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WHAT DOES INTRADERMAL INJECTION MEAN?
INTRADERMAL MEANS A SHOT RIGHT INTO THE MIDDLE OF THE SKIN.

ITS HARD TO DO TOO, THE HARDEST OF ALL SHOTS, ITS A TB SHOT.
WHAT ARE THE 2 SITES FOR A INTRADERMAL INJECTION?
INNER FOREARM
UPPER BACK
WHAT KIND OF SYRINGE DO YOU USE FOR AN INTRADERMAL INJECTION?
a Tuberculin SYRINGE
THERE ARE THINGS ABOUT THE NEEDLE ITSELF. IT HAS A WAY ITS MEASURED BY LENGTH, AND THE INSIDE DIAMETER OF THE HOLE. SO, WHAT IS THE LENGTH/GUAUGE OF THE INTRADERMAL NEEDLE?
LENGTH OF INTRADERMAL NEEDLE IS:
1/4 OR 1/2 INCH (SMALL ONE!)

THE GAUGE ON THE NEEDLE, (HOW FAT IT IS) IS 26-27 GAUGE
what is the maximun dose you can give with a ID shot?
maximum dose is

0.01 - 0.1 mL range, Max is
0.1mL
do you aspirate A INTRADERMAL INJECTION?
no

but if you don't get a bleb, you have to do the shot again
WHAT DOES A CORRECTLY GIVEN INTRADERMAL SHOT PRODUCE, WHAT DOES IT LOOK LIKE?
A CORRECTLY GIVEN INTRADERMAL SHOT PRODUCES A WHITE BLISTER called a bleb, A PIMPLE ON THE SKIN. LIKE A TB SHOT DOES!
IF YOU DON'T GET A BLISTER LOOKING THING FROM GIVING THIS TYPE OF SHOT, WHAT DO YOU DO?
YOU GOOFED UP SO YOU HAVE TO DO IT AGAIN BECAUSE THE MEDS WERE NOT DELIVERED!
WHAT DOES SUBCUTANEOUS MEAN?
IT MEANS FAT. SO A SUBQ SHOT IS GIVEN INTO THE FAT, NOT THE SKIN OR MUSCLE. ITS A SHOT RIGHT INTO FAT.
WHAT ANGLE DO YOU GIVE A INTRADERMAL INJECTION ANYWAY?
15º ANGLE FOR INTRADERMAL
HOW FAR DO YOU STICK THE NEEDLE IN GIVING A INTRADERMAL INJECTION?
WATCH THE BEVEL GO IN AND STOP JUST WHEN THE BEVEL IS NO LONGER VISIABLE. THIS SHOT IS THE ONLY ONE WHERE YOU WATCH THE BEVEL END
THERE ARE A BUNCH OF PLACES TO GIVE SUBQ SHOTS, AND THESE PLACES HAVE FAT LAYERS. WHERE?
OUTER ASPECT OF UPPER ARM
ABDOMEN (FROM B/L COSTAL MARGINS TO ILIAC CRESTS)
ANTERIOR ASPECTS OF THIGHS
SCAPULAR AREAS OF UPPER BACK
UPPER VENTRAL OR DORSAL GLUTEAL AREAS
WHAT TYPE OF SYRINGE YOU USE ON A SUBQ INJECTION?
3 mL
WHAT IS THE LENGTH AND GAUGE OF NEEDLE FOR A SUB Q?
3/8 - 5/8 INCH, 25 - 27 GAUGE
WHAT'S THE MAXIMUN DOSE FOR A SUBQ SHOT?
0.5 - 1mL RANGE, MAXIMUN 1 mL
which type of shot gets medicine to work faster, a subQ shot or an IM shot?
IM shot gets meds to work faster than a subQ.

Aqueous solution is absorbed in 10 - 30 in an IM shot. It takes a full 30 minutes for a subQ shot to get absorbed
What's a problem with IM shot as opposed to subQ shot?
there is an increased risk of injecting drugs directly into blood vessels.
So, does the nurse have to use longer needles to get a shot into muscle than a SC (subQ)?
yes, the IM shot requires a longer needle and larger gauge.
Generally average adult will use a 21 - 23 gauge 1/2 - 2 inch needle at a 90 º angle.
The IM shot is for 3 major muscles, one in the arm, one in the thigh, and one in the butt. what are the names of these muscles?
ventrogluteal muscle is in butt
dorsalgluteal muscle is in the butt

vastus lateralis muscle thigh muscle, (best place for babies)

deltoid muscle tricky here, only for small doses (0.5-1.0 mL)HINT has website for all this
http://images.google.com/imgres?imgurl=http://flightline.highline.edu/drydberg/balckboard/intramuscular_sites_for_injectio_files/image007.jpg&imgrefurl=http://flightline.highline.edu/drydberg/balckboard/intramuscular_sites_for_injectio.htm&h=294&w=303&sz=16&hl=en&start=7&tbnid=76CI4_SKBFyUtM:&tbnh=113&tbnw=116&prev=/images%3Fq%3Ddorsal%2Bgluteal%2B%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DGGGL,GGGL:2006-29,GGGL:en%26sa%3DN
which muscle is the preferred site for adults and anyone older than 7 months?

