DOCSLIB.ORG

Guru Poster Anaesthesia EU

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Guru Poster Anaesthesia EU Regional Anaesthesia for Upper Limb Interscalene Identify: 2-3 roots in a vertical helps to identify the correct level alignment between anterior and (symmetrical tubercles at C5, larger Sternomastoid middle scalene muscles; identify C5 & anterior tubercle at C6, no anterior C5 middle scalene C6 nerve roots; use doppler to check tubercle at C7). for vascular structures . C6 Avoid: The dorsal scapular nerve DSN Target: Using an in-plane approach (DSN) lies in the middle scalene anterior scalene from the posterior end of the probe muscle-avoid direct needle trauma; aim for the interscalene groove the vertebral artery lies deeper but C7 between the C5 and C6 roots. within needle range; large volume injections increase the risk of phrenic VA Interscalene Tips: An easy way to locate the nerve, sympathetic blockade (Horner’s interscalene site is to scan up from the syndrome) or epidural spread. C7 tranverse process shoulder, proximal supraclavicular region; the distinctive humerus surgery morphology of the transverse processes anterior posterior Supraclavicular Identify: The subclavian artery lying Tips: Rotate the lateral end of the on the first rib with underlying pleura. probe a little posteriorly to optimise omohyoid suprascapular The brachial plexus appears as a the image; keep the 1st rib in view nerve honeycombed structure lateral and beyond the needle tip to protect anterior superficial to the artery. against pneumothorax. scalene SCA Target: Using an in-plane needle Avoid: Pneumothorax: avoid needle middle scalene approach from the lateral end of tip penetrating beyond the first rib - it 1st rib brachial plexes the probe. You may need to make is vital to keep the tip in view throughout. 2-3 injections in the brachial plexus sheath to ensure LA spread to all Supraclavicular components including the “corner pocket” between the artery and rib. humerus, elbow, pleura hand surgery medial lateral Infraclavicular Identify: The pectoralis major & minor Tips: Arm abduction and external muscles, the axillary artery and vein, rotation improves the view and needle the 3 cords arranged around the access below the clavicle but is not artery. essential; the pectoral muscles help pec major to anchor nerve catheters at this site. Target: Using an in-plane approach pec minor from the cephalad end of the probe Avoid: Pneumothorax, blood vessel aim for the posterior cord deep to puncture (check for the cephalic vein medial the artery and check LA spread, joining the axillary vein). AA inject around the lateral cord on AV lateral Infraclavicular needle withdrawal, redirect the needle over the artery to the medial cord if posterior humerus, elbow, necessary. hand surgery caudad caphalad Identify: The axillary artery and veins Tips: Scan distally to confirm each Axillary medial (often multiple). The conjoint tendon nerve identity (median n stays with cutaneous nerve of teres major and latissimus dorsi brachial artery, ulnar n moves medially V is important: the four target nerves and superficially to the cubital tunnel, biceps U V (musculocutaneous, median, ulnar, radial n dives deep towards the M V radial) will lie above that tendon. The medial border of humerus with the AA R medial cutaneous n of the forearm profunda brachii artery); a nerve lies between median and ulnar just stimulator can be used to confirm V conjoint tendon beneath the deep fascia. nerve identity; expect variation in the position of nerves. coracobrachialis Target: Using an in-plane approach from the lateral end of the probe target Avoid: Intravascular injection (multiple triceps Axillary each nerve in turn (we block them in vessels) - watch the ultrasound for elbow, forearm, order: MC, R, U, M to preserve the injectate spread with each injection; hand surgery ultrasound view). avoid intrafascicular nerve trauma. caphalad caudad Peripheral nerves Radial brachial artery Median Ulnar ulnar nerve radial nerve median nerve medial humerus epicondyle lateral medial lateral medial medial lateral Proximal: Flex the elbow, place the probe over the lower 1/3 of the Proximal: Extend the elbow, the nerve lies medial to the brachial artery just Proximal: On the medial side of the distal humerus, above the humerus in an axial plane, look for the rounded appearance of the nerve above the elbow skin crease. medial epicondyle, locate the nerve before the nerve enters the cubital looping around the distal humerus. tunnel. Do not block the nerve in the tunnel itself. Radial Median ulnar nerve Ulnar radial nerve medial nerve ulnar artery elbow joint lateral medial lateral medial lateral medial Distal: Extend the elbow, place the probe over the lateral half of the Distal: At the mid-forearm level the nerve is a hyperechoic, honeycombed Distal: Nerve lies on the medial side of the ulnar artery. Starting at the wrist, elbow crease. The radial nerve here has a characteristic spindle shape (2 structure at the centre of 3 fascial planes. There may be an accompanying scan proximally until they separate. components + artery). artery which should be