Things Required:
- IMR
- Medications (this post shall explain how to serve a short-acting eg. Actrapid and a long-acting insulin simultaneously. If your order requires only one type of medication, just take that medication and ignore the second one)
- Syringe
- 3 Needles (2 x 19G, 21G)
- Gloves
- Alcohol swabs
- Kidney dish
1. Verify order and patient's need for this procedure. For example, if a patient is on sliding scale (ie. the amount of insulin needed is dependent on his hypocount), he may not need the insulin if his hypocount is of desirable value. Perform hand rub.
2. Get the correct medications out from the fridge (as insulin is usually stored there) and rub the bottles in your palms to warm them. Insulin, when injected cold, may be painful for the patient.
3. Swab the top of the bottles with alcohol swabs. Attach a 19G needle to the syringe and inject air equivalent to the unit of long-acting insulin needed into the long-acting (more cloudy appearance) insulin bottle and then inject air equivalent to the unit of short-acting insulin needed into the short-acting (clearer appearance) insulin bottle. Injecting air first will reduce the resistance when drawing the insulin.
That is, if I need 2 units of long-acting insulin and 3 units of short-acting insulin, I would inject 2 units of air into the bottle containing long-acting insulin first and then inject 3 units of air into the bottle containing short-acting insulin.
4. After injecting air, draw the required units of short-acting insulin. Change to another 19G needle and discard the first needle to avoid cross-contamination of the different insulin. Using the new 19G needle, draw the units of long-acting insulin needed. Discard the needle. Attach the 21G needle to the syringe.
5. Approach and identify patient with 2 patient identifiers again: patient’s name and IC by asking patient and verifying it with his wrist tag. Ensure that patient is not allergic to the medication by checking it with the IMR and by asking patient. Prepare the environment where necessary: adequate lighting, suitable working height, screening of the patient, who would have to expose himself)
6. Perform hand rub and wear gloves (wearing of gloves is dependable on hospital policy).
7. In Singapore, any subcutaneous injections are almost only performed in the abdomen area for adults. Thus, get patient to expose his abdomen and ask where was his last injection site (right or left side of the umbilicus) and avoid it. This is because injecting the same area over and over again with insulin will result in lipodystrophy, where the area would be slightly dented and insulin absorption diminished.
8. If patient's last injection site was to the right side of the umbilicus, measure two finger spacings away from the umbilicus on the left side and clean that area with alcohol swab.
9. Lightly pinch the area with your thumb and forefinger of your non-dominant hand. With your dominant hand holding the syringe like a dart, inject the needle fully, at 90 degrees to the skin and administer the insulin slowly.
10. Release the pinched area and take a piece of alcohol swab. Withdraw the needle and use the alcohol swab to apply pressure to the injection site for around 10 seconds. Do not rub the area as this would increase insulin absorption.
11. Inform patient that the procedure is completed and to inform you if he feels giddy. Remind him to have his meal or some food 30 minutes later. Ensure patient’s safety and comfort levels and that the call bell is within reach before leaving the patient.
12. In the IMR, record that subcutaneous insulin had been given. Check for any adverse reactions/ patient's response to the medications and document in the relevant notes.
Back to Procedures
No comments:
Post a Comment