ASPIRATING DRUGS FROM AMPULES AND VIALS

AMPULES 1. Before preparing to open the ampule, make certain that all of the drug content is in the ampule proper and not in the stem. Rationale: The drug tends to be trapped in the stem and it may be necessary to tap the stem several times to help bring the drug down. 2. Wipe the neck of the ampule with cotton ball soaked in 70% alcohol. Rationale: Wiping the ampule with an antiseptic solution is necessary to remo e the dust that might ha e lodged in it. !. "se sterile gau#e or dry cotton ball to hold ampule while breaking to protect the fingers. Rationale: Sterile material is necessary because it will be in direct contact with the opening of the ampule when the stem is removed. $. %iscard cotton or gau#e and the stem and put the ampule down. &. 'o remo e the drug, insert the needle into the ampule and withdraw the solution being careful not to touch the mouth of the ampule with the needle in order to minimi#e all chances of contamination. Rationale: 'he fluid in the ampule is immediately displaced by air, therefore there is no resistance to its withdrawal.

VIALS 1. (emo e metal cap by means of a file. Rationale: This exposes the rubber part which is the means of entrance into the vial. 2. )leanse rubber cap with cotton ball soaked in 70% alcohol. *n+ect air of the same amount as the solution to be withdrawn. (ationale, 'his increases the pressure within the ial and the drug can be withdrawn easily since fluids mo e from an area of greater pressure to an area of lesser pressure. !. -old the plunger firmly when withdrawing drugs from solution is in large amount. ial especially when

PARENTERAL MEDICATION

Introduction: 'he safe preparation and administration of parenteral medications is a routine nursing responsibility that re.uires de/terity0 sterile techni.ue0 a knowledge of the actions, usual dosage, desired effects, and potential side effects of the drug being gi en0 and the knowledge of how and where to gi e the drug. *t is possible to cause pain while gi ing the in+ection but, focusing on the beneficial effect that the medication brings to the patient will help ease such apprehension. Definition: 1arenteral drug administration can be taken literally to mean any non2oral means of drug administration, but it is generally interpreted as relating to in+ection directly into the body, by2passing the skin and mucous membranes. Principles: 1. "se only sterile needles and syringes. 2. 3elect appropriate length of needle to deposit the medication in the proper tissue layer. !. 3elect the in+ection site carefully to a oid ma+or ner es, blood underlying organs. essels and

$. 3elect an in+ection site that is relati ely free of hair, lesions, inflammation, rashes, moles, freckles and the like. &. (otate in+ection sites for patients establishing a predetermined plan. recei ing repeated in+ections by

4. 5btain assistance as needed in gi ing an in+ection when the patient is a frightened child or an uncooperati e adult. 7. 6spirate by pulling back on the plunger 7e/cept, heparin8 to a oid in+ecting subcutaneous and intramuscular medications into a blood essel. 9. )heck for drug allergies before administration of medication. :. *dentify the medication you will administer and obser e for side effects and therapeutic actions. Common Routes:

1. *ntradermal 2. 3ubcutaneous !. *ntramuscular $. *ntra enous

SYRINGES 6 syringe is a de ice used for in+ecting, remo ing or infusing fluids. 'hey are most commonly known in health care settings for in+ecting medications and for use in remo ing blood from the body. 3yringes can differ in si#e and type, and they can be made of glass or plastic. 'he syringe chosen usually depends on its intended purpose. 'he syringe consists of a plunger, barrel, hub, needle and the needle;s protecti e co er. *t is important that all parts of a syringe coming into contact with the body be kept free of contamination.

PARTS OF SYRINGES

Plunger - is located at the end of the syringe and can be made of clouded or colored glass or plastic. Its purpose is to fill or empty the barrel. The plunger is pulled back to fill the barrel and is pushed forward for emptying.

Barrel - is the part of the syringe that contains the fluid, whether it is a medication, blood or a solution drawn from the body. It is usually calibrated in tenths (a tenth is equal to 0.1 milliliters) to make precise measurements of the quantity of the fluid that is to be gi en or remo ed. The barrel can range in si!e from 0." m# to "0 m#.

Hub - the lower end of the syringe, opposite the plunger, terminates into a needle hub. The hub consists of a needle adapter that allows the needle to be attached to the syringe. The hub also functions to lock the needle in place while using the syringe for its desired function.

Needle - consists of the shaft, lumen and be el. $eedles ary in length, si!e of the shaft and si!e of the lumen. The shaft is the metal%s length and is usually chosen depending upon the route and site of administration, physical mass of the client, and the thickness of the medication. The lumen, also known as the bore, is the hollow space within the needle. The diameter of the lumen is known by the needle%s number gauge. The lumen is chosen with the same specifications as the shaft. The last part of the needle, the be el, is the pointed end and determines the needle%s sharpness.

Protective Cover/Cap - is pro ided to maintain the needle%s sterility. $eedle sticks are a common way of transporting infections to health care pro iders and clients. The needle%s be el is co ered to limit the amount of accidents that could happen in ol ing needles and to ensure that only the intended client recei es the needle stick. In an attempt to reduce contamination and increase safety, most needles are disposable and are thrown out after a single use.