avoided. Twitter YouTube Palmar Dorsal Lower lateral cutaneous n. Lower lateral cutaneous n. Radial n. of arm (Radial n.) of arm (Radial n.) Radial n. Get the Median n. Lateral cutaneous n. of forearm Axillary n. Axillary n. Lateral cutaneous n. of forearm Median n. APP (Musculocutaneous n.) (Musculocutaneous n.) Android iPad iPhone Supraclavicular n. (Cervical plexus) Intercostobrachial n. Ulnar n. Medial cutaneous n. Medial cutaneous n. Ulnar n. of arm of the forearm Medial cutaneous n. Medial cutaneous n. Posterior cutaneous n. Posterior cutaneous n. of the forearm of arm of arm (Radial n.) of the forearm (Radial n.) FOR FURTHER INFORMATION [email protected] · pajunk.com *This poster is an educational aid. It should not be used as a sole source of information for a new technique. Variations in anatomy are to be expected and no responsibility can be accepted for the technical ability of the practioner and individual patient outcomes. Regional Anaesthesia for Lower Limb Fascia iliaca Fascia iliaca – fractured neck of femur, femoral shaft, hip surgery Identify: Start with the probe in a sagittal plane above the muscle and beneath the fascia (and A just medial to the anterior superior iliac spine clearly beneath the circumflex artery). fascia iliaca and slide medially; note the deep circumflex iliac artery (a branch of external iliac) which Tips: Lateral tilt of the probe may improve lies superficial to the fascia 1-2cm above the the view and an assistant may be required to inguinal ligament and is a useful landmark. retract the abdomen in an obese patient. This suprainguinal parasagittal view demonstrates iliacus Target: Use an in-plane approach from the the muscle & fascia passing deep into the caudal end of the probe. The target is to pelvis - gravity aids the spread of LA towards deposit local anaesthetic on the belly the lumbar plexus (this approach is also of the iliacus muscle, beneath the fascia suitable to catheter placement). proximal to the inguinal ligament. Observe the spread of local anaesthetic proximally Avoid: Injection distal to the inguinal ligament. caphalad caudad Femoral Femoral – femoral shaft, quadriceps mechanism, knee surgery Identify: The femoral artery, iliacus and Tips: Choose a proximal site before the nerve fascia lata psoas muscles and fascia iliaca. Identify the branches immediately below the inguinal fascia iliaca indentation between the two components of ligament (if the femoral artery has divided then A femoral nerve iliopsoas. The nerve lies lateral to the artery, you are too distal). The nerve is usually more V usually flattened between the fascia and visible following injection of LA. Quadriceps muscle and it can take on a variety of shapes. weakness will affect active rehabilitation and mobility. iliacus Target: Using an in-plane approach from the psoas lateral end of the probe, local anaesthetic Avoid: Superficial injection, distal injection, injection must be beneath the fascia iliaca; intravascular injection. ensure the spread of LA surrounds the nerve. medial lateral Adductor canal Adductor Canal – knee surgery, cruciate ligament repair, supplement to sciatic nerve block for distal lower limb surgery Identify: The femoral artery beneath the Tips: If necessary trace the femoral artery sartorius muscle. The saphenous nerve lies in down from the inguinal region to the medial sartorius the same fascial plane, anterolateral to the thigh, especially in larger patients. The true artery, accompanied by the nerve to vastus adductor canal starts where the medial medialis. border of sartorius crosses the medial border A of adductor longus. Above that level it is saphenous nerve Target: Using an in-plane approach from technically a femoral triangle block but the vastus medialis V the lateral end of the probe inject in the outcome is similar. fascial plane alongside the femoral artery if adductor the nerve itself is not clearly identified (it will Avoid: Intravascular injection, trauma to the longus be easier to see after injection). nerve supplying vastus medialis. antetior posterior Subgluteal Subgluteal – a proximal approach to the sciatic nerve for surgery below the knee, an alternative to the popliteal approach when access is limited; the posterior cutaneous nerve of the thigh will not be blocked Identify: At this level the sciatic nerve lies the sciatic nerve. biceps femoris between biceps femoris laterally and semi- tendinosus medially. Deep to the nerve is the Tips: Trace the nerve up from the popliteal semitendinosus adductor magnus muscle and there is usually fossa if necessary; tilt the probe to optimize a clear fascial plane between this and the visibility (anisotropy). Track the spread of LA sciatic nerve proximally and distally to ensure complete superficial muscles. The nerve is rarely round, more femur usually flattened or triangular in cross section. coverage of the nerve. Block onset can be adductor magnus delayed dueto the size of the target . Target: Using an in-plane approach from the lateral end of the probe with a longer needle, Avoid: Check for arteries crossing obliquely aim for circumferential spread of LA around deep to the sciatic nerve.