BETTER CHECK THIS ONE ??????
ventrogluteal muscle is the perferred site for adults and children older than 7 months. Its also fine for kids younger than 7 months too.
how do you give a ventroglluteal shot?
heel of hand over greater trochanter with thumb pointed towards belly button. index finger pointed towards the anterosuperior iliac spine and middle finger pointed towards iliac crest.
why give a shot into a muscle anyway?
muscle is less sensitive to irritating and viscous (thick) drugs.
whats the most medicine you should give someone into a muscle?
The book says a well developed healthy person can take 4mL in larger muscles like the gluteous medius. Class room instruction says 3 mL.
the Z-track method is recommended for IM shots. whats this?
it just a trick of either pulling the skin sideways or pressing it downwards before giving the shot. It reduces meds leaking out of the muscle back into the SC tissue and causing pain.
YOU ONLY Z TRACK IM SHOTS AND NOT THE DELTOID
How do you put your hands to find the site of injection for the IM shot?
You put your hands on the hips like if you were having oral sex. where your hands are on the hips with fingers spread, site of injection is between the first and second fingers
Where / How do you know your hands are in the correct positoion for the IM shot into the ventrogluteral muscle?
the first finger has to touching the tip of the anterosuperior iliac spine. Thumb is pointed at the naval.
OK, you've located the ventrogluteal. There's another site you got to locate so to know where to draw the line for this shot. Where is that other place?
The dorsal gluteal. This site shows the places to give shots.
http://images.google.com/imgres?imgurl=http://flightline.highline.edu/drydberg/balckboard/intramuscular_sites_for_injectio_files/image007.jpg&imgrefurl=http://flightline.highline.edu/drydberg/balckboard/intramuscular_sites_for_injectio.htm&h=294&w=303&sz=16&hl=en&start=7&tbnid=76CI4_SKBFyUtM:&tbnh=113&tbnw=116&prev=/images%3Fq%3Ddorsal%2Bgluteal%2B%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DGGGL,GGGL:2006-29,GGGL:en%26sa%3DN
Where / How do you know your hands are in the correct positoion for the IM shot into the ventrogluteral muscle?
the first finger has to touching the tip of the anterosuperior iliac spine.
OK, you've located the ventrogluteal. There's another site you got to locate so to know where to draw the line for this shot. Where is that other place?
The dorsal gluteal. This site shows the places to give shots.
http://images.google.com/imgres?imgurl=http://flightline.highline.edu/drydberg/balckboard/intramuscular_sites_for_injectio_files/image007.jpg&imgrefurl=http://flightline.highline.edu/drydberg/balckboard/intramuscular_sites_for_injectio.htm&h=294&w=303&sz=16&hl=en&start=7&tbnid=76CI4_SKBFyUtM:&tbnh=113&tbnw=116&prev=/images%3Fq%3Ddorsal%2Bgluteal%2B%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DGGGL,GGGL:2006-29,GGGL:en%26sa%3DN
Theres a place on the butt where you can give an injection but it risky. where is that place?
Dorsal Gluteal.
http://flightline.highline.edu/drydberg/balckboard/intramuscular_sites_for_injectio.htm

Draw an imaginary line between the greater trochanter and the posterior superior iliac spine; at the middle of the imaginary line, go up about one inch
there is the vastus lateralis IM shot. where's this ?
its the muscle in the leg where you would rest your hands after running a 100 yard dash while leaning over. This is easy. Place hands just above the knee and other below the trochanter. use middle area b/t hands for the shot
The deltoid shot:

how do you figure out where to give this?
2 to 3 finger's breath below acromion process. There's a triangle (pointed down) to locate. Its 2 fingers down from acromion process. That's it
where's the best place for a deep, large IM injection?
ventrogluteal
what type of syringe would you use for a deep, ventrogluteal shot?
3 mL syringe for this deep IM shot.

Length of / gauge = 1 1/2-2"
23 -21 gauge
Max dose:
b/t 0.5 - 5 mL. But never more than 3 mL at one time. More than this requires dividing the dose.
what part of the syringe can you touch?
the end of the plunger called the FLANGE

the BARREL
what is the bevel?
the tip of the needle
what kind of damage can you do giving a shot?
damage to a nerve
damage to a blood vessel
so we look at sites to avoid damage. Especially the siatic nerve, w/h runs down the back of the leg
the TB syringe is the smallest syringe of all of them. what is the TB syringe used for? (Tuberculin)
very small doses.

