1- Powdered Meds

• Parenteral route is beneficial for pts who are unconscious, nauseous or vomiting, and with NPO status
• IV route is delivered immediately to the blood stream, it avoids first pass metabolism
• IM route gives more immediate onset of action than PO. They are suitable for patient's that doesnt require IV access but is vomiting
• IM has slower onset of action than IV, but is quicker than most oral solutions
• For IM administration, 20-25 gauge needle is used for aqueous solutions in adults and 18-25 needle for viscous or oil based solutions
• Subcut route requires slow, sustained absorption of meds. Often used in palliative care for slower absorption of pain med and prolonged pain relief
• Subcut is steadier compared to IM
• Subcut angle is 45 degrees, which requires a 26-30 gauge and 8 mm needle. For extremely thin patients, it is recommended to be given at 90 degree angle with proper size syringe of 4-8 mm
• The three parts of the syringe and needle are barrel, plunger, and tip
• Barrel is the outer portion on which the calibrations for the measurement of drug volume are located.
• Plunger is the inner cylindrical portion that fits snugly into the barrel.  This portion is used to draw up and eject the solution from the syringe.
• The tip is the portion that holds the needle. 
• The tip, plunger, and inside of the barrel must be kept sterile since they directly contact the medication.
• 1 mL- insulin syringe, tuberculin syringe
• 3, 6, 12, 20, and 60 mL syringes. The syringes can be either luer locked or catheter tipped. 
• When reading a 3 mL syringe - the longer lines represent 0.5 mL or 1 mL. The shorter lines represent 0.1 mL. 
• Insulin syringes come in sizes of 100 units and 50 units.
• Tuberculin syringes are calibrated in 0.01 mL and 0.1 mL. The syringe holds a total of 1 mL
• In tuberculin syringe, the longest lines represents 0.1 mL, the intermediate lines equal 0.05 mL, and the shortest lines are 0.01 mL. 
• The needle has five basic parts, the protective cap, hub, cannula or shaft, bevel, and safety device
• protective cap – keeps the needle sterile. 
• hub – attaches the needle to the syringe
• cannula or shaft – the hollow portion of the needle
• bevel – the sharpest point of the needle. Located at the end of the needle above the flat surface from where the medication comes
• safety device - used to cover the needle after the injection is completed
• The smaller the number of the gauge, the bigger the size of the needle; the bigger the number of the gauge, the smaller the size of the needle.
• The tissue being  injected determines the gauge and length of the needle
• Subcut injection: The needle is injected into the subcutaneous tissue. Use a 27 G or 29 G, ½ inch to ⅝ inch for insulin injections.  Other subcutaneous injections may require a 25 G or 27 G needle. 
• IM injection: The needle is injected into muscle. Use a 20 G to 25 G, ½ inch to 1 inch for children, 1 inch to 1½ inches for adults.
• ID injection: The needle is injected into the dermis. Use a tuberculin syringe with a 26- or 27-gauge needle that is ¼ to ½ inch long. 
• babies and smaller children require a smaller needle to reach the proper tissue.
•  people with heavy fat deposits will require a longer needle to reach the required tissue. Also, those who are emaciated or do not have much fat deposits may require a shorter needle. 
• For a subcutaneous injection, there are various sites that can be used. The needle is inserted between a 45- to 90 degree angle, depending on the size of the person.
• For an intramuscular injection, there are various sites with sufficient muscle mass. The angle of the insertion is 90 degrees.
• For an intradermal injection, the preferred location is on the forearm. The angle of the injection is 5 to 15 degrees.
• The filtered needle is used when withdrawing medication from a glass ampule. Any tiny shards of glass that fall into the ampule when the top is broken off are caught in the filter.
• The insulin syringe is supplied as a 50u/0.5 mL syringe and 100u/1mL syringe. All are 29 gauge with a 0.5 inch needle. 
• The tuberculin syringe is 1 mL with a 28 gauge x 0.5 inch needle.
• There are different gauge sizes that are colour coded on the leur lock. For example, the orange colored leur lock is a 25G x ⅝ inch needle and the grey coloured leur lock is a 22G x 1½ inch needle.