1. IM, ID, Subcutaneous, (i.e., Insulin, Heparin) Page 435-456 – Wilkinson/Treas Fundamentals Volume 2 (SF)

12.  Usually only a small amount of the drug is given.  Used for allergy, TB tests.  Common sites:  Inner lower arm  Upper chest  Back beneath scapula

13.  Administration  Use small syringe with a short needle (#25-27, 1/4 to 5/8 long)  Hold at a 5-15° angle with bevel up.  Drug produces a small bleb just under the skin.  Do not massage area of injection site.

14.  Usually a small amount of drug - up to 1 mL. Absorption is slower & drug action usually takes longer than IM/IV routes.  Verify drug is labeled for SQ route  Used for vaccines, insulin, heparin as well as other drugs.

16.  Common Sites:  Outer aspect of the upper arm  Anterior aspect of the thigh  Abdomen  Scapular area of the back  Upper ventrogluteal &  dorsogluteal areas

17.  Administration:  Type of syringe  Needle size & length  Heparin is usually 1 mL=25-27G with 3/8 to 5/8 inch needle  Insulin with insulin syringe 28-31G with 3/16 to 1 inch needle  Determine length of needle by pinch test  ½ width of pinched skinfold  Determine angle of insertion by pinch test  1 inch = 45 degree / 2 inch = 90 degree  No aspiration  Rotate injection sites  Avoid areas of lumps, bumps & bruises.

18.  Drugs injected into the muscle are more quickly absorbed because of a greater blood supply to muscle tissue.  The muscle can take a larger volume of drug without discomfort.  Amount varies based on muscle size and condition.

20. Deltoid Dorsogluteal DO NOT USE Ventrogluteal Vastus lateralis

21.  Adults can tolerate up to 5 mL of medication in the ventrogluteal muscles.  Recommended amount for the deltoid muscle is no more than 1 mL.  Labeled for IM use.  May be used for all types of medications: analgesics, etc..

26.  Common sites:  Ventrogluteal site  Vastus lateralis site  Dorsogluteal site-Do Not Use  Deltoid site  Rectus femoris site

27.  Administration  2 - 5mL syringe  Size & length of needle  #21-22, 1 1/2 in / adults /gluteal  #23-25, 1 in / adults / deltoid  Large for viscous drugs  Longer for obese/ shorter for emaciated  #22-25, 5/8 - 1 in, infants/child

28.  Medication supplied in units  U - 100 - means 100 units/mL  U - 500 means 500 units/mL  Specialized Insulin syringe  Given SQ or IV  Only use orange tipped syringes  Do not aspirate or massage site

29.  30 unit  50 unit  100 unit  Insulin pens

30.  Rapid-acting : Humalog  Fast Acting : Lispro  Short-acting: Regular  Intermediate acting: NPH, Lente  Long-acting: Ultra Lente  Sustained: Glargine (Lantus)  Premixed: Intermediate & short acting mixtures (70/30 or 50/50)

31.  Name of Insulin  Type of Insulin  Number of units to be given  Time to be given  Route of administration

32.  Read orders thoroughly  Use an insulin syringe  Read labels carefully  Regular insulin is clear  Should always be drawn up first  Check with another RN-High Risk Drug  orders, label & amount

33.  Regular insulin should be drawn up first  Clear before cloudy (i.e., NPH)  Draw up exactly as ordered  Sliding - scale insulin  based on BS levels

34.  Administration  Supplied in units  Must be given IV or SQ  Various strengths available  Fast – acting, short half life  Antidote - protamine sulfate  Dose based on lab values  Incompatible with other drugs  DO not interrupt or delay administration

35.  Small, short needle, SQ  Change needle (avoid bruising)  0.2 mL  SQ dose not to exceed 1 mL  Double check order, dose, vial, & amount  Use TB syringe (mL side)  Know symptoms of overdose  DO NOT aspirate or massage