Total capacity is 0.1mL. so its very small. long and narrow thing. You can even give a shot for 0.01 mL which is 1/100 of a mL.
The insulin syringe is used only for ...
insulin and nothing else.
only holds a whole mL
another only holds a half mL
calibrated in UNITS
******************************
capacity is 0.33 to 1 mL
calibrated in insulin units
the standard syringe holds how much fluid?
3 mL

calibrated in 0.1 mL.
what is a tubex / carpuject?
requires tubex injector
some must be activated to use
does not require syringe
Needle numbers are opposite in numbering plans so . . .
the smaller the #, the larger
the needle!
what sizes do intradermal needles come in?
26 - 27 gauge so this is small!
what sizes do subQ (SC) come in?
25 - 27 gauge
SC shots are:
non irritating
non viscous
H2O soluble
and isotonic. what does that mean
isotonic means same as body tissue viscosity
Intramuscular or IM shots

what sizes do these needles come in?
19 to 23 gauge needles
the 19 looks like a sword
the 23 looks friendly
usually use 21 - 23 gauge
needle selection is based on vicosity
*****************************
Needle lengths:

from 1/4" to 3 "!

how do you determine this for the client?
by assessing the patient!
age
quality of the site
type of injection
what is the usual size needle for a Intradermal shot?
1/4 to 1/2 inch.
what size are SC needles?
3/8 to 5/8 is used
what is the size for IM needles?
1 1/2-2 "
this is again based on client size and quality of tissue
regarding IM shots and old folk and kids, what about this?
quality of tissue issue.
may use 1/2 to 1 inch for child or elder.
*****************************
OK, medicine comes in containers. Lets talk about containers.
what is a vial?
made of glass w/ a snap off top

this is a single dose vial!!!
************************
is there such a thing as a multi dose vial?
yes
date when opened

good for 72 hours after opened BUT check w/ facility policy!
how do you get meds out of a vial with out creating a vacuum?
you must replace fluid with air to avoid a vacuum.
What are ampoules?
small glass containers
single dose
You have to use filter needles b/c of the glass
****************************
change needle b/f injection
always use a filter needle when you use a break open glass ampoule.
Tubex or carpujets

whats special here?
some must be activated
req. use of tubex holder
needle IS attached; can't change it
before giving a shot you what?
gather equipment
syringe
needle
alcohol
there's technique with drawing up meds into a syringe that requires you to never draw solution up into the needle that you use (unless its insulin) Why?
the solution gets on the shaft which gets on the tissue going in and out and causes it to sting when you push it in.
Needles come loose when you get one. So what?
Open syringe
get needle ready
wipe stopper
etc
How to draw up from an ampoule:

gather equipment
get fluid in body of ampoule by flicking it
what else?
get filter needle ready
open syringe
lay needle in package
apply filter needle
open ampoule
draw up
change needle!
whats an air lock?
purpose is to keep fluid from running back out of the tissue.
So how do you draw up meds and the air lock, which is first, how do you do this?
draw up the medication first

then draw up the airlock
OK.

how much airlock is needed for a IM shot?
IM shots get a 0.2 mL airlock
how much of an airlock does a SC shot get?
0.1 mL airlock
what shots don't get air locks?
insulin and heparin

Heparin is used as a anticoagulant. Important and used alot apparently
whats the purpose of an airlock?
to help seal in meds so it doesn't escape out, leak back thru tissue!
SITES FOR INJECTION!

what is an intradermal shot?
a shot that goes into the middle of your skin. You watch the bevel on this shot only. When the bevel is no longer in site, STOP. The result should be a white blister
Where do you give intradermal shots?
inner forearm

upper back
what kind of shots are intradermal?
TB shots are intradermal
some allergy shots are intradermal
what are thoughts on intradermal shots?
5 to 15 º angle
prep w/ alcohol & let dry
pull skin taught
insert until bevel is covered
stablize needle & inject slowly
pull it out quickly same angle it went in.
SC shots:

what angle?
45º in
prep w/ alcohol allow to dry
dart quickly
stabilize
ASPIRATE (not heperin!)
inject slowly so no pain
withdraw quickly&same angle
Massage if indicated (not heperin)
How much med would go into a SC shot?
0.5 to 1 mL is the MOST SC is 1 mL.
so heperin shots we don't do two things: what?
don't aspirate Heperon
don't massage Heperon
where do SC shots go?
outer upper arm
around the belly
upper thigh

