Venipuncture And Injections Needle parts Hub Cannula shaft

Venipuncture And Injections

Needle parts • • Hub Cannula (shaft) Bevel Point

Needle Selection • Length ¼ - 6” • Gauge 13 – 30 g

Syringe Parts • Plunger • Barrel • Tip

Prepared Medications • Ampule: Sterile prefilled container; single dose • Cartridge-Needle Unit: Disposable sterile cartridge w/ premeasured amount. • Vial: Sterile prefilled bottle

Flip top

Drawing Medications • • Ampule Vial Never remove ……… Never touch ………. .

Draw measured amount of air and exchange

INJECTIONS Site Selection • Intramuscular • Subcutaneous • Intradermal

Intramuscular • Used when meds given subcu are irritating; faster absorption; larger amount needed • 90 degree insertion • Gluteus medius: Z-trak • Middeltoid • Ventrogluteal • Vastus Lateralis

Intramuscular Injections • Wipe surface in circular pattern from center to 2” • Let dry • Spread skin and insert needle 3/4 • Do NOT insert needle to hub • Draw plunger to look for blood • Remove needle and massage muscle

Sites to Avoid • • Scar tissue Burned areas Edematous Traumatized Areas near large vessels Change in skin texture or pigment Areas with a mole or wart

Gluteus Medius • Draw line from greater trochanter to PSIS. • Injection given above and outside this line. • Watch out for sciatic nerve & gluteal artery.

Gluteus Medius

Z-Trak • • • Upper outer quadrant of buttocks Slide skin and gluteal muscle to side Inject Slide muscle back Better absorption; less painful; less irritation; no discoloration due to leaking

Middletoid • 3 fingers below edge of acromion and above axilla • Can only tolerate small amounts of meds • Major vessels, nerves and bones to be avoided here.

Middletoid

Ventrogluteal • No major vessels or nerves here • Patient on side or supine • Palpate greater trochanter, iliac crest, ASIS. • Place your right palm on pts left troch, index finger on ASIS and middle finger along iliac crest.

Ventrogluteal

Vastus Lateralis • Free of major blood vessels and nerves • Divide distance between greater troch and patella into thirds. • Use middle third.

Vastus Lateralis

Subcutaneous • • • Small amounts (2> ml) Absorption through capillaries Administer slowly 45 degree insertion Heparin, epinephrine, insulin, vaccines

Subcutaneous • • Administered below epidermis Outer surface of upper arm Lateral aspect of thigh Upper 2/3 of back Abdomen (2” around umbilicus) Front of thigh Rotate injections

Intradermal • • Skin tests for allergies Sensitivity to drug TB test (susceptibility to disease) To aid in diagnosis of parasitic infection and fungal diseases

Subcutaneous Tips • Avoid edematous or scarred tissue • If patient is thin, grasp skin in a bunch • Do not aspirate • Do not rub area after injection

Intradermal Injection • Injected between layers of skin • Inner surface of forearm 4” distal to elbow • Insert bevel up at a 5 -15 degree angle

NEEDLE SELECTION Subcutaneous 2 -3 cc ½-5/8” 23 -25 g Intramuscular 2 -5 cc or. 5 -2 cc middletoid 1 -1½”, 18 -22 g 1”, 22 -23 g . 5>cc ¼½ Intradermal 3/8” 25 -27 g Insulin 30, 50, 100 units ½ - 5/8” 27 -29”

VENIPUNCTURE • Site Selection – Short or long term use – Start looking distal • Needle Selection – Butterfly – Angiocath/Heplock

Venipuncture Insertion

Veins of Arm

Hand Veins

Recommended sites for venous cannulas

Sites To Avoid • • • Tortuous Repeatedly used veins Poor skin condition Thin, superficial veins Bifucating veins Veins affected by surgery

Infiltration • • Swelling or redness Cool skin at the site Pressure or burning at site No blood return