授课题目

Unit 10  Injections

授课形式

lecture and demonstrate

授课时间

2006.11.20

授课学时

4

教学目的

与 要 求

1.  describe the injection principles

2.  name parts of a needle and syringe

3.  state usual injection sites.

4.   demonstrate steps in administering injections.njections

1.   

基本内容

Unit 10  Injections

1.Injection principles

2.Injection equipment

3.Injection methods 

1) Medication extraction

2) Intradermic injection

3) Hypodermic injection

4) Intramuscular injection

5) Intravenous injection

重 点

难 点

1.  injection principles.

2.  How to lessen client’s pain during injection?

3.  Sites of  intradermic injection and intravenous injection.

4.  four reasons of  IV failure.

主要教学

媒 体

PPT, video

主 要 外

语 词 汇

Injection, syringe, disposable, needle, ampule, vial

有关本内容的新进展

Safty syringe

主要参考资料或相关网站

1、Zhou Kexiong. Basic Nursing Skills

2、SABDRA F.SMITH. Clinical Nursing Skills. Prentice Hall Health.

系、教研室

审查意见

已审合格，同意授课。

课后体会

1.  时间正好

2.  学生基本能听懂和理解。

3.  适当增加与学生的交流，锻炼学生口语。

4.  因为内容重要，可以在最后让学生用中文重复操作步骤和重点内容。

教学内容

时间分配和

媒体选择

Unit 10  Injections

【Learning objectives】

1. describe the injection principles

2. name parts of a needle and a syringe

3. state  usual injection sites.

4. demonstrate steps in administering injections

Injection Principles

Abide by check principles.

Abide by aseptic principles.

Medication should be dra招生简章wn up from the container just before injection. 

Select syringe and needle of the appropriate size in terms of the route, site, volume of injection and characters of drug, condition of client. Generally, large and long needle is appropriate for high viscosity or irritating medication.

Select appropriate injection site: Site should be away from nerves, bones, and blood vessels. The skin surface of the site should be free of inflammation, bruises, nodules and scars. For the client with long period of injection, the nurse should change the site frequently to protect tissue.

Expel all air bubbles in the syringe before injection. Rationale: Air bubbles may cause discomfort or embolism.

Observe for flashback of blood after injection. Once the needle inserted, pull back the plunger a little. When administering medication by hypodermic or intramuscular injection, if you see blood in the syringe, do not inject the solution. Remove the syringe right away and discard syringe. Prepare a new syringe and try again. Avoid injecting into blood vessel. When administering medication by intravenous injection, the nurse must see blood in syringe first, and then inject medication.

Insert needle at appropriate depth and angle. Different types of injection require different angle and depth of needle insertion. Nurses should perform the injection following standard procedure to ensure the medication is injected into appropriate tissue.

Administrate painless technique

Dispose of used equipment. Used equipment should be disinfected first, and then be disposed of. Proper disposal of vials and used needles and syringes is very important. They should never be reused. Do not replace the needle cap after injection. Needles must always be discarded in a puncture resistant container.

Injection Equipment

Medication tray, including: Sterile gauzes

Sterile swabs

Antiseptic solutions (alcohol and Anerdian, Iodophors or iodine tincture )

Sterile tweezers and vat

File and vial opener

Contamination container

Syringe and needle

Injection Methods

Ⅹ－Ⅰ　Medication Extraction

【Purpose】To prepare medication for injection

【Equipment】

【Procedure】

Drawing up medication from an ampule

1.  Prepare equipment, wash hands and wear mask. Rationale: Prevent cross-contamination.

2.  Check the medication administration record (MAR). Check expiry dates and the package of each item including the drug and determine their quality. Rationale: Ensure correct medication administration.

3.  Pick up ampule & flick the upper stem several times with a fingernail if there’s liquid at the place. Rationale: Avoid waste of medication.

4.  Cut ampule’s neck with file.

5.  Wipe around the ampule’s neck with alcohol swab.

6.  Wrap a sterile gauze around the ampule’s neck and break the neck with an outward snapping motion.

7.  Check syringe and needle and prepare to withdraw the medication from the ampule usiwww.med126.comng one of the following methods:

a b

Figure 10-2 Drawing up medication from an ampule

8.  Remove the needle from the solution. Hold the needle upright, expel any air that may have been drawn into the syringe. Make sure the syringe contains the right amount of medication. Rationale: Ensure medication dosage is correct.

9.  Cover the needle with guard then put on the syringe bag. Rationale: Prevent contamination of syringe or needle.

10. Recheck against the MAR.

Drawing up medication from a vial

   a b c

Figure 10-3 Drawing up medication from a vial

1.  Prepare equipment, wash hands and wear mask. Rationale: Prevent cross-contamination.

2.  Check the medication administration record (MAR). Check expiry dates and the package of each item including the drug and determine their quality. Rationale: Ensure correct medication administration.

