Presentation on theme: "Intramuscular Injections IM’s"— Presentation transcript:
1 Intramuscular Injections IM’s Chapter 22 Perry & Potter
2 Review – IV Fluids Order: ½ NS @ 125cc/hr Drop factor: 15 gtt/ml Drop rate:31.25 gtt/min (31-32)125 cc/hr x 15 gtt/ml = (31-32)60 minOrder: D5 ½ 100 ml/hrDrop factor: 10 gtt/ml16.6 gtt/min (16-17)
3 Review – IV Medications Order: Maxeran 10 mg IVPB ½ hour ac mealsAvailable: 10 mg/mlFurther dilute: 50 ml NS, infuse over 15 minWhat is the rate:200 ml/hr50 ml X ? = 200 ml/hr15 min minWhat is the drip rate (drop factor 15 gtt/ml):50 gtt/min
4 Order: Pantoprazole 40 mg IV now Available: 40 mg vial Reconstitute with 10 ml NS (final concentration 4 mg/mL). Reconstituted solution may be given intravenously (over 2 minutes) or may be added to 100 mL D5W, NS, or LR (for 15- minute infusion).Stable in D5W, LR, NS.Y-site administration: Incompatible: Midazolam, zinc.How much do you add to the minibag:10 mlWhat is the rate:440 ml/hrWhat is the drip rate with drop factor of 15 gtt/ml:110 gtt/min (this will be difficult to count)
5 What would you do? Reason for primary infusion & reason for IV med Primary line: NS with 40 meq 75 ml/hrOrder: Pantoprazole 40 mg IV nowWhat do you need to know before you begin?Reason for primary infusion & reason for IV medDrug information (expected & unexpected)Client’s history & allergiesClient’s knowledge of medicationIV compatibility!!!
7 Video Review IV therapy IV Medications Monitoring an IV Site, checking Infusion Rate, and Changing an IV Solution ContainerReplacing IV Solution Container and Administration TubingIV MedicationsAdministrating IV Medications by Piggyback Infusion
8 Review – Subcutaneous Medication/Insulin Order: Lovenox 40 mg SC ODAvailable: 300mg/3ml (100mg/ml)Info: Lovenox is a sterile aqueous solution containing enoxaparin sodium, a low molecular weight heparin. Lovenox® is indicated for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE)How much do you withdrawl?0.4 mlIdentify the appropriate syringe:1 mlWhere are you going to administer this medication?Outer aspect of abdomen (never arms)
9 Video Review Mixing Two Insulin's in One Syringe Important information you need to know?If insulin’s are compatibleIs it safe to give (know clients blood sugar)Insulin(s) information (onset, peak, duration)Draw up rapid acting insulin first (unmodified)Check dose with RN/instructorKnow S&S of hyper/hypoglycemiaInjections sites
10 Intramuscular Injections (IM’s) Faster absorptionLess danger of causing tissue damageRisk of injecting into blood vessels existsMuscle is less sensitive to irritating and viscous drugsLarge well developed muscles (adults) can tolerate as much as 5 ml of medication (infants ml, toddler 1-2ml, preschool 2-3ml, adolescents 3-5ml)Usual max dose: 3mL in adult
11 Vastus lateralis and ventraogluteal sites used in infants Deltoid used in well developed children and adolescentsIn estimating needle length in children, grasp muscle between thumb and index, needle length showed be half the distance between fingers.Insert needle as close to 90 degrees as possibleRotate sites to decrease risk of hypertrophy
12 Needle Gauge Gauge often determined by length Most water soluble medications use:22-27 gauge needleMore viscous medications use:18-25 gauge needleOlder or cachectic clients may need shorter smaller gauge needle
13 Needle length Average length: Children: 5/8 – 1 inch Adults: 1- 1 ½ inches
14 Assessment Assess integrity of a muscle prior to injection Help client assume a position that reduces strain on the muscle.Area must be free of infection or necrosis, bruising or abrasions, underlying bones, nerves & major blood vessels.
