Parenteral AdministrationEquipment (continued)NeedlesParts are the hub, shaft, and beveled tip.Opening at the needles beveled tip is the lumen.Size of the diameter of the inside of the needles shaft determines the gauge of the needle; the smaller the gauge, the larger is the diameter.Needle gauge selection is based on the viscosity of the medication.

Parenteral AdministrationEquipment (continued)Needle LengthSelected based on the depth of the tissue into which the medication is to be injectedIntradermal: 3/8 to 5/8 inchSubcutaneous: 5/8 to 1/2 inchIntramuscular: 1 to 1 1/2 inch

Figure 23-12Needle length and gauge. (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

Intramuscular injectionsGauge-20-22Length-1-1 inchesAngle-90 degreesDarting motionASPIRATE

Parenteral AdministrationIntramuscular InjectionsInvolves inserting a needle into the muscle tissue to administer medicationSite SelectionGluteal sitesVastus lateralis muscleRectus femoris muscleDeltoid muscleZ-track MethodUsed to inject medications that are irritating to the tissues

Figure 23-15, CLocating IM injection for ventrogluteal site. (C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Figure 23-16, C & DLocating right dorsogluteal site. Giving IM injection in left dorsogluteal site. (C, D, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Figure 23-17, CGiving IM injection in vastus lateralis site on adult. (C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Figure 23-18Rectus femoris muscle. A, Child/infant. B, Adult. (From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)

Figure 23-19, CGiving IM injection in deltoid site. (C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Figure 23-20(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

Intradermal InjectionsGauge-25-29Length-1/4 to inchAmount- 0.1 mlAngle-15 degreesDO NOT ASPIRATE

ParenteralAdministrationIntradermal InjectionsIntroduction of a hypodermic needle into the dermis for the purpose of instilling a substance such as a serum, vaccine, or skin test agentNot aspiratedSmall volumes (0.1 ml) injected to form a small bubblelike wheal just under the skinUsed for allergy sensitivity tests, TB screening, and local anestheticsA tuberculin syringe used with a 25-gauge, 3/8- to 5/8-inch needle

Figure 23-21Angles of insertion for intramuscular (90), subcutaneous (45), and intradermal (15). (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

Subcutaneous injectionsGauge-25-29Length-3/8, and 5/8 inchesAngle-45 degrees DO NOT ASPIRATE

Parenteral AdministrationSubcutaneous InjectionsInjections made into the loose connective tissue between the dermis and the muscle layerDrug absorption slower than with IM injectionsGiven at a 45-degree angle if the patient is thin or at a 90-degree angle if the patient has ample subcutaneous tissueUsual needle length is 1/2 to 5/8 inch and 25 gaugeUsed to administer insulin and heparin

Figure 23-22Subcutaneous injection. Angle and needle length depend on the thickness of skinfold. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Nursing ProcessNursing DiagnosesAnxietyHealth-seeking behaviorsInjury, risk forKnowledge deficientMobility, impairedNoncompliance: drug regimenSensory/perception, disturbed

Measurements located on the BARRELL*Total syringe hold 1 ml, if full would have 100 units of insulin. *Safety features designed to decrease needle sticks*Some needles permanently attached, some removable. *Needle gauges-which has a larger diameter a 20 gauge or a 25 gauge? Answer-a 20 gauge

Thicker meds need larger diameter needle, such as a 20, 18 or 16. *Deltoid-0.5 ml. Adults other sites-maximum 2 ml. *Ventrogluteal site-pt needs to be in prone, supine or side lying position. Landmarks are-greater trochanter, anterior superior iliac spine and iliac crest. *Dorso gluteal-tic tac toe board on one cheek. *Always use vastus lateralis on infants. Hands at side=where longest finger hits*Play patty cake. Where palms hit thigh. *Can only hold 0.5 ml.

*Example of Z track method. Used if irritating or staining. *BEVEL UP!!! *Assessment- had a shot before? Muscle mass, weight, hydration status. Mobility issues for getting to site. Allergies and reaction/ *