Battlefield Medications: Administer Injections C168W243 DEPARTMENT OF COMBAT MEDIC TRAINING
<ul><li>Given a patient requiring an injection and the necessary medical equipment,  </li></ul><ul><li>administer medicati...
Safety Note <ul><li>*Everyone wears exam gloves and goggles. </li></ul><ul><li>*Place ALL needles in Sharp Containers afte...
Look at Your Needle in the Package <ul><li>Using your student handout, circle the sterile parts of the needle. </li></ul><...
Identify Your Needle Hub   Shaft   Lumen   Bevel Identify the following parts of a needle…
Measure Your Needle <ul><li>How is length and gauge determined? </li></ul><ul><li>Length – tip of the needle to junction o...
Pick the Right Needle for the Job <ul><li>Four factors to considered when selecting the right needle for the job </li></ul...
Identify Your Syringe Using the picture in your student handout, identify the following parts of a syringe.  Plunger   Bar...
Touch Your Syringe <ul><li>Sterile parts of the syringe </li></ul>Plunger Needle Adapter Inside of the Barrel
Measure your Syringe <ul><li>The total volume of the syringe is measured in  </li></ul><ul><li>Millimeters (ml) </li></ul>
Pick the Right Syringe for the Job General Rule:   The syringe should be large enough to hold the entire dose and the cali...
Check On Your Learning <ul><li>Q: What parts of the are needle sterile? </li></ul><ul><li>Q: What factors influence the le...
Check On Your Learning <ul><li>Q: Which parts of the syringe are sterile? </li></ul><ul><li>Q: How do you know which syrin...
The  VERY  First Time They Meet… Assembling the Needle and Syringe <ul><li>Inspect all packaging </li></ul><ul><li>Unpack ...
Check On Your Learning <ul><li>While preparing to administer an injection, the needle is removed from the flexible wrapper...
Check On Your Learning <ul><li>If the plunger of the syringe does not move smoothly, why should it be discarded and a new ...
The Right Medication <ul><li>How many times should the medication label be verified and when? </li></ul><ul><li>Three Time...
The Medication is  Vial <ul><li>You have the “right” medication, but is the medication safe to administer?  How would you ...
Things You Should Know Before Medication is Drawn <ul><li>How do you know if you have the right amount of medication in th...
<ul><li>Verify Drug and Check the Container </li></ul><ul><li>Remove the Vial’s Protective Cap </li></ul><ul><li>Clean the...
Check On Your Learning <ul><li>Q: When should the medication be compared to the doctors orders and why?  </li></ul><ul><li...
Check On Your Learning <ul><li>Q: How are clean needles recapped?  </li></ul><ul><li>Q: Should you recap “dirty” needles? ...
<ul><li>Dr. Cooper has assessed a patient and ordered you to draw up medication for him. </li></ul><ul><li>Doctor’s Orders...
<ul><li>Verify Drug and Check the Container </li></ul><ul><li>Remove the Vial’s Protective Cap </li></ul><ul><li>Clean the...
Reconstituting Medication <ul><li>Some medications are placed in a vial in POWDERED form and must be reconstituted with a ...
Reconstituting Medication Demonstration <ul><li>Verify Drug and Check the Containers </li></ul><ul><li>Withdraw Correct Am...
Check On Your Learning <ul><li>While attempting to reconstitute a powdered medication, the diluent is difficult to inject....
<ul><li>Dr. Mayer has assessed a patient and ordered you to draw up medication for him. </li></ul><ul><li>Doctor’s Orders:...
Reconstituting Medication Practical Exercise <ul><li>Verify Drug and Check the Containers </li></ul><ul><li>Withdrawn Corr...
Ampules It is made entirely of glass. The medication you need is inside. There are NO openings, caps, rubber stoppers or l...
Impossible Mission Made Easy <ul><li>Located on the neck  of every ampule is a break line.  </li></ul><ul><li>Once cleanse...
But Wait… <ul><li>What if glass gets in the ampule… </li></ul><ul><li>and then glass gets in the syringe… </li></ul><ul><l...
Draw Medication from an Ampule Demonstration <ul><li>Tap Ampule to Force Medication  out of the Neck </li></ul><ul><li>Cle...
Check On Your Learning <ul><li>You have snapped the neck and currently inspecting an ampule.   </li></ul><ul><li>What are ...
<ul><li>Dr. Mabry has assessed a patient and ordered you to draw up medication for him. </li></ul><ul><li>Doctor’s Orders:...
Draw Medication from an Ampule Practical Exercise <ul><li>Tap Ampule to Force Medication  out of the Neck </li></ul><ul><l...
Intradermal Injections <ul><li>In preparing to become a 68W, each of you received an intradermal injection. </li></ul><ul>...
