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67 Cards in this Set

  • Front
  • Back
What are the three main indications for injections, phlebotomy, blood cultures, ABG and IV's?
1. Illness or injury that requires parenteral medication

2. Analysis of venous or arterial blood in evaluating disease.

3. Fluid resuscitation
What are the six "Rights" of drug administration?
Right DRUG

Right DOSE

Right PATIENT

Right TIME

Right ROUTE

Right DOCUMENTATION
What is associated with the "RIGHT" of drug administration - Right DOCUMENTATION?
Patient's name

Date and time of administration

Name of the drug and dosage

Route of Administration

Reactions

Signature and Title
What are the primary drug errors?
Drug given to the wrong patient

Incorrect drug is administered

Drug given by an incorrect route

Drug given at wrong time

Incorrect dose is administered

Incorrect data is entered on chart
Of all the six "Rights" of drug administration this one is key for patient protection?
Right Documentation
What three parts make up the syringe?
Tip, Barrel, Plunger
3 CC hypodermic syringes are used for what?
IM and SC injections
5 CC hypodermic syringes are used for what?
IM injections, venipuncture
10, 30, and 60 CC hypodermic syringes are used for what?
Aspirations and Irrigations
What type of syringe is a tuberculin syringe?
1 CC for intradermal injections
These syringes are usually labeled in units.
Insulin Syringes
Sharpened end of the needle at the tip
Point
Hollow core of the needle that forms the opening
Lumen
Hollow steel tube of the needle
Shaft
Point where the shaft and the hub of the needle join
Hilt
Proximal end of the needle that mounts onto the syringe
Hub
The length of a needle varies from what to what?
3/8 of an inch to 2 inches
This is determined by the diameter of the lumen. The large this number, the smaller the bore of the needle. This ranges between 16-30.
Gauge
What are the routes of injection?
Intradermal

Subcutaneous

Intramuscular
This is when there is an injection in the dermal layer

The injection angle is 10-15 degrees with the bevel up

The injection sites are those such as Mantoux/PPD-forearm and back-allergy testing.
Intradermal
This is when an injection is just below the skin surface. The injection angle is 45 degrees with the bevel up. The injection sites include abdomen, thighs, upper arms. Insulin is given this way.
Subcutaneous
Low weight molecular heparin is given how?
Subcutaneous injection, but not in the upper extremities.
This is when an injection is deep into the muscle. The injection angle is 90 degrees with the bevel up. Injection sites include dorsogluteal, ventrogluteal, vastus lateralis and deltoid. Antibiotics and other agents are given this way.
Intramuscular
The landmarks for this injection site is the posterior iliac spine and the greater trochanter of the femur. This is a traditional IM injection site for adults. The needle length is usually 1 1/4 inches to 3 inches and this is not used in infants and children.
Dorsogluteal site
The landmarks for this injection site are the greater trochanter of the femur, the anterior super iliac spine (ASIS), Iliac crest. This is used in infancy through adulthood. Adult needle length is 1 1/4 to 3 inches and the child length is 5/8 to 1 1/2 inches. The needle gauge is 18-23 and you give the injection at 90 degrees with the bevel up.
Ventrogluteal site
This injection site is used in adults. The middle third of the anterolateral aspect of the quadriceps muscle. Needle length is 1 1/4 to 1 1/2 inches. Needle Gauge is 20-23, 90 degrees and bevel up.
Vastus lateralis site in adults
This is below the greater trochanter but within the upper lateral aspect of the quadriceps muscle. The needle length should be 1/8 of an inhc, needle gauge 22-25 with 90 degrees and bevel up.
Vastus lateralis site in infants and children
This injection site has landmarks at the acromion and deltoid tuberosity. Adults needle length 5/8 to 1 1/2 inches. Needle gauge 23-25 90 degree with bevel up consider not using in the frail and elderly. Do not use this in infants and children.
Deltoid site
This is the most common method for the collection of blood for the laboratory.
Phlebotomy
What are the four main preferred venipuncture sites?
Median antecubital vein

Cephalic vein

Basilic vein

Veins in the hands or feet
What are contrindications to venipuncture and tourniquet application?
Site of active skin infection

Sclerotic vein

Extensive scarring

Edematous or impaired arm or hand

Post-masectomy arm-lymphostasis

Hematoma

Previously injured vein

Dialysis with shunt

Femoral bypass
When you use a 24 gauge needle in phlebotomy it is for what patients?
Neonates, infants, sometimes elderly patients.
When you use a 22 gauge needle in phlebotomy it is for what patients?
Children, Elderly
When you use a 20 gauge/18 gauge needle in phlebotomy it is for use in what patients?
Adults
What are three collection methods for phlebotomy?
1. Vacutainer

