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Needle gauges...

Posted

Hey All,

I am a new nurse...new grad..and was wondering if any of you can tell me what meds work best with what needle gauges for IM..etc., injections. Thanks! Also, what common meds that can be mixed together in a syringe and given together through a push :)

You need at least a 20G to give blood, and for injections you want to look at the length, IM (1 inch to 1& 1/2 inch) injections are deeper than subcu ( 1/2 to 5/8 inch). And keep in mind if you have a skinny little old lady you will need a much shorter needle to hit the im spot than an obese person. The gauges for injections is usually 22-25 I think, at least where I work.

danegerous, BSN, RN

Specializes in ICU/CCU. Has 12 years experience.

All I know is Valium is a real pain in the behind to give IM and you don't reconstitute it...it's just turns to syrup.

And to be honest, I never give meds mixed in a syringe for a push. I can't imagine ever being in such a hurry that you would need to do that. Even in a code, meds are given individually. Other than insulin, I guess.

As far as meds mixing while in the tubing, that's a totally different story. I use Epocrates on my android phone to allow me quick access to what is compatible in an IV.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

1. Lantus (insulin glargine) is a long-acting basal insulin; never mix it with any other insulin because mixing will render it deactivated.

2. Phenergan (promethazine) is to be given deep IM, so use a 1.5 inch needle when injecting this medication.

3. Try to use a filter needle when drawing meds from a glass ampule so that small particles of glass won't be drawn up, either.

4. I personally wouldn't mix meds to give IV push for the sake of time.

5. The facility where I am currently employed uses 18 and 20 gauge IV catheters for the administration of blood products.

IVRUS, BSN, RN

Specializes in Vascular Access. Has 32 years experience.

But remember.. If your giving a unit of blood to the frail, elderly individual, a 22 gauge works well. The is no reason to use anything bigger, unless you need to pour the unit into them, like in the case of an emergent situation. (Our pediatric pts usually get a 24 gauge placed.)

LordErrorProne-RN

Specializes in Med-Surg/ER/Mat. Has 1 years experience.

I could be wrong but so far as im aware you are not allowed to run blood through a gauge less than 18, the gauge isnt based on how fast you will be running it. packed cells should never be run through a 24 -22 even for a pediatric pt, cause the blood cells get damaged being forced through that small of a gauge which if you are transfusing the pt you would end up doing them worse than if u didnt transfuse because now the liver has to take care of all those broken cells. however if you are running plasma or volume expanders then yea you can go with a smaller gauge.

To OP the only 2 things i have mixed in a syringe for push is gravol and morphine, and insulin. as for gauge, i usually will use a 1 1/2 22 gauge, unless you are giving a thick fluid then you would have to go bigger like 20. i try my best to avoid 18 since its like putting a tube in someone's thigh.

Hope that helped, please correct me if im wrong i would like to learn too.

IVRUS, BSN, RN

Specializes in Vascular Access. Has 32 years experience.

Sorry Lord,

But you can, and should always use the smallest gauge and length IV catheter for the prescribed therapy, per INS guidelines. If I am infusing it fast, like one unit over an hour, then yes, I want a larger gauge to accomadate the flow. However, my elderly and pediatric patients are more prone to fluid overload problems, and therefore, one unit infuses over 3-4 hours. SO in this case, yes, a 22 gauge works excellent. Think of it this way.. If I can draw blood via a small 24-26 gauge butterfly needle and not lyse the cells, then why can't I also infuse via the same gauge.. I can, but again, if it needs to go in quickly, I use a larger gauge catheter. The AABB (American Association of Blood Banks) has statements to this effect in their manual. The ol' notion of not infusing blood through anything but a 18 or larger is erroneous. Many of your clinical educators in nursing schools aren't infusion savy as their expertise is elsewhere.

LordErrorProne-RN

Specializes in Med-Surg/ER/Mat. Has 1 years experience.

Thanks IVRUS

Yea, you are right. i was just thinking about it from the stand point of where i work -surgical/obs- where i try to start with an 18 guage because you never know when someone is going to need a bolus, but ya i did some more research into it and transfusion time will determine what gage you will use, if its rapid then a 16-18 gauge is recommended if its slow then a 20-22 is recommended if its peds then 23-25 is recommended. :o

Sorry Lord,

But you can, and should always use the smallest gauge and length IV catheter for the prescribed therapy, per INS guidelines. If I am infusing it fast, like one unit over an hour, then yes, I want a larger gauge to accomadate the flow. However, my elderly and pediatric patients are more prone to fluid overload problems, and therefore, one unit infuses over 3-4 hours. SO in this case, yes, a 22 gauge works excellent. Think of it this way.. If I can draw blood via a small 24-26 gauge butterfly needle and not lyse the cells, then why can't I also infuse via the same gauge.. I can, but again, if it needs to go in quickly, I use a larger gauge catheter. The AABB (American Association of Blood Banks) has statements to this effect in their manual. The ol' notion of not infusing blood through anything but a 18 or larger is erroneous. Many of your clinical educators in nursing schools aren't infusion savy as their expertise is elsewhere.

We were taught in school nothing smaller than 20 gauge. I had a patient in clinical once with a 22 g access who was getting PRBCs, and they had to start a new IV for her because the blood wasn't moving through the 22.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

1. Lantus (insulin glargine) is a long-acting basal insulin; never mix it with any other insulin because mixing will render it deactivated.

Worse, it could theoretically turn it into fast acting insulin, causing a nice bolus of fast acting insulin, though newer studies have shown the effect isn't nearly what it was originally believed to be. The Lantus works by being acidic, it crystallizes under the skin when the body attempts to neutralize the pH. The body breaking down this crystallization over time it was causes it to be slow acting, therefore, anything that can neutralize the pH would make it faster acting.

danegerous, BSN, RN

Specializes in ICU/CCU. Has 12 years experience.

I'm pretty sure you want to give pRBCs and whole blood in a bigger IV to prevent lysing, the same reason you don't use standard iv tubing.

sonja77

Specializes in medical, telemetry, IMC. Has 6 years experience.

We give PRBCs through 22s quite often. Yes, ideally we would like a 20 gauge,but sometimes we're lucky if we can get a 22 placed!

And we never had any issues about blood not infusing through a 22 gauge!

What would you guys recommend for vitamin K? what gauge?