Equipment <ul><li>What is the standard needle length and gauge for intradermal injections? </li></ul><ul><li>Length - ¼ to...
Intradermal Injection Sites Inner Forearm Back of the Upper Arm Below Shoulder Blades What should all of these sites have ...
Intradermal Medication Placement
Prepare for an Intradermal Injection <ul><li>What are the minimum questions a  </li></ul><ul><li>patient should be asked b...
Things to Know BEFORE  it is Too Late… <ul><li>Describe how the needle should be introduced into the skin? </li></ul><ul><...
Things to Know BEFORE  it is Too Late… <ul><li>What does “Aspirate” mean? </li></ul><ul><li>“ To draw by suction” </li></u...
Your Goal: RECREATE the “Wheal”
Intradermal Injections Demonstration <ul><li>Verify/Gather Equipment </li></ul><ul><li>Assure Emergency Equipment and Pers...
Check On Your Learning <ul><li>At what angle should the needle be inserted to deliver a intradermal injection? </li></ul><...
<ul><li>A brand new company of Soldier medics has arrived to Fort Sam Houston. </li></ul><ul><li>The Doctor’s Orders: </li...
Intradermal Injections Practical Exercise <ul><li>Verify/Gather Equipment </li></ul><ul><li>Assure Emergency Equipment and...
Subcutaneous (SQ) Injections <ul><li>What is the absorption rate for SQ injections? </li></ul><ul><li>15-30 Minutes </li><...
Subcutaneous Medication Placement
Equipment <ul><li>What is the standard needle length and gauge for subcutaneous injections? </li></ul><ul><li>½ to 1 inch ...
Subcutaneous Injection Sites 1 st  Choice 2 nd  Choice 3 rd  Choice Not to exceed 0.5 ml Not to exceed 2.0 ml Per Physicia...
Things to Know BEFORE  it is Too Late… <ul><li>Describe how the needle should be introduced into the skin? </li></ul><ul><...
Subcutaneous Injections Demonstration <ul><li>Identify and Screen the Patient </li></ul><ul><li>Verify/Gather Equipment </...
Check On Your Learning <ul><li>What is the purpose for subcutaneous injections? </li></ul><ul><li>Absorption rate desired ...
<ul><li>The Doctor’s Orders: </li></ul><ul><li>Administer 0.5 ml  </li></ul><ul><li>of 0.9% Sodium Chloride,  </li></ul><u...
Subcutaneous Injections Practical Exercise <ul><li>Identify and Screen the Patient </li></ul><ul><li>Verify/Gather Equipme...
Intramuscular (IM) Injections <ul><li>What is the absorption rate for IM injections? </li></ul><ul><li>10-20 Minutes </li>...
Intramuscular Medication Placement
Equipment <ul><li>What is the standard needle length and gauge for intramuscular (IM) injections? </li></ul><ul><li>Not le...
Intramuscular (IM) Injection Sites 1 st  Choice – Deltoid Muscle Not to exceed  2.0 ml
 
Intramuscular (IM) Injection Sites 2 nd  Choice - Gluteus Maximus   Not to exceed  5.0 ml
Intramuscular (IM) Injection Sites 3 rd  Choice Vastus Lateralis Not to exceed 5.0 ml Knee Posterior Anterior Hip
Things to Know BEFORE  it is Too Late… <ul><li>Describe how the needle should be introduced into the skin? </li></ul><ul><...
Intramuscular Injections Demonstration <ul><li>Identify and Screen the Patient </li></ul><ul><li>Verify/Gather Equipment <...
<ul><li>Q:When administering an intramuscular injection should you aspirate?  Why or why not? </li></ul><ul><li>Q: At what...
<ul><li>Q: What is the purpose for IM Injections? </li></ul><ul><li>Q: What are the preferred injection sites for an intra...
<ul><li>The Doctor’s Orders: </li></ul><ul><li>Administer 0.5 ml  </li></ul><ul><li>of 0.9% Sodium Chloride, </li></ul><ul...
Intramuscular Injections Practical Exercise <ul><li>Identify and Screen the Patient </li></ul><ul><li>Verify/Gather Equipm...
Summary <ul><li>What factor determines the gauge of the needle? </li></ul><ul><li>Thickness of the medication administered...
<ul><li>Of the three injections you have learned, which injections should you aspirate and why? </li></ul><ul><li>Intramus...
QUESTIONS?
