55 Administering Medications Lesson 2: Injection Methods.

55 Administering Medications Lesson 2: Injection Methods

Lesson Objectives Upon completion of this lesson, students should be able to: Define and spell the terms to learn for this chapter. List and define the four sites for intramuscular injections. State the rationale for using the Z-track injection method.

Intramuscular Injections
Intramuscular (IM) injections administer medication directly into muscle tissue Always given at 90-degree angle in one of four muscle sites Deltoid Vastus lateralis Dorsogluteal Ventrogluteal

FIGURE 55-8 Angle of insertion for three types of injections.

FIGURE 55-9 Sites for intramuscular injections.

Deltoid Muscle Upper outer surface of upper arm Site of small muscle mass Works well for small-volume injections, but not for large ones For example: tetanus boosters in adults This site should never be used in infants or small children; size of muscle is too small

Deltoid Muscle Found by measuring two finger widths below acromion process of the shoulder Never give IM injections in the back of an arm Use a 23-gauge, 1-inch needle For individuals with small arms, use a 25-gauge, 5⁄8-inch needle

Procedure 55-7 (continued) Administering Parenteral Subcutaneous or Intramuscular Injections FIGURE C Intramuscular injection sites: deltoid.

Vastus Lateralis Muscle On outer portion of upper thigh Part of quadriceps Safest site for IM injections

Vastus Lateralis Muscle Lies below greater trochanter of femur and within upper lateral quadrant of the thigh Recommended by American Academy of Pediatrics as preferred injection site for infants and children

Vastus Lateralis Muscle In the adult, extends from middle of the anterior thigh to middle of the lateral thigh One handbreadth below greater trochanter and extends to one handbreadth above knee Patient may be either sitting or lying supine

Dorsogluteal Muscle Used for large volume, deep IM injections or irritating viscous medications Upper outer quadrant of the buttocks Landmarks carefully observed to ensure proper placement of the injection in this site and to avoid damage to sciatic nerve

Dorsogluteal Muscle Patient should lie prone and point toes inward or bend over end of examining table Draw imaginary line from greater trochanter of the femur to the posterior superior iliac spine

Dorsogluteal Muscle Give injection above and lateral to the line Or divide buttocks in four equal parts and give injection in the upper outer quadrant

FIGURE 55-10 Injecting the upper outer quadrant of the buttocks.

Ventrogluteal Muscle Best site to use Safer than dorsogluteal site because there are no major nerves or blood vessels Safe for infants, children, and adults

Ventrogluteal Muscle Place palm of right hand on greater trochanter and index finger on superior iliac crest Stretch index finger as far as possible along iliac crest and then spread middle finger away from your index finger

Ventrogluteal Muscle Injection is made in space between index and middle finger Always use the hand opposite the side of the planned injection on the patient

Procedure 55-7 (continued) Administering Parenteral Subcutaneous or Intramuscular Injections FIGURE B Intramuscular injection sites: ventrogluteal.

FIGURE 55-11 Injecting the ventrogluteal muscle.

Z-Track Method Used when a medication is irritating to the subcutaneous tissues or when medication may discolor the skin Pull skin to the side before inserting needle Pulling of the skin displaces the tissue

Z-Track Method Then inject medication, release the skin, remove the needle Medication will not be able to seep back to the skin's surface Critically important to withdraw the needle before releasing the skin

Procedure Administering a Z-Track Injection FIGURE A–E An example of a Z-track method of injection.

Subcutaneous Injections
Given just under the skin in the fat tissue Used for small doses of nonirritating medications such as immunizations, insulin, and heparin

Back of the arm, upper back or abdomen and thighs Given at 45-degree angle to skin surface unless injection is heparin or insulin, in which case 90-degree angle used

Procedure Administering Parenteral Subcutaneous or Intramuscular Injections FIGURE A Subcutaneous injections are administered at a 45-degree angle. Tibanna/Shutterstock

FIGURE 55-12 Sites for subcutaneous injection.

Patients who self-inject Site of injection must be rotated so as not to form scar tissue by repeatedly injecting same sites Patients receiving allergy injections should remain in the office after injection per office protocol 20 or 30 minutes to ensure patient is not having any type of allergic reaction

FIGURE 55-13 Rotation sites for administering insulin.

Intradermal (ID) Injections
Commonly used for allergy skin testing Minute amount of material injected within top layer of skin to determine patient's sensitivity Common sites: upper chest and upper back, anterior forearm

Small wheal or bubble that contains the injection fluid appears on the skin Do not rub the area after giving injection

Procedure 55-8 Administering an Intradermal Injection FIGURE A Intradermal skin injection sites.

FIGURE 55-14 Intradermal injections are administered at a 10–15° angle
FIGURE Intradermal injections are administered at a 10–15° angle. Diana Valujeva/Shutterstock

Tuberculin Skin Test Administered intradermally to see if patient has ever been exposed to tuberculosis Small amount of TB protein (antigens) injected under top layer of skin on patient's inner forearm

Tuberculin Skin Test If person has ever been exposed to TB bacteria, skin will react to antigens by developing firm red bump at site within 2 days Test does not determine if infection is active or inactive (latent)

Tuberculin Skin Test Purified protein derivative (PPD) skin test uses measured amount of TB antigens via injection administered under top layer of skin on patient's forearm

Tuberculin Skin Test Mantoux test is good test for TB infection Often used when symptoms, screening, or testing, such as chest X-ray, show a person may have TB

Tuberculin Skin Test Ask patient to sit down and turn up inner side of his or her forearm Skin where test is done should be cleansed with alcohol wipe and allowed to dry

Tuberculin Skin Test Using tuberculin syringe, small injection of TB antigen (PPD) is put under top layer of skin Fluid makes a wheal under the skin Circle may be drawn around test area with a pen

Procedure 55-8 (continued) Administering an Intradermal Injection FIGURE B–G Administering an intradermal skin test.