Load more

Recommended publications
  • An Intramuscular Injection Is an Injection Given Directly Into The
    Depo Lupron and Testosterone are both given by intramuscular injection. The following is a guideline on their administration. Eileen Durham, RN, NP Version 12 Jan 2010 Description Intramuscular (IM) injections are given directly into the central area of selected muscles. There are a number of sites that are suitable for IM injections; there are three sites that are most commonly used in this procedure described below. The volume of viscosity of the medication to be injected determines the site that should be used. IM injections cause stretching of the muscle fiber so the larger the muscle used the less discomfort. Intramuscular Injection Sites Depo Lupron Depo Lupron 3 month preparation should only be injected into the Gluteus medius due to the viscosity and volume of the medication approx. 1.5 – 2 cc. Depo Lupron 1 month preparation can be injection into the vastus lateralis or the gluteus medius. Testosterone Testosterone administered to adolescents and adults can be injected into any of the sites listed below, as long as the volume is 1 cc or less. For a volume of 1.5 use the vastus lateralis or Gluteus medius, if the volume is 2 cc you must you the largest muscle the Gluteus medius. If the volume is greater then 2 cc you must divide the dose and give 2 injections as the maximum volume in the Gluteal muscle is 2 cc. Testosterone administered to infants and toddlers use only the anteriolateral aspect of the thigh. Deltoid muscle The deltoid muscle located laterally on the upper arm can be used for intramuscular injections.
    [Show full text]
  • Injection Technique 1: Administering Drugs Via the Intramuscular Route
    Copyright EMAP Publishing 2018 This article is not for distribution except for journal club use Clinical Practice Keywords Intramuscular injection/ Medicine administration/Absorption Practical procedures This article has been Injection technique double-blind peer reviewed Injection technique 1: administering drugs via the intramuscular route rugs administered by the intra- concerns that nurses are still performing Author Eileen Shepherd is clinical editor muscular (IM) route are depos- outdated and ritualistic practice relating to at Nursing Times. ited into vascular muscle site selection, aspirating back on the syringe Dtissue, which allows for rapid (Greenway, 2014) and skin cleansing. Abstract The intramuscular route allows absorption into the circulation (Dough- for rapid absorption of drugs into the erty and Lister, 2015; Ogston-Tuck, 2014). Site selection circulation. Using the correct injection Complications of poorly performed IM Four muscle sites are recommended for IM technique and selecting the correct site injection include: administration: will minimise the risk of complications. l Pain – strategies to reduce this are l Vastus lateris; outlined in Box 1; l Rectus femoris Citation Shepherd E (2018) Injection l Bleeding; l Deltoid; technique 1: administering drugs via l Abscess formation; l Ventrogluteal (Fig 1, Table 1). the intramuscular route. Nursing Times l Cellulitis; Traditionally the dorsogluteal (DG) [online]; 114: 8, 23-25. l Muscle fibrosis; muscle was used for IM injections but this l Injuries to nerves and blood vessels muscle is in close proximity to a major (Small, 2004); blood vessel and nerves, with sciatic nerve l Inadvertent intravenous (IV) access. injury a recognised complication (Small, These complications can be avoided if 2004).