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Battlefield Medications

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Battlefield Medications

  1. 1. Battlefield Medications: Administer Injections C168W243 DEPARTMENT OF COMBAT MEDIC TRAINING
  2. 2. <ul><li>Given a patient requiring an injection and the necessary medical equipment, </li></ul><ul><li>administer medications by injection, </li></ul><ul><li>IAW the Textbook of Basic Nursing, </li></ul><ul><li>7 th Edition, Rosdahl, Lippincott, </li></ul><ul><li>Chapter 63. </li></ul>Terminal Learning Objective
  3. 3. Safety Note <ul><li>*Everyone wears exam gloves and goggles. </li></ul><ul><li>*Place ALL needles in Sharp Containers after use. </li></ul><ul><li>Needles do not pierce skin unless an instructor is present. If unsure, WAIT! </li></ul><ul><li>*Inform instructors if you suffer a needlestick Injury. </li></ul><ul><li>*No one gets in trouble, the concern is your safety. </li></ul><ul><li>*OSHA says, “Needlestick injuries are wounds caused by needles that accidentally puncture the skin.” </li></ul><ul><li>Whether the puncture was with a clean needle or a used needle, </li></ul><ul><li>if the puncture was accidental, </li></ul><ul><li>let an instructor know right away. </li></ul>
  4. 4. Look at Your Needle in the Package <ul><li>Using your student handout, circle the sterile parts of the needle. </li></ul><ul><li>All parts of the needle are considered sterile. </li></ul><ul><li>Only the protective cover should be touched. </li></ul>
  5. 5. Identify Your Needle Hub Shaft Lumen Bevel Identify the following parts of a needle…
  6. 6. Measure Your Needle <ul><li>How is length and gauge determined? </li></ul><ul><li>Length – tip of the needle to junction of shaft and hub </li></ul><ul><li>Gauge – diameter of the lumen </li></ul><ul><li>The smaller the number the larger the gauge </li></ul><ul><li>What is the length and gauge of this needle? </li></ul>
  7. 7. Pick the Right Needle for the Job <ul><li>Four factors to considered when selecting the right needle for the job </li></ul><ul><li>Type of injection being given </li></ul><ul><li>Size of the patient (thin or not so thin) </li></ul><ul><li>Where the injection is given (arm or butt) </li></ul><ul><li>Thickness of the medication given </li></ul>To determine needle length To determine gauge
  8. 8. Identify Your Syringe Using the picture in your student handout, identify the following parts of a syringe. Plunger Barrel Needle Adapter Calibrated Scale
  9. 9. Touch Your Syringe <ul><li>Sterile parts of the syringe </li></ul>Plunger Needle Adapter Inside of the Barrel
  10. 10. Measure your Syringe <ul><li>The total volume of the syringe is measured in </li></ul><ul><li>Millimeters (ml) </li></ul>
  11. 11. Pick the Right Syringe for the Job General Rule: The syringe should be large enough to hold the entire dose and the calibration small enough to draw up an accurate dose. 10.0 ml 3.0 ml 1.0 ml
  12. 12. Check On Your Learning <ul><li>Q: What parts of the are needle sterile? </li></ul><ul><li>Q: What factors influence the length of the needle? </li></ul>Type of injection – Size of the patient – Injection site All parts of the needle (but not the protective cover)
  13. 13. Check On Your Learning <ul><li>Q: Which parts of the syringe are sterile? </li></ul><ul><li>Q: How do you know which syringe to select? </li></ul>Needle Adapter - Inside the Barrel - Plunger The syringe should be large enough to hold the entire dose and the calibration small enough to draw up an accurate dose.
