1. Injections 101

2. Objectives Describe proper techniques for administering injectable drugs Describe precautions to take when administering injectable products

3. 7 Rights of medication administration 1. Right Drug 2. Right Dose 3. Right Time 4. Right Patient 5. Right Route 6. Right Technique 7. Right Documentation

4. Injection Sites see pages 459, 460

5. Routes of Administration

7. View Video clip DVD 3 11-5

8. Do Workbook page 527 E & H Hypodermic Syringe Calibrations 3cc syringe

10. Insulin Injection Sites Alternate sites include the back of the arms, thighs, and buttocks –Slower onset with alternate sites

11. Film Clip DVD 3 11-4

12. Workbook Questions 31-40, p 515

13. Preparing Syringe Maximum volumes – Deltoid – No more than 0.5-1mL – Large muscle (gluteus medius) Adult – no more than 4mL Child – no more than 1-2mL Vaccines: Vastus Lateralis in child Deltoid in Adult

14. Workbook Page 529 K Reading Syringe and Needle Labels

15. Preparing Needle Choose correct needle LENGTH and GAUGE Minimize tissue injury and SQ leakage Allow easy passage (21 vs. 25 gauge) Needle length depends on injection site – Adults 5/8 ” vs. 1 ” vs. 1.5 ” – Children 5/8 ” vs. 1 ” – If less SQ fat, use smaller needle

16. Do & Check Workbook page 528 I Insulin Syringe Calibrations U-100 syringe

17. Check your vials!!!!!

18. Drawing medication into Syringe (see page 462-466)

19. Get Organized Get all supplies ready ex: Band-Aid, alcohol pad, cotton ball Double Check – Correct med, dose, & expiration date – Go over med with pt

20. Record – Medication name, dose, route, time, date – Location of administration (L/R deltoid) – Your signature & title

21. Do & Check Workbook page 528 J Tb Syringe Calibrations 1-ml Tb syringe

22. Administer the injection Cleanse area with alcohol swab – Allow alcohol to dry Target/landmarks – C technique and shoot (IM) – Bunch skin (SQ) Aspirate (IM) then inject – smooth motion with steady pressure

23. Final Steps Do not recap needle Sharps container Apply pressure to injection site with cotton ball (PRN) Apply adhesive bandage PRN Chart Have pt remain for ~15 minutes

24. Workbook Key Terms Assessment page 510 1-30

25. Managing Adverse Reactions

26. Vasovagal Syncope (Fainting) Be aware of pt behavior Have pt sit before administration Lay pt down if necessary Check airway, breathing and vital signs

27. Anaphylaxis Rare but potentially fatal Occurs within 15 minutes Call 911 Lay pt down, check airway, breathing, vital signs Be prepared and ready to administer epinephrine (Epipen)

28. Delayed Adverse Reactions Child – fever, fussy, crying, injection site Adult – injection site discomfort Symptomatic relief – Fluids – Pain medications

29. Reporting Adverse Reactions Incident Report Required for: - Rare, serious or unexpected events

30. Workbook Page 530 section M Correct state the principle reason why we do that….. Incorrect explain why………

31. The Z-Track Method (page 461) Used with irritating meds meds that may discolor the skin you need to pull the skin to the side prior to inserting the needle Then inject the medication release the skin, the med will not be able to seep back to the skin’s surface DVD 3 11-6

32. Z-track Injection

33. Intradermal (ID) Injection Small amount of liquid is injected within the top layer of skin a small “wheal” or bubble appears on the skin Do not rub

34. Intradermal (ID) Injection cont. Common sites –upper chest –upper back –anterior forearm – DVD 3 11-7

35. Intradermal Skin Test

36. Tuberculin Skin Test Administered intradermally Exposure to Tb A small amount of TB protein (antigens) is injected the skin will react by developing a firm red bump at the site within 2 days ~ Positive skin test cannot tell if the infection is active or inactive (latent)

37. Positive TB skin test

38. Performing a Tuberculin Skin Test A circle may be drawn around the test area with a pen Do not cover redness at the skin site is expected and the site may itch, DO NOT scratch pt MUST return to the office within 2 to 3 days after the test for reading

39. Tuberculin Skin Test Results Redness alone is a negative reaction A firm bump is a positive reaction The size of the firm bump (not the red area) should be measured 2 to 3 days after the test MA reports the findings of “positive” or “negative” interpreting” such test results is MD job

40. Measuring Mantoux Test Reactions Workbook Page 531 Section N Measure and Chart Charting example see page 488 - Textbook

41. What is Intravenous Therapy? involves administering fluids and solutions directly into the bloodstream Not legal for CA MA’s