Administer by deep sub-q injection nghĩa là gì năm 2024
This video shows how to administer a Subcutaneous Injection for delivery of medication. Also known by the abbreviations Sub-Q, SubCut, or SQ Injection. It talks through the equipment used, including the different subcutaneous injection needle sizes, sharps box. Do not administer the medication into the injection site if the skin is damaged, burned, bruised, hard, inflamed, or swollen. Some syringe plungers and rubber stoppers on vials contain latex; read the package insert to determine if the equipment contains latex. Do not pull back on the syringe (i.e., aspirate) after injecting heparin or insulin. Take steps to eliminate interruptions and distractions during medication preparation. OVERVIEWSubcutaneous tissue is not as richly supplied with blood vessels as are muscles; therefore, medications are absorbed more slowly via subcutaneous injections than with intramuscular (IM) injections. If there is a deviation in the correct route (e.g., IM instead of subcutaneous or subcutaneous instead of IM), the medication may be absorbed too quickly and cause adverse reactions related to the injection medication. Any condition that impairs blood flow is a contraindication for subcutaneous injection.undefined ref8">8The best sites for subcutaneous injection in adults include the outer aspect of the upper arms, the abdomen from below the costal margins to the iliac crests, and the anterior aspects of the thighs (Figure 1). These areas are easily accessible and are large enough to permit rotating multiple injections. For subcutaneous vaccinations in adults, only the upper outer triceps of the arm is used. The patient’s body weight and amount of adipose tissue indicate the depth of the subcutaneous layer. Therefore, the needle length and angle of needle insertion should be based on the patient’s weight and an estimate of the depth of the subcutaneous tissue (Figure 2). Typically, a 22- to 25-G, ⅝-inch needle is used for vaccinations. Heparin and insulin are usually administered with a 31-G 3⁄16- to 5⁄16-inch needle. Nurses administering subcutaneous injections must use safety syringe devices and know how to activate the safety mechanism. If the patient is obese, pinching the tissue and using a needle long enough to insert through the fatty tissue at the base of the skinfold is effective. The skin being pinched should include only subcutaneous tissue. Thin patients may have insufficient tissue for injections; the upper abdomen is the best injection site for patients with little peripheral subcutaneous tissue. Using the no-pinch method reduces bilateral exposures to nurses. With this technique, the skin remains flat and a shorter needle is inserted at a 90-degree angle., A bilateral exposure occurs when the nurse pinches up the patient’s skin before injection and accidentally inserts the needle through the patient’s skin and into the finger. The second part of the exposure occurs when the needle must be withdrawn from the nurse’s finger and back through the patient’s skin and out. The patient has been exposed to the nurse’s blood and the nurse has been exposed to the patient’s blood (Figure 3). To ensure that a subcutaneous medication reaches subcutaneous tissue, these rules should be used to determine the angle of injection:
An injection pen allows the patient to self-administer medications (e.g., insulin) subcutaneously. This offers a convenient delivery method using prefilled, disposable cartridges. The patient inserts the needle and injects a predetermined medication dose. Teaching is essential to ensure that the patient uses the correct injection technique and delivers the correct dose of medication. Insulin pen use is increasing. These medication administration devices have been associated with increased patient compliance and decreased hypoglycemia when compared to the vial and syringe method. Furthermore, insulin pens have been shown to increase patients’ satisfaction levels and improve safety without increasing cost. Insulin pens contain a cartridge filled with medication and sometimes a removable needle tip (Figure 4). The needle is changed after each dose. Injection supplies and devices should never be used for more than one person., Some pens have a spring-loaded needle within the pen that automatically retracts after the medication has been injected (Figure 5). A jet injection system may be used for the administration of subcutaneous medication (Figure 6). Jet injection is a needleless system that injects fluid through the skin. A subcutaneous device is available that allows medication to be delivered into a cannula placed into the tissue (Figure 7). The cannula remains in the subcutaneous tissue for several days. Special Considerations for Insulin AdministrationInjection site rotation has changed because newer human insulins carry a lower risk for hypertrophy. The patient chooses one anatomic area (e.g., abdomen) and systematically rotates sites within that region to maintain consistent insulin absorption from day to day. Insulin absorption occurs most quickly in the abdomen, followed by the arms, thighs, and buttocks. Pain during insulin injections may be decreased by allowing alcohol skin preparation to dry before injecting insulin, relaxing muscles around the injection site, injecting room temperature insulin, and inserting the needle quickly. Needle length may also affect pain during insulin injections. Patients with diabetes experience significantly less pain when a shorter, straight insulin needle is used, rather than a long, tapered needle. Insulin administration should be coordinated around mealtimes to ensure timely blood glucose monitoring and the prevention of hyperglycemia and hypoglycemia. Special Considerations for Heparin AdministrationPatients receiving heparin are at risk for bleeding, including bleeding gums, hematemesis, hematuria, and melena. Results from coagulation blood tests (e.g., activated partial thromboplastin time) allow the nurse to monitor the desired therapeutic range for heparin therapy. Before administering heparin, the nurse should assess for preexisting conditions that contraindicate the use of heparin, as well as for conditions in which increased risk for hemorrhage are present. The patient’s current medication regimen, including use of over-the-counter and herbal medications (e.g., garlic, ginger, ginkgo, horse chestnut, feverfew) and possible prescription medication (e.g., aspirin, nonsteroidal antiinflammatory drugs, cephalosporins, antithyroid agents, probenecid, and thrombolytics) should also be assessed for possible interactions with heparin. When heparin is administered subcutaneously, it should be injected at a 90-degree angle and administered over a 30-second period. To minimize the pain and bruising associated with low-molecular-weight heparin (LMWH), the medication is given subcutaneously on the right or left side of the abdomen, at least 5 cm (2 inches) away from the umbilicus., LMWH requires no dietary monitoring, and it has fewer hemorrhagic complications than natural (or unfractionated) heparin. If the patient expresses concern regarding the accuracy of a medication, the medication should not be given. The concern should be explored, the practitioner notified, and the order verified. SUPPLIESSee Supplies tab at the top of the page. EDUCATION
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*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice. |