  14. 14. The VERY First Time They Meet… Assembling the Needle and Syringe <ul><li>Inspect all packaging </li></ul><ul><li>Unpack the syringe </li></ul><ul><li>Inspect the syringe </li></ul><ul><li>Unpack the needle </li></ul><ul><li>Assemble the needle and syringe </li></ul><ul><li>Inspect the needle </li></ul><ul><li>Recap the needle using the “scoop” method </li></ul>
  15. 15. Check On Your Learning <ul><li>While preparing to administer an injection, the needle is removed from the flexible wrapper. Ooopps , you drop the needle on the floor. The protective cap was in place when the needle touched to floor. Can the needle still be used? Why or why not? </li></ul><ul><li>No, the needle should not be used. All parts of the needle are considered sterile, including the hub. If the sterile hub touches to floor, it is no longer sterile. The contaminated hub could cause an infection. </li></ul>
  16. 16. Check On Your Learning <ul><li>If the plunger of the syringe does not move smoothly, why should it be discarded and a new syringe used? </li></ul><ul><li>If the syringe does not move freely, drawing the medication may be impossible. Additionally, administering the injection may be difficult or cause additional harm to the patient. </li></ul>
  17. 17. The Right Medication <ul><li>How many times should the medication label be verified and when? </li></ul><ul><li>Three Times </li></ul><ul><li>When obtained from storage </li></ul><ul><li>When the medication is drawn </li></ul><ul><li>When returning the medication to storage </li></ul>
  18. 18. The Medication is Vial <ul><li>You have the “right” medication, but is the medication safe to administer? How would you know? </li></ul>Check the Rubber Stopper Check the Fluid, Any Floaties? Check the Expiration Date (Multidose Vials are Special). Ensure the Medication was Stored Properly
  19. 19. Things You Should Know Before Medication is Drawn <ul><li>How do you know if you have the right amount of medication in the syringe? </li></ul><ul><li>The forward edge of the plunger is exactly on the prescribed ml mark of the syringe. </li></ul>
  20. 20. <ul><li>Verify Drug and Check the Container </li></ul><ul><li>Remove the Vial’s Protective Cap </li></ul><ul><li>Clean the Rubber Stopper </li></ul><ul><li>Remove Needle’s Protective Cover </li></ul><ul><li>Draw Air Into the Syringe </li></ul><ul><li>Insert Needle Into the Stopper </li></ul><ul><li>Inject Air Into the Vial </li></ul><ul><li>Draw the Medication </li></ul><ul><li>Withdraw the Needle from the Stopper </li></ul><ul><li>Expel Air Still in the Syringe </li></ul><ul><li>Verify the Correct Dosage </li></ul><ul><li>SCOOP the Needle Into the Protective Cover </li></ul><ul><li>Return the Vial or Discard </li></ul>Drawing Medication from a Vial Demonstration
  21. 21. Check On Your Learning <ul><li>Q: When should the medication be compared to the doctors orders and why? </li></ul><ul><li>Q: How do you determine the correct amount of medication has been drawn? </li></ul>When obtained from the place of storage, when drawn, when returned storage. To avoid administering the wrong medication to the wrong patient. Ensure the forward edge of the plunger is actually on the prescribed ml mark.
  22. 22. Check On Your Learning <ul><li>Q: How are clean needles recapped? </li></ul><ul><li>Q: Should you recap “dirty” needles? </li></ul>Place protective cover on work surface. With the dominate hand holding the syringe, “SCOOP” the needle into the cover. DO NOT hold the protective cover with the non-dominant hand. No
  23. 23. <ul><li>Dr. Cooper has assessed a patient and ordered you to draw up medication for him. </li></ul><ul><li>Doctor’s Orders: </li></ul><ul><li>Draw 0.1 ml of 0.9% Sodium Chloride </li></ul><ul><li>in a 1.0 ml syringe </li></ul><ul><li>with a 25 gauge needle. </li></ul>Drawing Medication from a Vial Practical Exercise
  24. 24. <ul><li>Verify Drug and Check the Container </li></ul><ul><li>Remove the Vial’s Protective Cap </li></ul><ul><li>Clean the Rubber Stopper </li></ul><ul><li>Remove Needle’s Protective Cover </li></ul><ul><li>Draw Air Into the Syringe </li></ul><ul><li>Insert Needle Into the Stopper </li></ul><ul><li>Inject Air Into the Vial </li></ul><ul><li>Draw the Medication </li></ul><ul><li>Withdraw the Needle from the Stopper </li></ul><ul><li>Expel Air Still in the Syringe </li></ul><ul><li>Verify the Correct Dosage </li></ul><ul><li>SCOOP the Needle Into the Protective Cover </li></ul><ul><li>Return the Vial or Discard </li></ul>Drawing Medication from a Vial Practical Exercise
