Parenteral Administration: Needle Structure and Measurement

Needle Structure

• A needle has five parts: hub, shaft, point, lumen, and bevel
• Hub: connects to the syringe
• Shaft: the length of the needle that is inserted into the body
• Point: the sharpened end of the shaft
• Lumen: the inside opening of the shaft
• Bevel: the slant of the point

Needle Measurement

• Needle size is measured by gauge (lumen size) and length
• Gauge: the smaller the gauge, the larger the needle (range: 13G to 27G)
• Length: varies according to use (range: ½ inch to 6 inches)

Intradermal (ID) Administration

• Uses a TB syringe (1 cc), 26G to 27G needle, and 3½ inch to ½ inch needle length
• Injection sites: anterior forearm, middle back, and upper chest
• Used for: allergy skin testing, TB skin testing medication (Mantoux/PPD)
• Injection angle: 10 to 15 degrees (with bevel facing up)
• Goal: formation of a wheal or bleb
• Amount given: 0.01 to 0.2 cc

Intramuscular (IM) Administration

• Injection is administered just under the epidermis

Professional Rights and Responsibilities

• Physicains should expose dishonest, corrupt, incompetent, or unethical colleagues
• Physicains in private practice may decline to accept any individual as a patient
• Physicains may patent any device that they discover or invent
• Both parties are free to enter into, or decline to enter into, the patient-physician relationship
• Physicains who are infected with an infectious disease should not engage in any patient contact or activity that may create a risk for the patient
• Physicains should not practice under the influence of any controlled substance, alcohol, or chemical agents that impair the ability to render treatment

HIPAA

• Involved with privacy, security, and claims issues in the health care system
• Standards for privacy of individually identifiable health information
• Allows the flow of health information while protecting the privacy of patients
• Issues identified by state and federal agencies
• Failure to comply with mandates can lead to sanctions and fines
• Enacted in 1996
• Two provisions: Title I (Insurance Reform) and Title II (Administrative Simplification)
• Long-term benefits of HIPAA: lower administrative costs, increased accuracy of data, and increased patient and customer satisfaction

Title I: Health Insurance Reform

• Provision of continuous insurance coverage for workers and their insured family members when the worker changes or loses a job
• Limits use of preexisting condition exclusions
• Prohibits discrimination for past or present poor health
• Guarantees individuals the right to purchase gap health insurance coverage after losing a job
• Allows renewal of health insurance coverage regardless of an individual's health condition

Title II: Administrative Simplification

• Focuses on health care setting
• Intended to reduce administrative costs
• Accomplished by standardizing the exchange of health care data
• Includes provisions to ensure the privacy and security of an individual's health data
• Standardization of electronic transmissions to reduce the number of forms and methods used in claims processing
• Two parts to provision: development and implementation of standardized electronic transactions using common sets of descriptors (code sets), and implementation of privacy and security procedures to prevent the misuse of health information and ensure confidentiality

Roles and Relationships

• Department of Health and Human Services (HHS): establishes and implements standards
• Centers for Medicare and Medicaid (CMS): enforces insurance portability and code set requirements of HIPAA
• Office of Civil Rights (OCR): enforces privacy standards
• Covered entity: may be a health plan, health care clearing house, or health care provider
• Electronic media: mode of electronic transmission; may include the Internet, extranet, telephone lines, fax modems, or disks or magnetic tape
• Transaction: transmission of information between two parties; can include