15 Assessment Review order (medication rights) Obtain medication informationReview history and assess factors contraindicating injection (muscle atrophy, shock, impaired circulation)What would you do if contraindicated?Call prescriber for alternative route!Medical history, allergies, medication historyClient’s knowledge/concerns
16 Prepare Medication 6 rights, 3 checks Prepared correct dose from vial/ampuleReplace needle with needle for injectionChildren: 5/8 – 1 inchAdults: 1- 1 ½ inches (22-27 gauge): 1 ½ inch (18-25 gauge) viscous medicationsCheck arm band/compare with MARExplain procedure, locate site, BE CONFIDENT
17 Ventrogluteal Site: #1A deep site, situated away from major nerves and blood vessels, less chance of contamination in incontinent clients or infants because it is away from rectum.Easily identified by prominent bony landmark.Safe for all clients
18 Ventrogluteal Land marking (p. 599): Place heel of hand over the greater trochanter of the client's hipright hand over left hipleft hand over right hip
19 Ventrogluteal con’t… Point thumb towards client's groin Index finger over anterior superior iliac spineExtend middle finger back along the iliac crest toward the buttockCreate a triangle between index finger, middle finger and the iliac crest (towards the buttocks)Inject in the middle of this triangleFlexing of the knee and hip helps person to relax
21 Vastus Lateralis siteVastus Lateralis - lacks major nerves and blood vessels, rapid drug absorption, developed muscleSite used for giving children IM medication (preferred for immunizations)Client should lie with the knee slightly flexed or in a sitting position
22 Vastus Lateralis Cont’d Land marking (p.600):Located on the anterior lateral aspect of the thighHandbreadth above the knee to a handbreadth below the greater trochanter of the femur.In width, from the midline of the thigh to the midline of the thighs outer side.Inject into the middle third of the muscle.
24 Deltoid siteNot well developed in most adults & children (not recommended for use in infants or children)Radial & ulnar nerves & brachial artery lie within the upper arm along the humerusUsed when other injection sites are inaccessibleUsed for small amount of drugs (1 ml or less)
25 Deltoid site con’t… Landmarking (p. 600): Expose upper arm Palpate lower edge of the acromion process (base of triangle)Inject in the middle of the triangle (3-5 cm below the acromion process)
27 Dorsogluteal site No longer a recommended site Runs risk of striking underlying sciatic nerve, greater trochanter, major blood vessel.Often used by nurses in hospitals (4 quadrant landmarking), practice is slowly changing
28 Z track Method Minimizes tissue irritation by sealing the drug within the muscle tissues anddecreasing pain.Recommended technique for all IM’swhen possible
30 Implementation Privacy Wash hands Expose only required area Select appropriate injection site & ensure client is comfortableLandmark siteCleanse site with antiseptic (center and rotate outward ~ 5 cm)With nondominant hand, pull skin cm down or lateral (Z track), hold this position until medication is administered.Gauze in nondominant hand
31 Remove cap (pull straight off) Hold syringe like a dartInject quickly at 90 degreesHold lower part of syringe to stabilize syringePull back on plunger 5-10 sec, if no blood inject medication slowly (1 ml/10 sec)Wait 10 sec, slowly withdrawl needle, place gauze over siteAssess siteObserve response to medicationRecord on MAR, record response (i.e prn/STAT)Document and report undesirable effects
33 Practice Examples Order: Demerol 50 mg IM q4h, prn Order: Gravol 25 mg IM, q4h, prnSupplied :Demerol 50 mg / ml (ampule)Gravol 50 mg / ml (vial)How much do you need of each?Demerol: 1 mlGravol: 0.5 ml(Draw up medication from vial first, using filtered needle)
34 Practice Examples 2. Order: Diphenhydramine 25mg IM stat Supplied: 50 mg/ml3. Order: Dimenhydrinate 50mg IM/IV/PO q4-6 h prn Supplied 50 mg/ml
35 Example Order: Solumedrol 100 mg IM stat Directions for Reconstitution Available 40 mg: Aseptically add 1 mL Bacteriostatic Water for InjectionAvailable 125 mg: Aseptically add 2 mL Bacteriostatic Water for InjectionHow much do you draw up in the syringe?1.6 ml125 mg X mg = 1.6 ml2 ml ?OrDose X Stock mg X 2ml = 1.6 mlHave mg
36 Lets Practice Next Lab: Sterile Dressings Perry & Potter: Chapter 38 & 39
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