  25. 25. Reconstituting Medication <ul><li>Some medications are placed in a vial in POWDERED form and must be reconstituted with a liquid (diluent) before administration. </li></ul><ul><li>Preparing these medications is as simple as injecting the diluent into the medication vial, mixing and drawing to required amount. </li></ul>
  26. 26. Reconstituting Medication Demonstration <ul><li>Verify Drug and Check the Containers </li></ul><ul><li>Withdraw Correct Amount of Diluent </li></ul><ul><li>Reconstitute the Medication </li></ul><ul><li>Invert Reconstituted Medication Vial to Dissolve Powder </li></ul><ul><li>Inspect Solution to Ensure it is Well-Mixed </li></ul><ul><li>Change Needle (and Syringe) </li></ul><ul><li>Withdraw Proper Amount of Medication </li></ul><ul><li>Administer </li></ul>
  27. 27. Check On Your Learning <ul><li>While attempting to reconstitute a powdered medication, the diluent is difficult to inject. What should you do? </li></ul><ul><li>If the vial with the powdered medication contains air, some air may have to be withdrawn to allow the diluent to be injected. </li></ul><ul><li>How do you determine if the reconstituted medication should be inverted gently or if vigorous mixing is required? </li></ul><ul><li>Check the medication label or the package insert. </li></ul>
  28. 28. <ul><li>Dr. Mayer has assessed a patient and ordered you to draw up medication for him. </li></ul><ul><li>Doctor’s Orders: </li></ul><ul><li>Drawn 0.5 ml of 0.9% Sodium Chloride </li></ul><ul><li>in a 3.0 or 5.0 ml syringe </li></ul><ul><li>with a 23 gauge needle. </li></ul>Reconstituting Medication Practical Exercise
  29. 29. Reconstituting Medication Practical Exercise <ul><li>Verify Drug and Check the Containers </li></ul><ul><li>Withdrawn Correct Amount of Diluent </li></ul><ul><li>Reconstitute the Medication </li></ul><ul><li>Invert Reconstituted Medication Vial to Dissolve Powder </li></ul><ul><li>Inspect Solution to Ensure it is Well-Mixed </li></ul><ul><li>Change Needle (and Syringe) </li></ul><ul><li>Withdrawn Proper Amount of Medication </li></ul><ul><li>Administer </li></ul>
  30. 30. Ampules It is made entirely of glass. The medication you need is inside. There are NO openings, caps, rubber stoppers or lids. THIS IS AN AMPULE
  31. 31. Impossible Mission Made Easy <ul><li>Located on the neck of every ampule is a break line. </li></ul><ul><li>Once cleansed, the neck can easily be broken by hand. </li></ul>
  32. 32. But Wait… <ul><li>What if glass gets in the ampule… </li></ul><ul><li>and then glass gets in the syringe… </li></ul><ul><li>and then glass gets into me? </li></ul><ul><li>Use a filter needle!! </li></ul>
  33. 33. Draw Medication from an Ampule Demonstration <ul><li>Tap Ampule to Force Medication out of the Neck </li></ul><ul><li>Clean the Neck of the Ampule </li></ul><ul><li>Break the Neck of the Ampule </li></ul><ul><li>Inspect the Ampule for Glass </li></ul><ul><li>Withdraw Proper Amount of Medication </li></ul><ul><li>(Do Not inject air into the ampule – you will get a shower) </li></ul><ul><li>Recap and Remove Filter Needle and Replace </li></ul><ul><li>Administer </li></ul>
  34. 34. Check On Your Learning <ul><li>You have snapped the neck and currently inspecting an ampule. </li></ul><ul><li>What are you inspecting for? </li></ul><ul><li>Small glass particles. </li></ul><ul><li>What do you do if you find something in the ampule? </li></ul><ul><li>Discard the ampule and get a new one. </li></ul><ul><li>When drawing medication from an ampule, should you draw air into the syringe? </li></ul><ul><li>Why or why not? </li></ul><ul><li>No. </li></ul><ul><li>The contents of the ampule are not under pressure </li></ul>
  35. 35. <ul><li>Dr. Mabry has assessed a patient and ordered you to draw up medication for him. </li></ul><ul><li>Doctor’s Orders: </li></ul><ul><li>Draw 0.5 ml of 0.9% Sodium Chloride </li></ul><ul><li>in a 3.0 or 5.0 ml syringe </li></ul><ul><li>with a 20 gauge needle. </li></ul>Draw Medication from an Ampule Practical Exercise
  36. 36. Draw Medication from an Ampule Practical Exercise <ul><li>Tap Ampule to Force Medication out of the Neck </li></ul><ul><li>Clean the Neck of the Ampule </li></ul><ul><li>Break the Neck of the Ampule </li></ul><ul><li>Inspect the Ampule for Glass </li></ul><ul><li>Withdraw Proper Amount of Medication </li></ul><ul><li>(Do Not inject air into the ampule – you will get a shower) </li></ul><ul><li>Recap and Remove Filter Needle and Replace </li></ul><ul><li>Administer </li></ul>
