selecting needles, BP meds...

  1. How do you select a needle based on what type of medication you are administering? For example, I know for a PCN injection you want a larger gauge (like 18?) because the solution is very thick. But what about other medications? This is something that I was never taught in nursing school and I know that some clinical instructors like to ask those questions. I've checked my books and my drug books and I haven't found anything. Is there some sort of website or other book that I can look into?

    Also, what justifies giving and holding antihypertensive medications? My patient this week was on amlodipine, metoprolol, lisinopril and was also on hydrochlorothiazide. Her BP prior to giving those drugs was 103/58. I told my primary nurse and we looked at her BP over the past few days and it has been close to the 103/58, so she OK'ed it, signed off on the MAR stating that I checked with her prior to giving those medications and said if something were to happen she would assume responsibility. I gave them, no problems. But still, 103/58...isn't that kind of risky when you're on four different medications that will affect your BP? I know sometimes on the MAR it will say things like "HOLD if SBP < 110" but there were no notes by any of these medications on the MAR.

    My patient was admitted for abd pain, ascites, abd mass, anemia; hx of HTN, CAD, cardiac stent.

    Thanks, everyone
    Last edit by shrimpchips on Jul 2, '09 : Reason: added admitting dx/medical hx
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    About shrimpchips

    Joined: Aug '06; Posts: 661; Likes: 202
    full-time student, nurse tech on a renal/plastic & reconstructive surgery unit; from US

    5 Comments

  3. by   CuriousMe
    I think you're on the right track. From what I've been taught, there aren't hard and fast rules for either of those questions. It's about using the information you know about physiology, pharmacology and pathophysiology along with the information you know about the patient....in other words, clinical judgment.

    For the needle, it's going to depend on the med you're giving, who you're giving it to (body size, etc), how much of it and how you're giving it (IM, Sub Cu, etc). Really the only thing that we've given as an injection and not as an IV push are insulin, heparin and vaccines. So the needle choice hasn't really been an issue for us.

    For the BP meds, looking at the BP for the past few days is crucial because it tells you how this patient reacts to the meds you listed. I'm not saying I would have made that call as a student nurse (I would have done what you did, told my RN) but I can see why she made that call.
  4. by   CrufflerJJ
    Quote from shrimpchips
    Also, what justifies giving and holding antihypertensive medications?
    Do you mean that you don't choose needle size by the amount of "hassle" your patient has given you in the past? By this, I mean a nice 21 gauge needle for a "decent" patient, or a 12-14 gauge 3" harpoon for the irritating folks? JUST KIDDING!

    For antihypertensives, obviously the biggie is BP. But also think about potassium level with potassium-excreting diuretics (like Lasix or HCTZ) - if the K level is low, that's one more thing to consider before helping them dump more K from the system.

    If they are bradycardic, think about that before pushing a beta blocker antihypertensive med (-olol). Some blockers affect BP more than heart rate, so that's just one more thing to be taken into consideration.
  5. by   Daytonite
    There are only a handful of medications where needle gauge and length are a consideration. PCN is one where needle gauge is important. There are others that are oil-based where a low gauge needle like an 18g is needed as well, but I can't think of the name of them (that's how frequently you'll give them!). IM injections into the deltoid muscle need to be done with 1 inch needles. Z-track injections, such as with Imferon which can stain the skin, need to go deep into the muscle so a 1 1/2 or 2 inch needle into the gluteal muscle should be used. SQ injections need to be done with small gauge short needles (25g 1/2 inch long).]

    I would have called the doctor before giving that hypertensive medication and documented it to cover my butt. 103/58 is low.
  6. by   shrimpchips
    Quote from CrufflerJJ
    Do you mean that you don't choose needle size by the amount of "hassle" your patient has given you in the past? By this, I mean a nice 21 gauge needle for a "decent" patient, or a 12-14 gauge 3" harpoon for the irritating folks? JUST KIDDING!
    LOL

    Quote from "CrufflerJJ
    For antihypertensives, obviously the biggie is BP. But also think about potassium level with potassium-excreting diuretics (like Lasix or HCTZ) - if the K level is low, that's one more thing to consider before helping them dump more K from the system.

    If they are bradycardic, think about that before pushing a beta blocker antihypertensive med (-olol). Some blockers affect BP more than heart rate, so that's just one more thing to be taken into consideration.
    You're right with those, but of course me thinking about antihypertensives, I instantly think about the blood pressure. For the record, my patient's K levels were normal and her HR was in the 80-90 range.

    Thank you for your reply! You just made me realize other things that are important
  7. by   shrimpchips
    Quote from Daytonite
    There are only a handful of medications where needle gauge and length are a consideration. PCN is one where needle gauge is important. There are others that are oil-based where a low gauge needle like an 18g is needed as well, but I can't think of the name of them (that's how frequently you'll give them!). IM injections into the deltoid muscle need to be done with 1 inch needles. Z-track injections, such as with Imferon which can stain the skin, need to go deep into the muscle so a 1 1/2 or 2 inch needle into the gluteal muscle should be used. SQ injections need to be done with small gauge short needles (25g 1/2 inch long).]

    I would have called the doctor before giving that hypertensive medication and documented it to cover my butt. 103/58 is low.

    Thanks, Daytonite!

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