&

INTRADERMAL

R INTRAC!TANE !" IN#ECTI N

It is the introduction of a solution by means of a syringe and a needle into the superficial layer of the skin or 'ust below the epidermis of the skin. Purposes: 1. To identify allergens to which the patient may be hypersensiti e (skin test). (. To diagnose indi iduals who ha e de eloped antibodies against specific pathogens, such as tubercle bacillus. ). To accinate, e.g. *+,. Sites of Injection: 1. Inner surface of the forearm (. -pper chest if not hairy

). -pper back Equipment: .. /ypodermic Tray lined with sterile towel containing0 1. (. ). 4. ". 6. :. 8. 1edicine Ticket 2olution prescribed 3isposable sterile tuberculin syringe 3isposable sterile (cc syringe 3isposable sterile needle ,("5(6, "789 3isposable sterile aspirating needle . 'ar of cotton balls soaked in :0; <=/ (more than ( +*s) >aste <eceptacle

*. 2harps +ontainer

Procedure: .ction 1. +heck for the physician?s order and assemble all equipment. Rationale: To ensure that the patient receives the right medication at the right time by the proper route. (. .ssess the patient?s history of allergies and note the substances the patient is allergic to and the normal allergic reactions. Rationale: Certain substances have similar compositions, the nurse should not administer substance if the patient is known to be allergic to prevent its occurrence.

). >ash your hand and assemble all equipment. Rationale: Handwashing deters the spread of microorganisms. $. @ollow the basic @i e <ights (1st " <ights). Rationale: Promotes the patient s safety by preventing medical error. &. Aick up syringe and attached the aspirating needle. Rationale: This prevents contamination of the needle and syringe. 6. Aroceed as in the procedure of preparing7withdrawing a drug from ampule or ial. Rationale: Pharmaceutical products for parenteral administration are supplied in various containers. $ote0 To prepare for skin testing, withdraw 0.Bcc of the diluents and 0.1cc of the prescribed medicine

:. +hange aspirating needle with ,(" or (6 needle. 1aintain sterility by retaining the cap of the needle. Alace on top of hypotowel. 8. Aresent preparation to +.I. for checking together with the empty ampule or ial of the drug prepared and pink booklet for signing. Rationale: This guards against error in medication. B. +arry tray to patient?s room. Identify the patient and eCplain the procedure. Rationale: This prevents error in medication. !n e"planation encourages the patient cooperation and reduces apprehension. 10. 2elect an area on the inner aspect of the forearm (or other appropriate sites). Rationale: The forearm is a convenient and easy location for introducing an agent intradermally. 11. +leanse the area with a cotton ball soaked in :0; alcohol wiping with a firm, circular motion and mo ing outward from the in'ection site. 3iscard used cotton ball. .llow the skin to dry. Rationale: Pathogens on the skin can ba forced into the tissues by the needle. #rying the skin will prevent introducing alcohol into the tissues during in$ection as alcohol is irritating to the tissues and this makes patient ubcomfortable. 1(. Aick up syringe and remo e the cap. -se your non5dominant hand to grasp the dorsal forearm and gently pull the skin taut. Rationale: Taut skin provides an easy entrance into intradermal tissue. 1!. Alace the needle "51" % angle against the patient?s skin. >ith be el side up, insert the needle beneath the skin so that the point of the needle can be seen through the skin. Insert the needle only about 178 inch. Rationale: &ntradermal tissue will be entered when the needle is held as near parallel to the skin as possible and is inserted about '() inch. 14. 2lowly in'ect the agent while watching for a small wheal or bleb to appear. If non appears, withdraw the needle slightly. Rationale: &f a small wheal or bleb appears, the agent is in intradermal tissue. 1". >ithdraw the needle quickly at the same angle that it was inserted. Rationale: *ithdrawing the needle +uickly and at the angle at which it entered the skin minimi,e tissue damage and discomfort for the patient. 16. 3o not massage the area after remo ing the needle. Aat dry. Dncircle the wheal with a blue or black pen and instruct the patient and7or watcher not to disturb the wheal nor erase the mark. Inform the patient7watcher that you will be back with physician after )0 minutes. Rationale: -assaging the area where an intradermal in$ection is given may interfere with the results by spreading medication to underlying subcutaneous tissue. ! red pen may influence the reading. The physician will interpret the result of the procedure. 1:. -se the fish5hook technique to recap the used needle and placed it on top of the hypodermic towel. Rationale: -ost accidental puncture wounds occur when recapping the needles. .eaving the needle uncapped protects the needle from accidental in$ury with the needle.

18. >rite the time in'ected, due time and site at the back of the medicine ticket. Rationale: The nurse considers the well/being of the patient. 1:. Inform the +.I. of the procedure done, patient?s name, due time and site. Dndorse the medicine ticket to the $=3. Rationale: !wareness of the procedure done and to give time to contact the physician for interpretation. (0. #ea e the medicine ticket and the used syringe on the hypodermic towel for possible re5skin testing. >ash your hands. Rationale: &f the result is doubtful, there may be a need for re/skin testing as ordered. Handwashing deters the spread of microorganisms. (1. =bser e the area for signs of a reaction within )0 minutes. .ccompany the attending physician or <=3 to interpret the result. Rationale: ! circle easily identifies the site of intradermal in$ection and allows for careful observation of the e"act area. ((. >rite the positi e (E) or negati e (5) sign on the appropriate space of the medicine ticket.