The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [559]
Figure 13.21 Needles.
Three categories of needle bevel are available.
Regular: for all intramuscular and subcutaneous injections.
Intradermal: for diagnostic injections and other injections into the epidermis.
Short: rarely used.
Medication preparation
Medicines are presented as liquids and can be drawn up directly from the vial or ampoule. If the medicine has been presented in a powder form it will need to be reconstituted. This is usually done using water for injections but some medications will require special diluents which are often supplied with the medication. When adding diluent to a powder, for example 2 mL to a 100 mg vial, the final volume will exceed 2 mL although this is usually not of any consequence if the total dose is to be administered (Downie et al. 2003). In order to ensure that the correct volume is withdrawn, it will be necessary to perform a calculation.
Medication calculations
The drug volume required from stock strength:
It is important to note that the ‘use of calculators to determine the volume or quantity of medication should not act as a substitute for arithmetical knowledge and skill’ (NMC 2008a).
Single-dose preparations
The volume of the injection in a single-dose container is sufficient to permit the withdrawal and administration of the nominal dose using a normal technique.
Multidose preparations
Multidose aqueous injections contain a suitable antimicrobial preservative at an appropriate concentration except when the preparation itself has adequate antimicrobial properties. When it is necessary to present a preparation for parenteral use in a multidose container, the precautions to be taken for its administration and more particularly for its storage between successive withdrawals are given.
Parenteral infusions
Parenteral infusions are sterile, aqueous solutions or emulsions with water; they are free from pyrogens and are usually made isotonic with blood. They are principally intended for administration in large volume. Parenteral infusions do not contain any added antimicrobial preservative (British Pharmacopoeia 2007, Hilary et al. 2001).
Specific patient preparations
Reducing pain of injections
Patients are often afraid of receiving injections because they perceive the injection will be painful (Downie et al. 2003). Torrence (1989) listed a number of factors that cause pain.
The needle.
The chemical composition of the drug/solution.
The technique.
The speed of the injection.
The volume of drug.
Applying manual pressure to an injection site before performing an injection can be an effective means of reducing pain intensity (Chung et al. 2002). Other ways of reducing pain during injections are covered in Box 13.12.
Box 13.12 Reducing the pain of injections
Correct length and gauge of needle.
Correct site.
Correct angle (90° for IM).
Correct volume (no more than 3 mL at a site for IM).
Rotate sites.
Consider using ice, freezing spray or topical local anaesthetic to numb the skin.
Listen to views of the experienced patient.
Explain the benefits of the injection.
Positioning of the patient so that the muscles are relaxed.
Use distraction.
If appropriate, ask the patient to turn their foot inwards (IM).
Insert and remove the needle quickly.
Inject medication slowly.
(Dickerson 1992, Downie et al. 2003)
Procedure guideline 13.12 Medication: single-dose ampoule: solution preparation
Essential equipment
Medication ampoule
Needle
Syringe
Sterile topical swab
Sharps container
Ampoule opening aid
Preprocedure
Action Rationale
1 Wash hands with bactericidal soap and water or bactericidal alcohol handrub. To prevent contamination of medication and