Bachelor of Science in Nursing Program * Health and Human Services * Malaspina University-College    

 

  Learning Activity on Parenteral Medication Administration:

Intradermal -Subcutaneous - Intramuscular – SC Infusion

 Overview                                                    Printer friendly version

Nurses administer injections in areas that range from newborn nursery to long term care. Our first memory of nurses may be through our early experiences in immunization clinics. Ask someone “What Do Nurses Do?” and giving needles will most certainly be on their list. By now you have mastered the seven rights and three checks for medication administration, learned about pharmacokinetics, and maybe even administered medications in your practice area - it is now time to add some parental routes.

Ends In View                                                         

  1. Explore concepts involved in administering parenteral medications.

  2. Review essential aspects of preparing medications from ampules and vials.

  3. Identify rationale for intradermal, subcutaneous, and intramuscular routes.

  4. Landmark sites for intradermal, subcutaneous, and intramuscular injections and s/c infusions. 

  5. Document the administration of parenteral medications appropriately.

  6. Practice injections: intradermal (ID), subcutaneous (s/c), intramuscular (IM, including z track) and subcutaneous infusions.

  7. Discuss needle stick injuries and safely disposal of needles.  

In Preparation

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Smith, Duell & Martin: Unit 5 Chapter 18 (549-556, 562-571) excluding insulin injections and insulin pump. 

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Fundamentals - p. 630- 647, stopping at intravenous medications. (some of this will be review: subcut.) 

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Review the meds listed in the practice situation AT THIS LINK - bring completed med cards to lab for these medications.  

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Review our policies on Medication Administration 

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Read this journal article, (4 pages) comparing injection techniques in different countries. 

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Complete the pre-test  and be prepared to hand in the week AFTER this class 

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Review of injection techniques according to the literature - interesting. 

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Review the following sites for more information:

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http://www.palliative.org/PC/ClinicalInfo/Publications/ContinuousSubcutaneousInfusion.html

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http://intrapump.com/insuflon.asp

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http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdr-rmtc/96vol22/22s1/22s1appb_e.html

  Large Group Work

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Review pertinent anatomy

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Identify strategies for landmarking

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Describe advantages and disadvantages of the different routes of administration

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Identify strategies to decrease the pain that is associated with needles

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Demonstrate preparation from vials and ampules

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Emphasize safe disposal of needles

  Small Group Work

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Observe and handle the assortment of needles and syringes available in the lab.

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Using a 2-3 ml syringe and a 1½ inch needle, draw 1 ml solution from a multiple dose vial.

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Using the same equipment, draw all the solution from an ampule containing 1 ml or 2 ml of solution.

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Demonstrate changing a needle as you would if the first one had been contaminated or the end of the needle is blunt.

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Landmark all the sites to give intradermal, subcutaneous, and intramuscular injections on a partner.

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Administer the following:
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Vitamin B 12, 1000ug IM

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Pneumovax 23 0.5 ml IM or s/c

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Heparin 5000 Units s/c

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Iron dextran parental test dose of 0.5 ml deep IM by Z-track technique

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Draw up 10 mg morphine (narcotic) for injection for an adult

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Vitamin K 1.0 mg IM for newborn

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Tuberculin PPD 5 TU 0.1ml intradermal

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Document appropriately all medications practiced, anticoagulants, and narcotics.  

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Homework  

bulletAt home, try landmarking on agreeable relatives, children, and friends.
bulletPractice your new psychomotor skills in giving an injection on an orange. 
bulletIn your clinical area, identify common parental medications. Locate the necessary equipment and sharps containers. Outline the institution’s policy and procedure for needle stick injuries. Ask your nursing colleagues their experiences with needle stick injuries. You may even contact occupational health and safety to determine the incidence of needlestick injuries at your institution.

In reflection

  1. Here is a site that will give you different quiz questions, if you are ready: Concept Media Instructor's Guide to Administration of Injections. (Acrobat file)
  2. Controversy between the "air bubble technique" and "Z track" - interesting. 
  3. Injection techniques for children.
  4. Think about your own experience in receiving injections. How might this affect your nursing practice? 
  5. How would you approach a person who was terrified of needles?
  6. Write down your concerns about giving injections, revisit what you have written after you have administered one, and then ten. How has practice improved your confidence and technique?       
  7. Look at the Biojet site for new innovations in injection techniques - neat pictures!

APPENDIX:

ADMINISTRATION OF MEDICATIONS

  Steps to Reduce Pain of I.M. Injections

  1. Encourage client to relax the muscle you will be injecting.

  2. Avoid extra sensitive areas.

  3. Let antiseptic dry.

  4. Numb injection site with ice.

  5. Change needle after drawing medication.

  6. Dart the needle in rapidly.

  7. Aspirate -- then inject slowly.

  8. For deep I.M. injections, use Z-track technique.

  9. Withdraw needle rapidly.

  10. Unless contraindicated, massage the muscle.  

Choose the Site for an Injection (Newton & Newton, 1979, pp. 18-24  - old but still very correct!)

  Factors to be considered (can you provide rationale or explanation for these?):

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solution to be administered (kind and amount)

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age of client

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choose a site where the skin surface is free of abrasions, bruises, infections, etc.

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alternating sites is necessary

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the desired therapeutic effect

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safety of client

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patient's comfort

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adequate muscle mass (I.M. injection) for the amount of drug to be administered

How Much is too Much

  1. S/C injections:
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     literature recommends a maximum 1.5 ml

  2. I.M. Injections:
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    safe limit is 3 ml  

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    some literature talks about a maximum level of 5 ml

  3. In establishing if one single injection should be given (re:  dosage in one syringe), the nurse should always consider:    
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    patient's age     

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    skin condition    

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    amount of fatty tissue 

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    drug's pharmacologic action (so... what does this mean...???) and 

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    adverse effects  

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    over 3 ml, always check with instructor (Winfrey, 1985, pp.38-39)

References

  1. Newton, D. & Newton, M. (1979, July).  Route, site and technique.  Nursing 79, pp. 18-24.

  2. Winfrey, A. (1985, July).  How much is too much.  Nursing 85, pp. 38-39.