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Chapter 37 Administering Intradermal, Subcutaneous, and Intramuscular Injections Parenteral route- which means not through the GI tract

Luer-Lock tip: has threaded grooves that screw onto the needle hub and lock in place Slip-tip: has a smooth, slightly tapered tip that inserts into the needle hub, requiring a slight twist of the syringe. Syringe types: 1 mL, 3 mL , and 5mL standard sizes 1) Tuberculin Syringe- is smaller in diameter and holds 1 mL. Excellent choice for administering small precise volumes of medication required for newborns and infants. Also for TB skin test. 2) Insulin Syringe- is similar size and shape to a TB syringe but used for units. 1 mL holds 100 units and the smaller size hold 0.3 mL that is best for children. Even used to give small doses of insulin with a permanently attached needle. 3) Prefilled Syringes- single dose ready to use and disposable. Some attached with needle and contains specific medications. (Carpujet and Tubex are designed for safe and quick loading and unloading.) Needles- small hollow tube with sharp, beveled cutting edge tip used the pierce skin. a) Hub used to attached the needle to the syringe, b) Bevel, the cannula or shaft and safety guard to cover the used needle as soon as it withdrawn. c) Gauge of a needle refers to the diameter of the needle and is indicated by numbers, higher the gauge number the smaller diameter of needle d) Choice of needle depends on several factors: viscosity, route, and size of muscle. Intradermal Injection- small amount of fluid in the dermis, or true skin layer immediately below the epidermis a) It is commonly used as diagnostic tool, such as testing for allergies or tuberculosis b) P.P.D called tuberculin purified protein derivative usually placed in the right ventral forearm, upper chest, and upper back over the scapula are the sites used for allergy testing c) The length of the needle for an ID injection should be to inch with a small diameter needle between 25 to 30 gauge and length to 5/8 inch d) Insert 15 deg angle to create a bleb (wheal) somewhat like a small, raised, fluid-filled blister ( do not aspirate) Subcutaneous Injection- deposits the medication in the subcutaneous layer below the skin and above the muscle layer a) Slower than a IM injection (absorption) b) Given at a 45 deg angle for thin clients and 90 deg angle for larger clients c) to 5/8 in 25 gauge needle/ 3/8 and 7/8 in with 24 and 29 gauge d) Used for insulin and heparin

e) Sites: back of the upper arms, the abdomen (2 in from the umbilicus also rapid absorption), the anterior thighs, the area of the back just below the scapulae, and the upper buttocks. ******volume max 1 to 2 mL for subcutaneous injection****** Intramuscular-directly into the largest portion of a muscle, called the body of the muscle a) Ventrogluteal- the safest and most comfortable IM injection site for all clients older than 7 months. Near the anterior superior iliac spine and the iliac crest Not near any major blood vessels or nerves b) Dorsogluteal- is no longer a choice for IM injections and never used for children. ***********volume max 3mL for gluteal sites************************ c) Deltoid- adults and children with adequate muscle mass. Upper arm below the acromion.(21-22 gauge 1 in needle) d) Vastus Lateralis-free from nerves and blood vessels for kids younger than 3 yrs. Absorption form this site is better than from other IM sites e) Rectus Femoris- located in the longitudinal midline of the anterior thigh. Not used to inject infants nor children. Injection for 3mL Z track Method-prevents irritating and dark-colored medications, such as iron dextran from leaking out of the injection site to sensitive tissues for subcutaneous tissues that may stain. a) reduce inflammation and discomfort b) technique preventing seepage c) medications: haloperidol(Haldo) and hydroxyzine(Vistaril)

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