    [Show full text]
  • Self-Administering a Vitamin B12 Injection
    Self-administering a Vitamin B12 injection This is usually given as an intramuscular injection, every 2-3 months. Alternatives to an intramuscular injection are: Oral Vitamin B12 at a dose of at least 1000mcg per day. • Available as tablets or a spray. They can be bought over the counter and available at most health food stores and pharmacies. • Oral Vitamin B12 is not recommended if: - If you have a bowel condition such as inflammatory bowel disease, Coeliac disease, small bowel overgrowth, bile acid malabsorption and short bowel (you will require injections) - You require an initial loading of B12 (soon after diagnosis) It is important to monitor your symptoms if you change to oral B12. If symptoms return, then the oral/sublingual dose can be increased to 2000mcg or you may need to consider starting back on injections. https://www.hollandandbarrett.com/shop/product/betteryou-pure-energy-b12-boost-oral-spray-60099160?skuid=099160 https://www.hollandandbarrett.com/search?query=%20Vitamin%20B12%20Tablets&utm_medium=cpc&utm_source=google&isSearch=true# gclid=EAIaIQobChMIh5nLgOH26AIVxLTtCh0JIA_GEAAYASAAEgJL-fD_BwE&gclsrc=aw.ds Subcutaneous (SC) injection; this is off-licence but still effective. It is considered an easier method of administration. It is how insulin and blood thinning medication are usually self-administered. Equipment needed to self-inject - Prescribed medicine - 1 syringe (2 ml) - 2 needles (1 for drawing up the drug and 1 for administration – you can use the same size needle for both). o For an IM injection; the needle gauge should be 19-25. The needle length is 1- 1 ½ inches (up to 3 inches for larger adults) o For a SC injection; the needle gauge should be 25-27.
    [Show full text]
  • Efficacy/Risk Profile of Triamcinolone Acetonide in Severe Asthma
    ARTICLE IN PRESS Respiratory Medicine CME (2008) 1, 111–115 respiratory MEDICINE CME CASE REPORT Efficacy/risk profile of triamcinolone acetonide in severe asthma: Lessons from one case study Cesar Picadoà Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain Received 26 November 2007; accepted 22 January 2008 KEYWORDS Summary Insulin; Some prednisone-resistant asthma patients respond to intramuscular triamcinolone Refractory asthma; acetonide (TA). The use of TA has been questioned on the basis of its potential toxicity. Severe asthma; TA’s ratio of clinical efficacy to systemic effects compared with oral prednisone has not Steroid-dependent been clearly defined. asthma; We report the case of a prednisone-insensitive severe asthma patient with insulin- Triamcinolone dependent diabetes, hypertension and diabetic retinopathy treated with repeated sessions acetonide of laser therapy. By daily monitoring the needs of insulin doses we compared the systemic effects of prednisone and TA. The analysis of the balance between systemic effects (insulin doses) and beneficial effects (PEF values) show that TA has a better benefit/risk profile than prednisone. The patient has been followed up for 3 years and has received injections of TA repeated at intervals ranging from 21 to 60 days according to patient response and the evolution of PEF and clinical symptoms. During this period the patient lost 3 kg of weight, while presenting increased bone mineral density, normalized arterial tension, and improved proliferative diabetic retinopathy. The present case report shows that TA has a better benefit/risk profile than prednisone. TA can be a valuable alternative in the control of some patients with severe prednisone- resistant asthma.
    [Show full text]
  • How to Administer Intramuscular, Intradermal, and Intranasal Influenza Vaccines
    How to Administer Intramuscular, Intradermal, and Intranasal Influenza Vaccines Intramuscular injection (IM) Intradermal administration (ID) Intranasal administration (NAS) Inactivated Influenza Vaccines (IIV), including Inactivated Influenza Vaccine (IIV) Live Attenuated Influenza Vaccine (LAIV) recombinant hemagglutinin influenza vaccine (RIV3) 1 Gently shake the microinjection system before 1 FluMist (LAIV) is for intranasal administration 1 Use a needle long enough to reach deep into administering the vaccine. only. Do not inject FluMist. the muscle. Infants age 6 through 11 mos: 1"; 1 through 2 yrs: 1–1¼"; children and adults 2 Hold the system by placing the 2 Remove rubber tip protector. Do not remove 3 yrs and older: 1–1½". thumb and middle finger on dose-divider clip at the other end of the sprayer. the finger pads; the index finger 2 With your left hand*, bunch up the muscle. should remain free. 3 With the patient in an upright position, place the tip just inside the nostril 3 With your right hand*, insert the needle at a 3 Insert the needle perpendicular to the skin, to ensure LAIV is delivered into 90° angle to the skin with a quick thrust. in the region of the deltoid, in a short, quick the nose. The patient should movement. breathe normally. 4 Push down on the plunger and inject the entire contents of the syringe. There is no need to 4 Once the needle has been 4 With a single motion, depress plunger as aspirate. inserted, maintain light pressure rapidly as possible until the dose-divider clip on the surface of the skin and prevents you from going further.
