Injection sites

The onset of action is fast (within 60 seconds) for the intravenous anesthetic agents and somewhat slower for inhalation and local anesthetics. The induction time for inhalation agents is a function of the equiUbrium estabUshed between the alveolar concentration relative to the inspired concentration of the gas. Onset of anesthesia can be enhanced by increasing the inspired concentration to approximately twice the desired alveolar concentration, then reducing the concentration once induction is achieved (3). The onset of local anesthetic action is influenced by the site, route, dosage (volume and concentration), and pH at the injection site. 

Thorotrast (colloidal Th02) was once used as a radiopaque agent in medicine (see Radiopaques). Its injection in a dose of 2.0—15.0 g caused rises in body temperature, nausea, and injury to tissues at the injection site, followed by anemia, leukopenia, and impairment of the reticuloendothehal system. After intravenous adrninistration, thorotrast particles are taken up by reticuloendothehal cells of the fiver and spleen. Thorotrast is virtually not eliminated from the body (91). Between 1947 and 1961, 33 cases of cancer of the fiver, larynx, and bronchi and sarcoma of the kidneys, developing from 6 to 24 years after thorotrast administering, have been described in the literature (92). 

Well-site selection Criteria for assessing the feasibility of a deep-weU-injection site include (1) uniformity, (2) large injection formation). Adjustment of pH and buffering of the waste maybe necessary. 

Several nonpeptidic, orally active vasopressin receptor antagonists have been developed. The dual V1A/V2R antagonist conivaptan is used in the treatment of hyponatraemia and could also become useful for diseases such as congestive heart failure, in which increased peripheral resistance and dilutional hyponatremia both are present [4]. Side effects of conivaptan include headache, injection site reactions, vomiting, diarrhoea, constipation and thirst. 

After removing the needle from an IM, SC, or IV injection site, place pressure on the area Fhtients with blooding tendencies often require prolonged pressure on the area... 

The sites for SC injection are the upper arms, the upper abdomen, and the upper back (Pig. 2-6). Rotate injection sites to ensure proper absorption and to minimize tissue damage. 

Pull tiie skin, SC tissues, and fat (that are over tiie injection site) laterally, displacing tiie tissue to tiie side... 

FIGURE 2-8. Z-track injection (A) The tissue is tensed laterally at the injection site before the needle is inserted. This pulls the skin, subcutaneous tissue, and fat planes into a Zformation. (B) After the tissue has been displaced, the needle is thrust straight into the muscular tissue. (Q After injection, tissues are released while the needle is withdrawn. As each tissue plane slides by the other, the track is sealed. 

Gossitis, stomatitis, gastritis, furry tongue, nausea, vomiting, diarrhea, rash, fever, pain at injection site, hypersensitivity reactions,... 

Other adverse reactions associated with penicillin are hematopoietic changes such as anemia, thrombocytopenia (low platelet count), leukopenia (low white blood cell count), and bone marrow depression. When penicillin is given orally, glossitis (inflammation of the tongue), stomatitis (inflammation of die mouth), dry mouth, gastritis, nausea, vomiting, and abdominal pain occur. When penicillin is given intramuscularly (IM), there may be pain at die injection site Irritation of the vein and phlebitis (inflammation of a vein) may occur witii intravenous (IV) administration. 

Other adverse reactions that may be seen with administration of the cephalosporins are headache, dizziness, nephrotoxicity (damage to the kidneys by a toxic substance), malaise, heartburn, and fever. Intramuscular (IM) administration often results in pain, tenderness, and inflammation at the injection site Intravenous (IV) administration has resulted in thrombophlebitis and phlebitis. 

PARENTERAL ADMINISTRATION. When these drag > are given intramuscularly, the nurse inspects previous injection sites for signs of pain or tenderness, redness, and swelling. Some antibiotics may cause temporary local reactions, but persistence of a localized reaction should be reported to the primary health care provider. It is important to rotate injection sites and record the site used for injection in the patient s chart. 

The most common adverse reactions widi meropenem include headache, nausea, vomiting, diarrhea, anorexia, abdominal pain, generalized pain, flatulence, rash, and superinfections. This drug also can cause an abscess or phlebitis at die injection site An abscess is suspected if die injection site appears red or is tender and warm to die touch. Tissue sloughing at die injection site also may occur. 

Soreness at the injection site, urticaria, dizziness, rash, chills, fever, and hypersensitivity reactions may be seen with the administration of this drug. 

Spectinomycin. Spectinomycin may be given as a single dose, but multiple doses may be prescribed for complicated, widespread gonorrhea. The nurse warns the patient tiiat the IM injection may be uncomfortable and tiiat soreness at die injection site may be noted for abrief time. The nurse emphasizes die importance of following die primary healtii care provider s recommendations... 

MANAGING PAIN Pain at the injection site may occur when diese drug are given IM. The nurse warns the patient that discomfort may be felt when it is injected and that additional discomfort may be experienced for a brief time afterward. The nurse places a warm moist compress over die injection site to help alleviate the discomfort. 

When administering die antitubercular drug by die parenteral route, die nurse is careful to rotate the injection sites. At die time of each injection, die nurse inspects previous injection sites for signs of swelling, redness, and tenderness. If a localized reaction persists or if die area appears to be infected, it is important to notify die primary health care provider. 

Other—physical dependence, pain at injection site, and local tissue irritation... 

HYDANTOINS Fhenytoin is the most commonly prescribed anticonvulsant because of its effectiveness and relatively low toxicity. However, a genetically linked inability to metabolize phenytoin has been identified. For this reason, it is important to monitor serum concentrations of the drug on a regular basis to detect signs of toxicity Fhenytoin is administered orally and parenterally. If the drug is administered parenterally, the IV route is preferred over the intramuscular route because erratic absorption of phenytoin causes pain and muscle damage at the injection site... 

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