  37. 37. Intradermal Injections <ul><li>In preparing to become a 68W, each of you received an intradermal injection. </li></ul><ul><li>What was it and why? </li></ul><ul><li>TB (tuberculosis) Test </li></ul><ul><li>Testing your exposure to the disease </li></ul><ul><li>Cite one more reason intradermal injections administered? </li></ul><ul><li>Allergy Testing </li></ul>
  38. 38. Equipment <ul><li>What is the standard needle length and gauge for intradermal injections? </li></ul><ul><li>Length - ¼ to ½ inch Gauge - 25 to 27 </li></ul><ul><li>What is the standard syringe for intradermal injections? </li></ul><ul><li>Tuberculin or other 1.0 ml syringe </li></ul>Read Carefully - That’s 0 . 1 ml NOT 1 . 0 ml
  39. 39. Intradermal Injection Sites Inner Forearm Back of the Upper Arm Below Shoulder Blades What should all of these sites have in common? Free of hair, tattoos and scars NOT over a vein or bony area
  40. 40. Intradermal Medication Placement
  41. 41. Prepare for an Intradermal Injection <ul><li>What are the minimum questions a </li></ul><ul><li>patient should be asked before </li></ul><ul><li>administering any injection? </li></ul><ul><li>What is your name? </li></ul><ul><li>What are you allergic to? </li></ul><ul><li>What drug reactions have you experienced? </li></ul><ul><li>*Are you or is there a possibility you could be pregnant? </li></ul><ul><li>* Females Only </li></ul>
  42. 42. Things to Know BEFORE it is Too Late… <ul><li>Describe how the needle should be introduced into the skin? </li></ul><ul><li>Bevel Up at a 15-20 Degree Angle </li></ul><ul><li>How far should the needle be inserted into the skin? </li></ul><ul><li>Just until the bevel disappears. </li></ul>Only This Far
  43. 43. Things to Know BEFORE it is Too Late… <ul><li>What does “Aspirate” mean? </li></ul><ul><li>“ To draw by suction” </li></ul><ul><li>In this case: </li></ul><ul><li>Once the needle is in the tissue draw back the plunger. </li></ul><ul><li>Aspirating while administering injections </li></ul><ul><li>identifies if a needle is inadvertently placed INTO a blood vessel. </li></ul><ul><li>Should you aspirate intradermal injections? </li></ul><ul><li>NO </li></ul>
  44. 44. Your Goal: RECREATE the “Wheal”
  45. 45. Intradermal Injections Demonstration <ul><li>Verify/Gather Equipment </li></ul><ul><li>Assure Emergency Equipment and Personnel Availability </li></ul><ul><li>Select Site, Expose Site, Position Patient </li></ul><ul><li>Clean Site </li></ul><ul><li>Remove Needle’s Protective Cover </li></ul><ul><li>Hold Skin </li></ul><ul><li>Insert Needle </li></ul><ul><li>Inject Medication </li></ul><ul><li>Remove Needle </li></ul><ul><li>Cover Site - Remember “Do Not Scratch, Rub or Wash” </li></ul><ul><li>Discard Needle and Syringe </li></ul><ul><li>Watch the Patient for a Reaction </li></ul><ul><li>Where and when should the test be read? </li></ul><ul><li>Record </li></ul>
  46. 46. Check On Your Learning <ul><li>At what angle should the needle be inserted to deliver a intradermal injection? </li></ul><ul><li>15-20 degrees </li></ul><ul><li>If a wheal does not appear, what is your next course of action? </li></ul><ul><li>Withdraw the needle </li></ul><ul><li>Dispose of the needle and syringe </li></ul><ul><li>Re-administer the injection </li></ul><ul><li>Do intradermal injections require aspiration? </li></ul><ul><li>No. </li></ul>
  47. 47. <ul><li>A brand new company of Soldier medics has arrived to Fort Sam Houston. </li></ul><ul><li>The Doctor’s Orders: </li></ul><ul><li>Administer 0.1 ml </li></ul><ul><li>of 0.9% Sodium Chloride, </li></ul><ul><li>ID, </li></ul><ul><li>to PV1 Noriega, </li></ul><ul><li>A very thin, 24 year old female. </li></ul>Intradermal Injections Practical Exercise
  48. 48. Intradermal Injections Practical Exercise <ul><li>Verify/Gather Equipment </li></ul><ul><li>Assure Emergency Equipment and Personnel Availability </li></ul><ul><li>Select Site, Expose Site, Position Patient </li></ul><ul><li>Clean Site </li></ul><ul><li>Remove Needle’s Protective Cover </li></ul><ul><li>Hold Skin </li></ul><ul><li>Insert Needle </li></ul><ul><li>Inject Medication </li></ul><ul><li>Remove Needle </li></ul><ul><li>Cover Site - Remember “Do Not Scratch, Rub or Wash” </li></ul><ul><li>Discard Needle and Syringe </li></ul><ul><li>Watch the Patient for a Reaction </li></ul><ul><li>Where and when should the test be read? </li></ul><ul><li>Record </li></ul>