2. Butterfly winged

3. Syringe technique
What do you do during the phlebotomy procedure?
Identify the patient - name and DOB

Reassure the patient

Explain the procedure

Position the patient in a comfortable sitting or reclining position

Extend the patient's arm so that it is not bent at the elbow
What is something you never do in phlebotomy?
You never perform phlebotomy with the patient standing due to a possible vasovagal reaction.
Where do you apply the tourniquet?
4-6 inches above the intended puncture site

2 minute maximum
If the vein is palpable, but not sufficiently dilated you can do what?
Rub over it with alcohol pad

Ask patient to open and close fist

Place extremity in dependent position

Apply warm compress
When you are grasp the patient's arm in phlebotomy, how many inches and were do you place your thumb?
2-3 inches below the phlebotomy site
When performing phlebotomy you hold the needle at what angle?
15-30 degree angle
When you have blood flowing you do what?
Remove the tourniquet - helps to prevent hemolysis
When you are preparing a site for a blood culture what do you do?
Clean the site with an antimicrobial in a circular bulls eye motion outward from site to a diameter of 2-4 inches to remove flora that would otherwise be introduced into the vascular system with venipuncture.
What are the indications for an ABG?
Assessment of ventilation and oxygenation - usually patients with respiratory issues.
With an ABG there are increased risks of what?
Coagulopathy

Anticoagulation
What are contraindications to doing an ABG?
Arterial pulse not palpable

Negative allen test

Surface landmarks not visible

Arterial disease
What are the ABG sites?
Radial
Brachial
Femoral
What is the most common ABG site?
Radial
What is involved with the ABG procedure?
Advance needle until flashback

Collect 3-5cm of blood

Remove the needle

IMMEDIATELY apply firm pressure for at least 10 minutes

Hold syringe upright and tap out any bubbles

Cork or Cap syringe
What do you do after you have collected the sample in ABG?
Roll in fingers to mix heparin

Place syringe in ice

Send to lab immediately

Re check patient at five and fifteen minutes
What are the complications associated with ABG?
Hemorrhage
Hematoma
Thrombosis
Arterial Spasm
Nerve Damage
What is the purpose of peripheral IV insertion?
Fluids
Medications
Blood and blood components
Parenteral nutrition
Providing or maintaining intravenous access to the patient
What are the contraindications for placing and IV?
Site of active skin infection
Sclerotic vein
Extensive scarring
Edematous or impaired arm or hand
Postmasectomy arm-lymphostatisis
Hematoma
Previously injured vein
What is an 18 gauge IV used for?
Blood, blood products, viscous medications, IV contrast
What is a 16 gauge IV used for?
Surgery, Trauma, Fluid Resuscitation
What is a 14/12 gauge IV used for?
major trauma, codes, emergency fluid resuscitation
What are the preferred sites for IV insertion?
Always start distally

Metacarpal and Cephalic veins of the hand

Cephalic and basilic of the wrist/forearm

Median antecubital vein
When do you use the median antecubital vein?
If NO other access is available

To accommodate a large bore needle

Administer drugs that require large volume dilution
What factors do you take into account when choosing a site for IV insertion?
Prescribed therapy
Duration of therapy
Condition or size of the vein - sclerosed, tortuousness, valves
What do you take into account when choosing an IV catheter?
Choose the shortest catheter with the largest gauge appropriate for the type of procedure, solution and patient.
When placing an IV what position do you place the patient in?
Supine
How many times do you clean using the circular bulls eye motion before putting in an IV?
3 times
You do not apply this after applying the antimicrobial prep because this negates the beneficial effect of the prep.
Alcohol
How far do you advance the catheter once the needle is inserted into the vein?
2-3 cm
When advancing the canula, you advance it up to the?
hub
After the needle is removed and the catheter is in place what do you do?
Flush the catheter to insure patency

Attach the IV tubing or cap to the cannula hub.

Check for flow and or infiltration

Secure the cannula and dress the site

Dispose of sharps and waste appropriately
What are complications associated with peripheral IV's?
Dislodge canula:
Loose tape
Cannula backed out of the vein
Patient removed - "it fell out"

Hematoma

Tenderness

Occlusion - inability to advance or flush the line

Infiltration:
Swelling at and above the IV site
Discomfort
Burning
Pain

Nerve, tendon, ligament damage:
Extreme pain
Muscle contraction

Phlebitis:
Tenderness and redness - tip of canula along the vein
Vein is hard on palpation
Fever