    [Show full text]
  • Intramuscular Injections: GUIDELINES for BEST PRACTICE B
    2.1 ANCC Contact Hours Abstract The administration of injec- tions is a fundamental nursing skill; however, it is not without risk. Children receive numer- ous vaccines, and pediatric nurses administer the major- ity of these vaccines via the intramuscular route, and thus must be knowledgeable about safe and evidence-based immunization programs. Nurses may not be aware of the potential consequences associated with poor injection practices, and historically have relied on their basic nursing training or the advice of colleagues as a substitute for newer evidence about how to administer injections today. Evidence-based nursing practice requires pediatric nurses to review current literature to establish best practices and thus improved patient outcomes. Key words: Child; Evidence-based nursing; Injection intramuscu- lar; Vaccination. AbbyPediatric Rishovd, DNP, PNP Intramuscular Injections: GUIDELINES FOR BEST PRACTICE B. Boissonnet / BSIP SA / Alamy Alamy / B. Boissonnet / BSIP SA March/April 2014 MCN 107 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. ver the past decade, the childhood vaccine (2011), and the World Health Organization (2004) have schedule has increased in complexity. De- now all strongly discouraged the practice of aspirating for pending upon the combinations adminis- blood when administering an IM injection. A randomized tered, children now may receive as many control trial found that the standard injection technique as 24 immunizations via intramuscular consisting of slow aspiration and injection followed by O(IM) injection by 2 years of age (Centers withdrawal of the needle was more painful and took lon- for Disease Control and Prevention [CDC], 2011). Pedi- ger than rapid injection without aspiration (Ipp, Taddio, atric nurses administer the majority of injections and thus Sam, Gladbach, & Parkin, 2007).
    [Show full text]
  • Self-Administering an Intramuscular Injection
    Self-administering an Intramuscular injection If you have testosterone injections: - You can consider self-injecting Sustanon. - We do not recommend self-administration of Nebido as this is a more difficult to give (due to the high viscosity and preferred site of administration). If you wish to switch from Nebido to Sustanon, so you can self-inject, we will get advice from your GIC - A change to testosterone gel is an option. If this is something you wish to consider then please discuss with your GIC or a medical professional at the Health Centre. Equipment needed for an IM injection - Prescribed medicine - 1 syringe - 2 needles (1 for drawing up the drug and 1 for administration – you can use the same size needle for both) - Sharps box (purple lid for testosterone injections and yellow lid for everything else) Below is a list of the syringes and needle sizes required. If you are injecting a drug not listed below then please contact the Health Centre for further advice. These can be purchased online without a prescription. This is normally the most cost-effective way; Amazon have a good stock. If you have any problems purchasing equipment please contact the Health Centre. There is no need to purchase alcohol wipes. PHE (2013) advised that if you are physically clean and in good general health then swabbing prior to injecting is not required. Drug Syringe Size Needle Gauge Needle Length Site Angle 1- 1½ inches (up Testosterone Thigh, upper 2ml 19-25 to 3 inches for 90 (Sustanon) arm, buttocks larger adults) 1-1 ½ inches (up Thigh, upper B12 (IM) 2ml 19-25 to 3 inches for 90 arm, buttocks larger adults) Comes preloaded with 2 syringes, one MMR Thigh 90 for drawing up and one for injecting Where to inject The easiest site when self-administering an IM injection is the middle third of the vastus lateralis muscle of the thigh.