  49. 49. Subcutaneous (SQ) Injections <ul><li>What is the absorption rate for SQ injections? </li></ul><ul><li>15-30 Minutes </li></ul><ul><li>What is the duration? </li></ul><ul><li>Hours to Weeks </li></ul><ul><li>What type of medication should be given SQ? </li></ul><ul><li>Small Amounts – Watery - Nonirritating </li></ul>
  50. 50. Subcutaneous Medication Placement
  51. 51. Equipment <ul><li>What is the standard needle length and gauge for subcutaneous injections? </li></ul><ul><li>½ to 1 inch </li></ul><ul><li>23 to 25 Gauge </li></ul><ul><li>Also consider Patient’s: </li></ul><ul><li>amount of SQ tissue, age, size and general condition </li></ul><ul><li>What is the standard syringe for subcutaneous injections? </li></ul><ul><li>Will depend of the amount of medication given </li></ul>
  52. 52. Subcutaneous Injection Sites 1 st Choice 2 nd Choice 3 rd Choice Not to exceed 0.5 ml Not to exceed 2.0 ml Per Physician’s Orders
  53. 53. Things to Know BEFORE it is Too Late… <ul><li>Describe how the needle should be introduced into the skin? </li></ul><ul><li>Bevel Up at a 45 Degree Angle </li></ul><ul><li>How far should the needle be inserted the site? </li></ul><ul><li>Depth depends on the condition of the patient. </li></ul><ul><li>Should you aspirate subcutaneous injections? </li></ul><ul><li>Yes </li></ul><ul><li>Because the needle is placed deeper into the tissue, there is a better chance to hit a vessel. </li></ul>
  54. 54. Subcutaneous Injections Demonstration <ul><li>Identify and Screen the Patient </li></ul><ul><li>Verify/Gather Equipment </li></ul><ul><li>Assure Emergency Equipment and Personnel Availability </li></ul><ul><li>Select Site, Expose Site, Position Patient </li></ul><ul><li>Clean Site </li></ul><ul><li>Hold Skin with Non-dominate Hand </li></ul><ul><li>Insert Needle </li></ul><ul><li>Release Skin </li></ul><ul><li>Aspirate </li></ul><ul><li>Inject Medication </li></ul><ul><li>Remove Needle and Cover Site </li></ul><ul><li>Massage Site </li></ul><ul><li>Discard Needle and Syringe </li></ul><ul><li>Record </li></ul><ul><li>Watch the Patient for a Reaction </li></ul>
  55. 55. Check On Your Learning <ul><li>What is the purpose for subcutaneous injections? </li></ul><ul><li>Absorption rate desired is slower than IM route. </li></ul><ul><li>For small amounts of watery and nonirritating medication. </li></ul><ul><li>What are possible sites for subcutaneous injections? </li></ul><ul><li>Upper arm, Vastus lateralis, Abdomen </li></ul><ul><li>At what angle should the needle be inserted for a subcutaneous injection? </li></ul><ul><li>45 degrees </li></ul>
  56. 56. <ul><li>The Doctor’s Orders: </li></ul><ul><li>Administer 0.5 ml </li></ul><ul><li>of 0.9% Sodium Chloride, </li></ul><ul><li>SQ, </li></ul><ul><li>to PFC Jefferson, </li></ul><ul><li>very thin 18 year old female. </li></ul>Subcutaneous Injections Practical Exercise
  57. 57. Subcutaneous Injections Practical Exercise <ul><li>Identify and Screen the Patient </li></ul><ul><li>Verify/Gather Equipment </li></ul><ul><li>Assure Emergency Equipment and Personnel Availability </li></ul><ul><li>Select Site, Expose Site, Position Patient </li></ul><ul><li>Clean Site </li></ul><ul><li>Hold Skin with Non-dominate Hand </li></ul><ul><li>Insert Needle </li></ul><ul><li>Release Skin </li></ul><ul><li>Aspirate </li></ul><ul><li>Inject Medication </li></ul><ul><li>Remove Needle and Cover Site </li></ul><ul><li>Massage Site </li></ul><ul><li>Discard Needle and Syringe </li></ul><ul><li>Record </li></ul><ul><li>Watch the Patient for a Reaction </li></ul>
  58. 58. Intramuscular (IM) Injections <ul><li>What is the absorption rate for IM injections? </li></ul><ul><li>10-20 Minutes </li></ul><ul><li>What is the duration? </li></ul><ul><li>Hours to Weeks </li></ul><ul><li>What type of medication should be given IM? </li></ul><ul><li>Viscous or Irritating – Large Volumes </li></ul>
  59. 59. Intramuscular Medication Placement
  60. 60. Equipment <ul><li>What is the standard needle length and gauge for intramuscular (IM) injections? </li></ul><ul><li>Not less than 1 inch Up to 2 inches </li></ul><ul><li>(Unless patient is extremely thin) (For obese patients) </li></ul><ul><li>20-22 Gauge </li></ul><ul><li>What is the standard syringe for intramuscular (IM) injections? </li></ul><ul><li>Will depend of the amount of medication given </li></ul>
