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Rapid Insulins
- Name Onset Peak Duration
- Aspart 15 min 1 hour 3-5 hours
- Lispro 15 min 1 hour 5 hours
- Glulisine 15 min 1 hour 5 hours
Rapid given with or before meals
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Short Insulins
- Name Onset Peak DurationRegular 30 min 2-4 hours 5-7 hours
Short - only one given in IV
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Intermediate Insulins
- Name Onset Peak DurationNPH 2 hours 6-12 hours 16-24 hours
- Lente 3 hours 8-12 hours 36 hours
Intermediate can be mixed, give 2x a day
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Long Insulins
- Name Onset Peak DurationGlargine 1 hour No peak 24 hours
- Detemir 3-4 hours No peak 24 hours
- Ultralente 4-6 hours 18-24 hours 36 hours
Long cannot be mixed, give 1x a day
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Intradermal needle
- Tuberculin: 25-27 G
- 3/8" @ 5-15oBevel up
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Intradermal Absorption
Most potent, therefore injected into dermis where absorption is slowest
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Intradermal Indications
Allergy testing, TB
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Intradermal Max Dose
0.1 mL
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Intradermal Sites
Inner forearm & upper back
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Intradermal Techniques
Stretch skin taut, bevel up
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Subcutaneous Needle
- 23-25 G
- 5/8" @ 45o
- 1/2" @ 90o
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Subcutaneous Absorption
Slower absorption than IM
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Subcutaneous Indications
Insulin, Heparin
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Subcutaneous Max Dose
1 mL
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Subcutaneous Sites
Back of arm, abdomen, thigh, scapula
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Subcutaneous Techniques
- If you can grasp 2": 90o
- Thin patients: abdomen
- Obese patients: long enough needle to get through fatty tissue
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Subcutaneous Injection Notes
- Pain receptors!
- DO NOT ASPIRATE, MASSAGE, OR RUB!!
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Intramuscular Needle
- 20-22 G
- 1 1/2" @ 90o
- Older adults: 23-25 G
- 1" @ 90o
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Intramuscular Absorption
Fastest absorption rate due to muscle's vascularity
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Intramuscular Max Dose
- Ventrogluteal: preferred site well developed & away from nerves & blood vessels; least risk (gluteus medius & minimus)
- Vastus Lateralis: anterior lateral aspect of thigh (infants & children), pt supine
- Deltoid: muscle not well-developed in many adults; used for small amounts
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Intramuscular Techniques
- Assess muscle: should be free of tenderness, make sure there are no hardened lesions
- ASPIRATE!!! (2-3 mL)
- Z track: used to minimize local skin irritation by sealing med in muscle tissue. Pull skin & sub Q tissue 1.5" laterally to the side, hold, aspirate, inject (hold 10 sec), withdraw needle, THEN release skin.
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Intramuscular Injection Notes
- Very obese 3"
- Thin 1/2-1"
- DO NOT USE DORSOGLUTEAL
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Intramuscular
- 90o deep into muscle 3 mL max med
- Gluteus: 20-23 G 1 1/2"-3" needle
- Deltoid: 23-24 G 5/8"-1" needle
- Never use bigger than a 1" needle & never >2 mL meds
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Subcutaneous
- 45o average 15o-45o thin 90o obese
- 25 G 5/8" needle @ 45o - usually
- Small doses - 0.5-1 mL. If more needed, give 2 shots
- Can use 1/2", 5/8", 1" needle
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Intradermal
- 10o-15o 26 G
- TB syringe - divided into hundredths
- Bleb or wheal - Bevel up
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Heparin
- 90o into abdomen grab skin
- 25 G 3/8"-5/8" needle
- Never rub
- Never aspirate
- Always use TB syringe
- Avoid 2" around umbilicus
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Insulin
- 5/8" needle 100 u = 1 mL
- Give @ room temp
- Never aspirate
- Administer within 5 min of preparing syringe
- Needle is permanent
- Insulin syringe - marked in units
- Only put insulin in an insulin syringe. NEVER give insulin in anything but an insulin syringe
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