3. Remove the metal cap from vial and cleanse top with Anerdian swab.

4. Check syringe and needle, then remove guard from needle.

5. Pull back on barrel of syringe to draw in a volume of air equal to the volume of the ordered medication dose. Holding the vial between your fingers, insert the needle through the rubber stopper into the air space. Don’t insert it into the solution. It’s too deep. Rationale: Injecting a volume of air equal to the volume of the medication can increase the pressure in vial. It’s difficult to draw up medication with negative pressure.

6. Inject air into the vial (Figure 10-3a).

7. Invert the vial. Make sure the needle is in the solution to be withdrawn. Withdraw the ordered dose of medication by pulling back on the plunger. Adjust dose if necessary. (Figure 10-3b).  

8. Remove needle from vial (Figure 10-3c). Rationale: Fix needle hub with index finger as withdrawing.

9. Expel air bubbles.

10. Cover the needle with guard then put up the syringe bag.

11. Recheck against the MAR.

Ⅹ－Ⅱ　 Intradermic Injection

【Purpose 】

【Injection sites】

Inner aspect of middle ventral forearm (For medication allergy test)

Area around the end of deltoid (For vaccination )

【Equipment】

【Procedure】

1.  Prepare medication test solution and take equipment to client’s room.

2.  Identify the client and medication.

3.  Explain action of medication and procedure of administration. History of allergy must be known inside out.

4.  Select site for injection. Wash your hands and wear mask.

5.  Cleanse area twice with alcohol swabs. Rationale: The antiseptic solution containing iodine can’t be used, which will interfere with the test results.

6.  Check medication again.

7.  Expel all air bubbles from syringe.

8.  Gently pull the skin taut on ventral forearm.

9.  Identify client again.

10. Insert needle at a 5^。 angle with the bevel of the needle facing up. Rationale: If the angle of inserting is larger, the needle may insert into subcutaneous tissue.

11. After the whole bevel goes into skin, fix the syringe firmly. Rationale: Insert the bevel of needle into the skin completely to avoid leaking of medication

12. Inject 0.1ml medication slowly. Observe for signs of wheal formation and blanching at the site. Rationale: Ensure the dose of injected volume of medication is accurate .If there is any reaction, stop test and manage reaction.

13. Withdraw needle. Do not massage the area. Rationale: Pressing on the area may affect the test results and medication may disperse into the deeper tissue or out through the needle insertion site 

14. Record time.

15. Ask client not to press or scratch the are, and just to tell nurse as soon as possible in case of any discomfort.

16. Dispose of equipment. Rationale: Do not replace the needle cap.

17. Wash hands, and recheck against the MAR.

18. 15—20 minutes later, observe and record result. Rationale:If necessary, inject 0.lml normal saline solution at the same site of the other forearm for comparative study.

u  Different procedure of ID compared with IM

l.Equipment(用物)

2.Enquiry(询问)

3.Cleansing(消毒)

4.Inserting

5.Withdrawing(拔针)

6.Communication.

7.Observing and recording result

Ⅹ－Ⅲ Hypodermic Injection

【Purpose 】

【Injection sites】

Area around the end of deltoid.

Lateral aspects of upper arm.

Abdomen, avoid umbilicus area.

Scapular and waist area of back.

Front and side of thigh.

(Figure 10-4)

Figure 10-4 Hypodermic injection sites

【Equipment】

【Procedure】

1.  Prepare madication and take equipment to client’s room.

2.  Identify the client and medication.

3.  Explain action of medication and procedure of administration.

4.  Select site for injection and have the client assume a position appropriate for the site selected. Rationale: Proper position will make the local tissue relax and reduce the discomfort of the client.

(1) If the outer aspect of upper arm is selected, the client may have a sitting or lying position, the arm should be relaxed at the side of body.

(2) If the back area is selected, the client may be prone, on side, or assume a sitting position.

(3) If the abdomen is selected, the client may lie in semirecumbent position or supine position with the knees flexed.

(4) If the anterior thighs are selected, the client may sit or lie with the leg relaxed.

5.  Wash your hands and wear mask..

6.  Cleanse area with Anerdian swabs.

7.  Check medication again.

8.  Remove the needle cap and expel all air bubbles from syringe.

9.  Using the non-dominant hand, gently grip the skin over the site.

10. Identify client again.

11. Using the dominant hand, introduce 1/2~2/3 of the needle at a 30-40° angle quickly with the bevel of the needle facing up. Rationale: Ensure that the drug is delivered into the subcutaneous tissue. A quick injection is less painful.

12. Release the skin once the needle is in position and fix the syringe firmly.

13. Pull back the plunger a little. Rationale: If blood is seen in the syringe, do not inject the solution. Remove the syringe right away and discard this syringe. Prepare a new syringe and try again.

14. If there is no blood in the syringe, slowly push the plunger to inject the drug solution until all the medication is gone from the syringe. Rationale: Avoid injecting into blood vessel.

15. Withdraw the needle quickly. Rationale: Slow withdrawal of the needle pulls the tissues and causes discomfort.

16. Hold pressure on the site for a moment.  

17. Dispose of equipment. Rationale: Do not replace the needle cap

18. Wash hands, and recheck against the MAR.

Ⅹ－Ⅳ 　Intramuscular Injection

【Purpose 】

【Injection sites】

1.  Dorsogluteal Site

(1) Cross method.