  61. 61. Intramuscular (IM) Injection Sites 1 st Choice – Deltoid Muscle Not to exceed 2.0 ml
  62. 63. Intramuscular (IM) Injection Sites 2 nd Choice - Gluteus Maximus Not to exceed 5.0 ml
  63. 64. Intramuscular (IM) Injection Sites 3 rd Choice Vastus Lateralis Not to exceed 5.0 ml Knee Posterior Anterior Hip
  64. 65. Things to Know BEFORE it is Too Late… <ul><li>Describe how the needle should be introduced into the skin? </li></ul><ul><li>Bevel Up at a 90 Degree Angle </li></ul><ul><li>How far should the needle be inserted? </li></ul><ul><li>Depth depends on the condition of the patient. </li></ul><ul><li>Should you aspirate intramuscular injections? </li></ul><ul><li>Yes </li></ul><ul><li>Because the needle is placed deeper into the tissue, there is an increased chance to hit a vessel. </li></ul>
  65. 66. Intramuscular Injections Demonstration <ul><li>Identify and Screen the Patient </li></ul><ul><li>Verify/Gather Equipment </li></ul><ul><li>Assure Emergency Equipment and Personnel Availability </li></ul><ul><li>Select Site, Expose Site, Position Patient </li></ul><ul><li>Clean Site </li></ul><ul><li>Hold Skin with Non-dominate Hand </li></ul><ul><li>Insert Needle </li></ul><ul><li>Release Skin </li></ul><ul><li>Aspirate </li></ul><ul><li>Inject Medication </li></ul><ul><li>Remove Needle and Cover Site </li></ul><ul><li>Massage Site </li></ul><ul><li>Discard Needle and Syringe </li></ul><ul><li>Record </li></ul><ul><li>Watch the Patient for a Reaction </li></ul>
  66. 67. <ul><li>Q:When administering an intramuscular injection should you aspirate? Why or why not? </li></ul><ul><li>Q: At what angle should the needle be inserted for an intramuscular injection? </li></ul>Check On Your Learning Yes. - If you aspirate blood, the end of the needle may be in a blood vessel. Medication delivered into the blood stream, a different route of delivery, could alter the effect of the medication and possibly injure the patient. 90 degree angle
  67. 68. <ul><li>Q: What is the purpose for IM Injections? </li></ul><ul><li>Q: What are the preferred injection sites for an intramuscular injection? </li></ul>Check On Your Learning When rapid absorption rate & long duration is desired. When administering viscous or irritating medications. When large volumes of medication is needed. Deltoid Muscle Gluteus Maximus Vastus Lateralis
  68. 69. <ul><li>The Doctor’s Orders: </li></ul><ul><li>Administer 0.5 ml </li></ul><ul><li>of 0.9% Sodium Chloride, </li></ul><ul><li>IM, </li></ul><ul><li>to CPT Jones, </li></ul><ul><li>an average sized 42 year old male. </li></ul>Intramuscular Injections Practical Exercise
  69. 70. Intramuscular Injections Practical Exercise <ul><li>Identify and Screen the Patient </li></ul><ul><li>Verify/Gather Equipment </li></ul><ul><li>Assure Emergency Equipment and Personnel Availability </li></ul><ul><li>Select Site, Expose Site, Position Patient </li></ul><ul><li>Clean Site </li></ul><ul><li>Hold Skin with Non-dominate Hand </li></ul><ul><li>Insert Needle </li></ul><ul><li>Release Skin </li></ul><ul><li>Aspirate </li></ul><ul><li>Inject Medication </li></ul><ul><li>Remove Needle and Cover Site </li></ul><ul><li>Massage Site </li></ul><ul><li>Discard Needle and Syringe </li></ul><ul><li>Record </li></ul><ul><li>Watch the Patient for a Reaction </li></ul>
  70. 71. Summary <ul><li>What factor determines the gauge of the needle? </li></ul><ul><li>Thickness of the medication administered </li></ul><ul><li>How are clean needles recapped? </li></ul><ul><li>The Scoop Method </li></ul><ul><li>How are “dirty/used” needles disposed of? </li></ul><ul><li>In a Sharps Container </li></ul><ul><li>When must filter needles be used? </li></ul><ul><li>When drawing medication from an ampule </li></ul>
  71. 72. <ul><li>Of the three injections you have learned, which injections should you aspirate and why? </li></ul><ul><li>Intramuscular (IM) and Subcutaneous (SQ) </li></ul><ul><li>To ensure the end of the needle is in the desired type of tissue and NOT in a blood vessel. </li></ul><ul><li>Which injection has a faster rate of absorption in an “average” healthy person, IM or SQ? </li></ul><ul><li>IM </li></ul>Summary
  72. 73. QUESTIONS?
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