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Injectable medications - skills
Transcript of Injectable medications - skills
1) Understand why injectable route is sometimes most appropriate
2) Identify injection routes
3) Discuss injection sites and identify best practice, pros and cons of each
4) Understand and identify safe practice
5) Gain an understanding of second checking related to injectable medicines
6) Practice simulation of injection technique
Speed - IM quicker than s/c quicker than oral
Medication is not altered by internal secretions
Medication not absorbed by alimentary tract
Where patient cannot take oral medications eg swallowing difficulties, following oral surgery, NBM
Where longer term release of medicine is required (absorbtion of some depot injections can last 2-5 weeks)
The metabolism of a drug to an inactive metabolite the first time it passes through the liver.
Digestion of large molecules (proteins and carbohydrates) occurs in small intestine (ileum) - broken down to amino acids and glucose which are absorbed across wall into portal circulation - drains into portal vein - to liver. Here some drugs are metabolised (=first pass effect) before entering circulation via inferior vena cava.
eg levodopa (to treat Parkinson's Disease). 98% is metabolised during the first pass. Used to give 100 fold dose, but now give drug carbidopa (a protective enzyme).
Biotransformation = process of metabolizing parent drug to different compounds called metabolites. The drug metabolite may decrease, increase or stay the same in pharmacological activity compared to parent drug.
Alternative routes eg parenteral routes (IV, s/c, IM injection) rather than enteral routes (via GI tract) are then sought.
What do I need to know?
Professional issues: once injectable drug is given cannot be retrieved!
Remember 5 Rights
Incident form for any error or near miss
Knowledge: although conisdered to be routine, administration of injectables requires knowledge of A&P, pharmacology, psychology, communication skills and practical expertise
Standards for Medicines Management (NMC 2008)
Second (double) checking
Checks and error traps are built in to medication processes. A key error trap is double checking all complex dose calculations and double checking by a second person in defined, high risk circumstances eg IV infusion, complex calculations.
Trusts will all have own local policies regarding double checking which vary acording to patient group and what is considered high risk.
High risk medications:
(DH 2004: Building a safer NHS for patients)
Injectable medications - skills
First pass reviewed......
Advantages and disadvantages of injectables
Sites for injections
Giving an injection - sub cutaneously (s/c)
Giving an injection intramuscularly (IM)
'one of the most serious health and safety threats in European workplaces...' (European Parliament Report 2010)
are a common occupational hazard
nurses are most at risk
needlestick injuries can happen during many procedures: injection, venepuncture, aspiration, handling waste...
very close so can dispose of needles and other sharps (glass vials) safetly
- demo - tow types:
1) where needle guard is placed over needle
2) where needle is sprung back into syringe after use
Allergic reactions - slower than oral, upto 30 minutes after injection
Aim: to deposit medication into skeletal muscle where there is a rich blood supply to allow medication to be absorbed quickly and effectively.
i/m site chosen reflects viscosity, volume and amount of sub cutaneous tissue (fat) patient has. Nurses should use clinical judgement, incorporating evidence-based practice into selecting appropriate site.
4 common sites:
deltoid muscle (upper arm)
ventrogluteal muscle (top pf thigh/hip)
vastus lateralis muscle (thigh)
dorsogluteal muscle (upper buttock)
Examples: analgesia, anti-emetics, iron, vitamins
Medication is injected into the subcut (fatty) layer under the skin
Small volumes only (upto 2 mls) minimal blood supply in this layer therefore slower absorbtion rate.
No apsiration of needle necessary
eg insulin, heparin, vaccines, local anaesthetics)
Injection site rotated
First Pass Efffect
Sub cut sites
Giving a sub-cut injection