Tuberculin Skin Test Do not cover the site with a bandage Some redness at skin site is expected Site may itch

Tuberculin Skin Test Important it not be scratched because scratching may cause redness or swelling that would make test difficult to read Patient return to office within two to three days after test to have skin test checked

Tuberculin Skin Test Results Redness alone at skin test site is negative reaction to tuberculin skin test Firm bump is positive reaction to the test

Tuberculin Skin Test Results Size of firm bump (not red area) measured two to three days after test to determine result Interpreting such test results is not within scope of practice for medical assistant

Intravenous (IV) Therapy
Injects medications or therapeutic solutions directly into bloodstream for immediate circulation and use by the body State practices acts designate which health care professionals can initiate IV fluid therapy and medication administration

In some states, medical assistant may start IV fluid therapy with advanced training and physician supervision Preventing Hospital Admissions Outpatient IV therapy settings allow patients who require IV therapy to receive treatment without being hospitalized

Reduction in Medical Costs Using outpatient centers may allow patients to be discharged earlier from hospitals Cost effective for both patients without health care insurance and for insurance companies

Patient Satisfaction Most patients prefer to avoid hospitalization for IV therapy Allows more freedom in schedule and more time with family Children more comfortable in nonhospital environment

Indications for Intravenous Therapy Route to administer medication Administering blood and blood products Replacing lost fluids and correcting electrolyte imbalances Aiding in administration of nutritional supplements

Medications Administered Intravenously Chemotherapy medications Rheumatoid arthritis medications Antibiotics Monoclonal antibodies

Medications Administered Intravenously Analgesics IV administration of medications by per unit dosage or continuous Flow rate regulated by flow clamp or infusion pump

Blood Products Patients with weakened immune systems require therapeutic blood products; often unable to produce their own antibodies Immunoglobulin (contains antibodies)

Blood Products Patients who have hemophilia are lacking clotting factors; receive clotting factors by intravenous therapy Administration not within scope of practice of a medical assistant

Special Requirements IV administration requires special knowledge and precautions; involves direct access to bloodstream

Special Requirements Any office in which IV fluid therapy performed must have: Emergency equipment Emergency medical access Established office policies for routine administration, dealing with adverse reactions, and handling emergencies

Special Requirements Following reported to physician immediately: Any combination of redness, swelling, heat, bleeding, and loss of feeling at site of infusion Before IV site is chosen, tubing selected and connected to correct solution container, following sterile technique

Special Requirements Tubing flushed to remove all air Tape and dressing supplies for site prepared beforehand Preparation tray with IV starter materials and prepared IV solution taken to patient IV solution hung on IV pole

Special Requirements IV site and appropriate size and type of catheter selected IV generally started in the arm IV catheter includes outer cannula to thread into vein and inner needle to serve as a guide for insertion and then to be removed

Special Requirements Constricting tourniquet placed above site Skin cleansed Catheter introduced into vein to obtain open blood supply

Special Requirements Tourniquet released and removed Plastic cannula advanced into vein Needle is removed Site anchored with tape, IV tubing connected, and dressing of site is completed

Special Requirements IV regulated with flow clamps or IV pump as prescribed by physician Gloves worn during procedure as part of standard precautions All needles and biohazard materials disposed of according to office policy and OSHA standard precautions

Preparing an Intravenous Tray Medical assistant must be trained Instructions frequently included in office or hospital procedure manual Once preparation of IV tray completed, check doctor's order as to what IV fluid solution is required

Preparing an Intravenous Tray It is the right patient It is the right solution It is the right drug It is the right technique

Preparing an Intravenous Tray It is the right route Solution is properly labeled with patient's name, date and time of administration, and name of doctor who ordered it

Preparing an Intravenous Tray Most facilities have disposable IV administration sets ready for use All placed on separate IV or Mayo tray Position items in the order of their usage Notify whoever is going to start IV that tray is ready for the patient

Medical Assistant's Role Setting up IV tray Provide patient with reassurance during procedure

Medical Assistant's Role Recognize some of the possible side effects that intravenous therapy can cause Infections at site of needle Phlebitis (inflammation of the vein) Infiltration

Infiltration Tip of IV catheter withdraws from vein or pokes through vein into surrounding tissue Vein's wall becomes permeable and leaks; IV fluid infuses tissues outside intravascular space

Infiltration Frequently encountered with peripheral IVs Almost always requires replacement of IV at different location

Reactions During IV Therapy Bleeding or drainage from area of insertion Redness, pain, or swelling in area of insertion Blood backing up into tubing

Reactions During IV Therapy Needle or tube coming loose or being removed by patient Bring to attention of personnel who are conducting therapy Immediately inform physician

Questions? 72

55 Administering Medications Lesson 2: Injection Methods.

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55 Administering Medications Lesson 2: Injection Methods.

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