    [Show full text]
  • Injection Guide Overview and Goals of This Guide ����������������������������������� 1
    Injection Guide Overview and goals of this guide . 1 Overview of injections. 3 Why did my doctor choose an injectable medication? ��������������� 3 Differences between injectable medication and oral medication . 3 Types of injections. 4 Parts of a syringe ��������������������������������������������������� 4 Steps for injecting medication ��������������������������������������� 5 Storage ������������������������������������������������������������� 5 Preparation ��������������������������������������������������������� 6 Wash your hands ����������������������������������������������� 6 Prepare your medication for injection ��������������������������� 7 Prepare the injection site ��������������������������������������� 8 Injection ����������������������������������������������������������� 9 Intramuscular injection ����������������������������������������� 9 Subcutaneous injection ����������������������������������������10 Disposal. .11 Monitoring of the injection site ����������������������������� 12 References . .13 Injection-site records ������������������������������������������������14 Overview and goals of this guide This guide is a quick reference on how to use medications that are given by injection. It gives step-by-step instructions for preparing and injecting the medication. It also covers safety precautions. The instructions in this guide apply whether you are giving the injection to someone you care for or you are giving the injection to yourself. This guide is not meant to replace instructions from your doctor nor the information
    [Show full text]
  • Intramuscular Injection
    Welcome to Kaiser Permanente Southern California Student Unpaid Field Experience and Training Inpatient/Hospital and Outpatient/Ambulatory 1 Table of Contents 1 Policy: Student Unpaid Field Experience and Training- SC.QRM.PCS.026 Pg. 3 Appendix A. Onboarding Process 2 Policy: Drug-Free Workplace- NATL.HR.030 Pg. 13 3 Principles of Responsibility (Compliance) Respect Confidentiality, Privacy, and Security Pg. 20 Focus Resources on Member and Patient Care Protect Our Assets and Information 4 2020 Ambulatory Health Care and Hospital National Patient Safety Goals Pg. 31 5 Situation, Background, Assessment and Recommendation (SBAR) Pg. 33 6 Emergency Codes Pg. 34 Student Nurses Continue with Items 7-11 7 KP Nursing Professional Practice Model Pg. 36 8 KP Nursing Professional Practice: Nursing Vision and Values Pg. 37 9 Medication Administration Pg. 38 Policy/Practice Excerpts: Student Un-Paid Field Experience/ Regional High-Alert Medication Safety Practices Safe Medication Practices, General; Oral Drug Administration; Enteral Drug Administration; Intramuscular Injection; Subcutaneous Injection; Metered Dose Inhaler Use; IV Secondary Line Drug Infusion; Rectal suppository Administration 10 Bar Code Scanning Medication Administration- Instructions for Students Pg. 55 11 Nurse Knowledge Exchange + Pg. 56 2 3 4 5 6 7 8 Appendix A 1.0 Onboarding Process 1.1 All participating Schools agree to adhere to a standardized process for Program Participant prerequisites. 1.1.1 Student/Faculty prerequisites website address: http://kpnursing.org/_SCAL/professionaldevelopment/orientation/index.html
    [Show full text]
  • Large-Volume IM Injections
    FEATURE | Large-volume IM injections Large-volume IM injections: A review of best practices Intramuscular injections offer improved treatment adherence, ease in monitoring of adverse effects, and multiple administration sites Una HOPKINS, RN, FNP-BC, DNP; CLaudIA Y. ARIAS, RN, OCN ntramuscular (IM) injection is one of many routes for administering medications, includ- Dorsogluteal site ing antibiotics, vaccines, hormonal therapies, I 1,2 and corticosteroids. Even when alternate routes of administration are available, IM injections may be preferred when a patient cannot tolerate oral medication or when adherence is a concern.2 IM injections also may be beneficial for absorp- tion compared with other routes of administra- tion (ie, faster than subcutaneous injection and slower than intravenous administration). In addition, some medications contain components that can irritate subcutaneous tissue but not muscle tissue, which also can tolerate larger fluid volumes with minimal discomfort.3,4 Large-volume injections (3 mL or greater), however, are not frequently administered; and many clinicians may not be familiar with their appropriate use, possible side effects, and potential efficacy. Medications administered via large- volume IM injections include ceftazidime (Fortaz, Tazicef, generics), cefuroxime (Ceftin, Zinacef, generics), ertapenem (Invanz), penicillin G ben- zathine (Bicillin L-A, Permapen), and fulvestrant (Faslodex).5-9 This article discusses the practical issues related to administration of large-volume IM injections, in the setting of administering fulvestrant for the treatment of breast cancer, with a focus on best practices for efficacy and safety. IM injections are administered in five potential © MICHELE GRAHAM sites: deltoid (commonly used for adult vac- FIGURE 1A. Potential sites for intramuscular injection: Dorsogluteal site cinations), dorsogluteal, ventrogluteal, rectus 32 ONCOLOGY NURSE ADVISOR • JANUARY/FEBRUARY 2013 • www.OncologyNurseAdvisor.com FEATURE | Large-volume IM injections femoris, and vastus lateralis3,10,11 (Figure 1).
