Syringes and Needles

Syringe Parts

• Plunger moves back and forth to withdraw and instill medication
• Barrel holds the medication
• Plain tip is the part where the needle attaches
• Needle hub connects the needle to the syringe
• Needle pierces the skin for medication delivery

Syringe and Needle Selection

• Consider the type of medication being administered
• Choose the appropriate depth of tissue for injection
• Select based on the volume of the prescribed drug
• Account for the viscosity of the drug
• Adjust for the client's size

Redesigning Syringes and Needles

• A primary goal is to reduce needlestick injuries
• Reducing such injuries decreases the risk of blood-borne viral diseases like Hepatitis B, Hepatitis C, and HIV/AIDS

Pharmaceutical Preparation

• Drugs are sometimes packaged in a pre-filled cartridge
• A pre-filled cartridge is a sealed glass cylinder containing parenteral medication
• These cartridges have an attached needle
• Have been specifically designed to fit a particular syringe

Combining Drugs in a Syringe

• Ensure precise medication withdrawal, it is difficult to remove excess medication
• Consult a drug reference guide or compatibility chart to prevent chemical interactions
• Combining certain drugs can result in a precipitate, a liquid containing solid particles

Injection Routes

• Intradermal injections go between the layers of the skin
• Subcutaneous injections are administered under the skin
• Intramuscular injections target the muscle tissue
• Intravenous injections are instilled directly into veins

Injection Sites

• For intradermal injections, common sites: inner forearm, back, posterior upper arm, and upper chest, usually for diagnostic purposes
• Subcutaneous injections have fastest absorption in the abdomen, while slowest absorption occurs in the outer back of the upper arm, outer thigh areas, and "wallet area" of the buttocks
• Insulin injections involve rotating sites within the abdomen, avoiding a 2-inch margin from the umbilicus to prevent tissue injury
• Intramuscular injections sites include the deltoid, ventrogluteal, vastus lateralis, and rectus femoris muscles

Syringe Types

• Intradermal injections typically use a tuberculin syringe (1 mL) with 0.01 mL increments and a 25 to 27 gauge needle, ½ inch in length
• Subcutaneous injections may use an insulin syringe for insulin or a tuberculin syringe for heparin, with a 25 gauge needle, ½ to 5/8 inch in length
• Intramuscular injections require a 22 gauge needle, 1 ½ to 2 inches in length, and a 3 to 5mL syringe

Injection Angles

• Intradermal injections should be administered at a 10 to 15 degree angle
• Subcutaneous injections: use a 90 degree angle with a 2-inch skin fold for normal or obese individuals, and a 45 degree angle with a 1-inch fold for thin clients
• Intramuscular injections are given at a 90 degree angle
• It is recommended to use the z-track technique to seal the medication in the muscle

Insulin Combinations

• With mixed insulin combinations, medications should be administered within 15 minutes
• This ensures the medications act as if they were injected separately

Preventing Bruising with Heparin

• Change the needle after filling the syringe before administering the injection
• Avoid cleaning the injection site with alcohol wipe
• Do not aspirate the plunger
• Leave the needle in place for 5 seconds after injecting
• Apply pressure with gauze to control bleeding instead of rubbing (can increase local bleeding)
• Rotate injection sites and avoid areas with previous local bleeding

Intravenous Medications

• Administer medications into peripheral or central veins

Intravenous Administration Situations

• When a quick response is needed during emergencies
• Clients who have disorders that affect absorption or metabolism of drugs e.g. serious burns
• When blood levels of drugs are needed to maintain a consistent therapeutic level, such as when treating infections caused by drug-resistant pathogens or providing pain relief
• Clients wanting to avoid the discomfort of repeated intramuscular injections
• When there is need administer drug therapy over a prolonged period

Bolus Administrations

• "IV push" can be administered through a port in an existing IV line or via a medication lock
• A port in existing IV is a sealed opening extends from IV tubing
• A medication lock utilizes saline or heparin, with the end of IV catheter permitting instant access to the venous system when the plug is inserted

Intravenous Medication Administration

• Can occur through continuous infusion
• Can occur through intermittent infusion (bolus, piggyback, volume-control set)
• Can occur through central venous catheters (CVC): percutaneous, tunneled, and implanted

Administering Medicated Solutions

• Short-term (minutes to 1 hour) administration can be done via bolus, secondary (piggyback), or volume-control set

Secondary Piggyback Infusion

• Dilute medication in 50 to 100mL over 30 to 60 minutes
• Administer medication along with a primary IV solution

Volume-Control Set

• Also known as volutrol, soluset, or buretrol
• Used to administer IV medication in a small volume of solution at intermittent intervals
• Prevents accidental overload of the circulatory system

Central Venous Catheter

• Provides venous access to larger veins leading to the superior vena cava
• Can have single or multiple lumens (lines)
• Multiple lumens allow for simultaneous administration of incompatible substances

Central Venous Access Catheters

• Percutaneous inserted through skin in a peripheral vein
• Tunneled inserted into a central vein with part of the catheter secured in subcutaneous tissue
• Implanted sealed beneath the skin, provides greatest protection against infection

Administering Antineoplastic Drugs

• Antineoplastic agents (used for cancer) are toxic to normal and abnormal cells
• Absorption can occur through skin contact, inhalation, or oral pathways, potentially leading to headaches, dizziness, nausea, burning, or itching
• Should use double gloves
• Pharmacists attach warning labels