(2) Line method

a. Cross method  b. Line method

Figure 10－5 The dorsogluteal site for intramuscular injection

2.  Ventrogluteal Site 

(1)  Triangle method:

   Figure 10-6 The ventrogluteal site for intramuscular injection

(2)Three fingers method

3.  Deltoid Site

4.  Vastus Lateralis Site

【Equipment】

Medication tray:

Syringe (2-10ml ) with needle (5.5-7 gauge)

Medication

【Procedure】

1.  Prepare medication and take equipment to client’s room.

2.  Identify the client and medication.

3.  Explain action of medication and procedure of administration.

4.  Select site for injection and have the client assume a position appropriate for the site selected. Rationale: Proper position will make the local tissue relax and reduce the discomfort of the client.

(1) If the dorsogluteal site is selected, the client may lie on the side with the upper leg straight and relaxed and placed in front of the lower leg, and the lower leg flexed, or prone with toes pointing inward, or assume a sitting position..

(2) If the ventrogluteal site is selected, the client may lie on the back or on side with upper leg straight and lower leg flexed.

(3) If the deltoid is selected, the client may sit or lie with arm relaxed.

(4) If the vastus lateralis is selected, the client may lie on the back or assume a sitting position.

5.  Wash hands and wear mask.

6.  Cleanse area with Anerdian swabs.

7.  Check medication again.

8.  Remove the needle cap and expel all air bubbles from syringe.

9.  Stretch the skin around the chosen site with the non-dominant hand.

10. Identify client again.

11. Using the dominant hand, plunge the needle 1/2~2/3 in quickly, at an angle of 90°. Rationale: Ensure that the needle is inserted into the muscle. Determine the depth of injection according to the age and weight of client. A quick injection is less painful.

12. Once the needle is in the site, release skin and fix the syringe firmly.

13. Pull back the plunger. If no blood is aspirated depress the plunger at approximately 1ml every 10 seconds and inject the drug slowly. If blood appears, just withdraw the needle completely and replace it and begin again.  Explain to the patient what has occurred. Rationale: Avoid injecting into blood vessel.

14. Withdraw the needle rapidly.

15. Hold pressure on the site for a moment.  

16. Dispose of equipment. Rationale: Do not replace the needle cap

17. Wash hands, and recheck against the MAR.

Ⅹ－Ⅴ 　Intravenous Injection

【Purpose】

To promote rapid absorption of the medication

To inject medication which is irritating to tissues or can’t be taken orally.

【Venipuncture sites】

【Equipment】

Medication tray:

Syringe

Winged needle (6 – 9 gauge)

Tourniquet

Protective pad

Medication

【Procedure】

1.  Prepare medication and take equipment to client’s room.

2.  Identify the client and medication.

3.  Explain the procedure to client.

4.  Select site for injection and set the protective pad under arm.

5.  Wash your hands and wear mask..

6.  Apply Anerdian to selected venipuncture site.

7.  Apply tourniquet 6cm above selected site. Rationale: To distend vein.

8.  Check medication again.

9.  Connect syringe with winged needle. Expel all air bubbles from syringe and winged needle.

10. Pull the skin taut.

11. Call client’s name. Ask client to close fist. Rationale: Promote sufficient blood.

12. With needle bevel up, enter client’s skin at an angle of 20-30^。 and then enter into vein at an angle of 5-15^。. Rationale: Adjust the angle of insertion in terms of the depth and thickness of selected vein.  

13. Observe flushback of blood. Rationale: Flushback of blood indicates the needle has gone into vein.

14. Flatten needle once it goes into vein and carefully advance needle up course of the vein.

15. Release tourniquet and fist.

16. Pull back the plunger. If blood returns, inject medication slowly. Observe client’s situation. Rationale: If no blood returns, do not inject the solution. Ensure medication is injected into blood vessel.

17. Withdraw needle quickly, and press sterile swab over venipuncture site. Hold firmly until bleeding stops.

18. Dispose of equipment.

19. Wash hands, and recheck against the MAR.

u  IV  Failure

Reasons

Flashback of blood Topical symptom

Don’t reach the vein —

1.inserted too shallow

2.incorrect direction

Inserted too deep    —

Inserted incompletely   + Pain， Bulge(肿胀) at once

 (shallow)

Inserted deep +  pain，Bulge  slowly

[Summary]

[Exercise]

1.  Describe injection principles.

2.  How to lessen client’s pain during injection?

3.  Sites of  intradermic injection and intravenous injection.

4.  State four reasons of  IV failure.

5. 

question

[PPT]

example

5’

viedo

10’

question

[PPT]

 15’

example

[PPT]

20’

photo

photo

example

photo

30’

perform

photo

photo

perform

viedo

PPT

photo

photo

perform

40’

viedo

table

photo

55’

photo

photo

PPT

60’

perform

70’

viedo

75’

photo

flash

Photo

 flash

photo

90’

Photo

100’

perform

viedo

photo

115’

130’

Photo

140’

perform

viedo

150’

Question

table

160’

question