    [Show full text]
  • Needle Gauge Resource List
    Needle Gauge Resource List COMMON USES FOR NEEDLE BY GAUGE SIZE Overview: There is currently no peer-reviewed research showing which needles work best in different situations. This resource comes from the Harm Reduction Coalition and Syringe Service Programs in Minnesota. The information here can serve as a starting point, but individual preferences may vary. The gauge (abbreviated as “G”) of a needle refers to the size of the hole in the needle. The higher the gauge, the smaller the hole. Needles come in various gauges and lengths. The length of a needle is listed after the gauge number. For example, 25G ½ refers to a 25 gauge, ½ inch-long needle. Longer needles (½ inch or longer) are commonly used for intramuscular injections, while shorter (shorter than ½ inch) needles are more often used for intravenous injections. Different sized needles are used for different purposes. For areas of the body with smaller veins like the hands or feet, a higher gauge needle or butterfly needle is commonly used. Please use the table below to understand what gauge needle is commonly used for different purposes (e.g., intramuscular injection, intravenous injection). Needle Gauge Resource List Needle Gauge: Needle Length: Used for: 18 1 Inch Transferring intramuscular hormones from vial to syringe 21 Intramuscular injections (e.g., naloxone, steroids, hormones) 22 ½ inch Intramuscular injections (hormones) Intramuscular injections (e.g., naloxone, steroids, hormones), 23 1 Inch methadone Intravenous drug use, intramuscular hormone administration, 25 1 Inch Intravenous crushed pills 27 ½ inch Standard insulin set, intravenous drug use 28 ½ inch Standard insulin set, intravenous drug use 29 ½ inch Intravenous drug use 5 30 ½ or /16 inch Intravenous drug use 5 31 /16 inch Intravenous drug use Minnesota Department of Health STD/HIV/TB Section 651-201-5414 www.health.state.mn.us/syringe 11/7/2019, To obtain this information in a different format, call: 651-201-5414.
    [Show full text]
  • Injection Considerations for Needle Length and Gauge Selection
    Injection considerations for needle length and gauge selection Intradermal injections INTRAMUSCULAR SUBCUTANEOUS pages 1 - 2 Subcutaneous injections INTRADERMAL pages 3 - 4 Epidermis Dermis Subcutaneous tissue Intramuscular injections Muscle pages 5 - 6 1 Intradermal injection considerations For needle length and gauge selection* INTRAMUSCULAR SUBCUTANEOUS INTRADERMAL Epidermis Dermis Subcutaneous tissue Muscle Intradermal (ID) Location of injection** Needle length** Needle gauge** Needle angle < 12 months (infants) Anterolateral aspect Paediatric of forearm, upper chest, 12 months to 18 years 10mm – 19mm 26 – 28 G º º to adult upper back, back of upper 10 – 15 arm > 18 years * Adapted from Fundamentals of Nursing Human Health and Function, Craven R, Hirnle C, Henshaw CM, 8th ed. Wolters Kluwer, 2017 ** Location, needle length & gauge dependent on patient age, physical condition and medication requirements. 2 Intradermal (ID) injection considerations: .8 .7 .6 .5 .4 .3 .2 10-15° Anterior aspect of the Upper chest Injection procedure forearm • Spread the skin taut, and insert the needle tip at a 10º – 15º angle. • Inject medication slowly. If a wheal does not appear, it was administered in the subcutaneous tissue. Upper back / back of arm This information is being provided for convenience only and is not intended to replace clinical decision making. Each clinician is soley responsible for determining the correct needle for each patient. 3 Subcutaneous injection considerations For needle length and gauge selection* INTRAMUSCULAR SUBCUTANEOUS
    [Show full text]