where ever there is fat!
where else can SC shots go?
back of scapula areas
belt areas around kidney areas
why would you not give a SC shot near the navel?
because it hurts like hell, thats all
IM shots:

prep w/ alcohol, let it dry
90º straight in b/c were going for muscle here. what if its small muscle mass being injected?
pinch it up
we use Z track w/ IM shots. why and what is it?
displace the tissue to avoid leakage of meds
YOU DON'T Z TRACK DELTOID SHOT!
******************************
inject slowly & wait 10 secs w/ Z lock
withdraw quickl and straight as you release skin
massage if appropiate
whats the max meds in IM shot?
3 mL
if you have to give more, split dosage.
what's the most med you can give in the deltoid muscle?
1mL is the max in a deltoid shot
there are landmark muscles for IM shots. what the landmark muscle in the leg for IM shots?
vastus lateralis muscle
how do you find this?
its attached to the greater trochanter of femur
*****************************
how do you hold a syringe to give a SC shot?
like holding a dart!
whats the proper technique to clean a site to give a shot?
in a circular motion w/ alcohol
If meds enter too rapidly, the patient could have a anaphylactic reaction. What is this?
this is when a intradermal shot and med enter circulation too fast. So, Doctor will give patient a test with intradermal shot to test for this
Intradermal sites should be considerered. what are we looking for?
free of lesiions

free of hair
inner forearm and upper back ideal
what's the best site for SC injections?
upper arms
abdomen b/l the costal margins to iliac crests
anterior aspects of thigh (above anterior lateralis)
do you wear gloves giving a shot?
all the pictures in the book show gloves on so yes
why is the ventral glutal the best place for a IM shot?
its the best developed muscle b/c of all the walking. This is the side of the hip site
what are the landmarks concerning a IM shot in the hip?
antersuperior iliac spine
iliac crest
how do you find the butt IM shot area?
find posterior spine
draw a line b/t there and trocanter on hip
give shot above this line
*********************
Pediatrics and shots!
scare the kids to death!
where is the best place to give shots to kids?
vastis lateralis is best IM site for Peds < 3 years old.
this is b/c they been walking for at least a year. Butt is good too but have to be at least one year old.
what about PEDS and deltoid shots?
do not give shots in deltoids under the age of 5 years
whats the maximun dose for ped shots?
0.5 mL is max dose for small infants.

1mL is max dose for small children and older infants

This takes careful assessement
you always wear gloves
wash your hands
clean site w/ alcohol
aspirate all _____ injections
SC & IM injections should be aspirated
except insulin and heperin
which shot do you not aspirate?
intradermal shots don't get aspirated
You always use an airlock for _____ injections
IM injection get airlocks
You Z track all IM shots EXCEPT
the deltoid !!!!
*************************
whats the very last thing you do after giving a shot?
chart the event
always document site
use narrative notes if there is a problem
how do you chart intradermal shots?
in narrative form and in one time only
what kind of things can alter absorption of a shot?
cold compress
tourniqueit slows absorption
heat will speed up absorption
what does massaging a shot do?
increase speed of absorption
what about needle sticks? which kind of shot should we be most concerned with with needle sticks?
IM shots are the most to be concerned with b/c of blood. this is why we cut down on IM shots b/c of blood borne insidences.
what tips should we follow concernng tips of needles?
do not recap used needles!
You may recap sterile needles
don't comtaminate syringe
don't touch plunger
don't touch inner barrel
keep _______ covered
tip

always wash soiled skin
there are 9 ways to reduce pain in a shot. whats the first way?
relax the muscle.
gluts? toe in and best if lyng down. They could faint while standing up!
how do you relax and give a shot to vastis lateralis?
relax, toe in,

Deltoid relax? have it supported by a table, arm flexed up, this relaxes muscle
other tips about inserting tips include...
avoid sensitive areas
may use ice prior to injection
wait for alcohol to dry
always change needles after drawing up (stops stinging)
insert straight, smooth, fast
inject drug slowly
withdraw straight, smooth, fast
gently massage muscle to help distribute med unless otherwise not to.
there are 9 ways to reduce pain in a shot. whats the first way?
relax the muscle.
gluts? toe in and best if lyng down. They could faint while standing up!
how do you relax and give a shot to vastis lateralis?
relax, toe in,

Deltoid relax? have it supported by a table, arm flexed up, this relaxes muscle
other tips about inserting tips include...
avoid sensitive areas
may use ice prior to injection
wait for alcohol to dry
always change needles after drawing up (stops stinging)
insert straight, smooth, fast
inject drug slowly
withdraw straight, smooth, fast
gently massage muscle to help distribute med unless otherwise not to.