Confused about injection procedure

[Clovery]

So I have a practicum coming up on injections. I feel like they kind of rushed through the demos in class and didn't demo the entire process at all. The syringes we will be using are the kind that come in sterile packaging, have a simple cap that comes completely on and off. We will be using multi-dose glass vials.

They told us that we must use the "scoop method" to recap a needle. (leaving the cap on the table, scoop the cap onto the needle then hold it at the sides to pull and secure it down). But I believe they said that in practice you should never recap a needle unless there isn't a sharps container available in the room. But since we are reusing our practice syringes several times, we need to recap them and they've stressed "scoop method" for this.

So here is what I'm confused about. This is the short version of the list of steps I was given.

- I gather equipment, wash my hands do all my checks, etc.

- prepare the medication, withdraw it from the vial

- after the meds have been prepared, do another check with the MAR before taking it to the patient

- transport the medications to the patient's bedside carefully

- ID patient, allergies, etc

- ?????

- hand washing, gloves

- get patient into position

- ID site, clean it

- remove the cap from the needle

- ztrack, give med, etc

I've bolded the steps that confuse me... So I open my sterile package, and then I remove the cap from the needle, in order to take the med from the vial. So now I have a needle full of medication without a cap, that I need to keep sterile. I don't think using the "scoop method" method to recap it is practical - there's such a good chance of touching the needle to a non-sterile surface, right??

So let's say I don't recap the needle. Now I'm walking into the patient's room with an uncapped needle in my hand. But when I get in there, I have to wash my hands, glove up, position the patient. What the heck am I supposed to do with the needle? I have to keep it sterile.

Sorry if this is obvious, but I just don't get it

Here is the full list of instructions that was provided to us. I've already checked my textbook and it doesn't make it any clearer. http://tinypaste.com/ddc39f

[CHovs]

When we were learning how to prepare IM medications, we were taught to use a blunt needle to draw up our medications then change the needle prior to administration.

For example: You have to draw up 3 cc of medication from a vial.

You would attach a blunt needle to a syringe. Inject your 3 cc of air, then withdraw your 3 cc of medication. Once you've done this, pull back on the plunger enough to take all the medication out of the blunt needle.

Here you would use your scoop method to recap your needle. Once done, twist it off and apply your 22 or 23 gauge needle you'll use for injection. Leave the cap on.

Once you go into the patient's room and do all of your checks, you will swab your injection site then uncap your needle to give the injection. Otherwise your needle should be capped from preparation untill injection.

Hope this helps you out !

[Clovery]

yes that does help, thank you.

I remember them saying we would need to change the needle out because some meds were caustic. But for our practical they said we wouldn't have to do that, only verbalize it. I don't know why they wouldn't list that in those steps they gave us, though.

But what about the plunger - I know the part of the plunger that goes inside the barrel should be kept sterile, and if we have meds in the barrel then the plunger is going to be sticking out some... Do I have to worry about breaking sterile field if I set the syringe down when the plunger is slightly out?

[CHovs]

As for the plunger you do not. The Plunger has a flat black rubber top to it that blocks any medication from leaking out of the barrel. Going back to the 3 cc example, say you had your 3 cc prepped in the syringe. Your plunger would be pulled back enough so that the black part is flush with the 3 cc line. When you go into the patient's room you can set the syringe down on the bedside table. You should take caution when drawing up the medication and when injecting that you only touch the top of the plunger (aseptic technique).

Sterile technique is not broken though if you lay it down. If you think about it, You've already touched it with non-sterile hands. It's impossible to keep the plunger "sterile"; you can only keep it clean by using caution with handling the syringe.

[Clovery]

okay that makes sense! thanks so much for the help!

[NCRNMDM, ASN, RN]

For our checkoff we were taught that you should do IM injections in this order: check the order for medication, dosage, route, patient, etc. Take the chart to the med room, check the chart again, select the appropriate sized syringe and take the medication out of the Pyxis, Omnicell, or whatever storage system you are using. Draw the medication up using the needle attached to the syringe, and passively recap the needle. Take an extra needle of the appropriate gauge into the patient's room along with the syringe with the recapped needle, and the chart. Check the chart against the patient, ask the patient if they have any allergies, and explain the procedure to the patient. Wash your hands, put on gloves, take the needle you used to draw the medication up off of the syringe and attach the new, sterile, needle that you brought with you. Finally, administer the injection, discard supplies, and wash hands.