SO WE'RE GOING TO GIVE
SHOTS AND WE'RE GOING TO GIVE
SUBCUTANEOUS INJECTIONS,

SO WE'RE NOT GIVING THE
DEEP INNER MUSCULAR.

YOU'LL DO THOSE NEXT SEMESTER.

BUT YOU DO HAVE A LOT OF
OPPORTUNITIES IN THE
NURSING HOMES

TO GIVE INSULIN AND HEPARIN.

THEY WANTED YOU TO BE ABLE
TO DO THAT WHILE YOU CAN

SO WE'RE GOING TO GET
THAT TAKEN CARE OF.

WHAT WE'RE GOING TO
DO IS GIVE TWO SHOTS.

WE HAVE A MAR, KIND OF HARD TO
SEE, BUT YOU HAVE TWO SHOTS
ORDERED FOR YOUR CLIENT,

AND I WANT YOU TO BE
THINKING OF THEM

AS TWO SEPARATE TIME FRAMES,
TWO SEPARATE SHOTS.

BECAUSE I WANT YOU TO
GO THROUGH THE WHOLE ROUTINE
OF GIVING ONE SHOT,

WALK AWAY FROM IT,
DROP ANOTHER SHOT,
GO AND GIVE ANOTHER SHOT.

JUST SO THAT YOU CAN, KIND OF,
GET THROUGH THE STEPS THAT
IT ENTAILS TO GIVE IT.

SO WE HAVE TWO SHOTS TO GIVE.
WE HAVE INSULIN THAT WE'RE
GOING TO GIVE SUBCUTANEOUS

AND WE HAVE HEPARIN THAT
WE'RE GOING TO GIVE.

I'M GOING TO GO AHEAD AND
START WITH THE HEPARIN,

JUST BECAUSE IT'S
A SINGLE MEDICATION

AND THE HEP.. THE INSULIN
IS MIXING OF TWO MEDICATIONS,
SO WE'LL BUILD UP TO THAT.

ALRIGHT, WE TOOK OUR DOCTOR'S
ORDER. WE HAVE OUR TWO SHOTS.

LET'S PRETEND IT'S 5 O'CLOCK
IN THE EVENING AND AND WE'RE
GOING TO GIVE OUR HEPARIN.

TYPICALLY, HEPARIN IS
GIVEN IN THE EVENING

BECAUSE THEY NEED TO DRAW LAB
AND CHECK CLOTTING TIMES
IN THE MORNING.

SO WE GIVE IT AT FIVE AND THEY
DROP LABS AT 8 IN THE MORNING

AND THEY GET A GOOD INDICATOR
OF BLEEDING TIMES.

THERE'S TWO PARTICULAR TESTS
THAT WE PUT INTO ACTION WHEN
WE CHECK BLEEDING TIMES.

AND YOU NEED TO KNOW
WHAT THESE ARE.

WHEN YOUR CLIENT IS ON HEPARIN,
THEY'RE GOING TO CHECK HIS
PTT OR APT.

HIS PARTIAL PROTHROMBIN TIME

OR HIS ACTIVATED PARTIAL
PROTHROMBIN TIME.

AND THE IDEA IS THAT WE'RE
GIVING ENOUGH BLOOD THINNER

THAT THE PATIENT THEN BECOMES..

HAS THINNER BLOOD, WHICH IS ONE
AND HALF TO TWO AND A HALF TIMES

WHAT NORMAL BLOOD WOULD CLOT AT.

SO IT'S A LONGER CLOTTING TIME,
THE BLOOD'S THINNER.

SO WHAT THEY SAY IS IT'S ONE AND
HALF TO TWO AND HALF TIMES
THE CONTROL.

THE CONTROL BEING WHAT NORMAL
CLOTTING IS AND THEN...THINNER.

USUALLY, THE CONTROL IS
ABOUT 30 TO 40 SECONDS,

MOST OF US CLOT,
PUT A LITTLE PRESSURE ON THERE,
30 TO 40 SECONDS.

BUT WHAT THEY WANT IS TO HAVE
AN EXTENDED CLOTTING TIME

OF 45 TO 90 SECONDS SO THAT
THE BLOOD IS THINNER.

THAT WOULD BE KIND OF..
HIGHLIGHT YOUR THINKING TO GO,

"OH, BLOOD THINNERS WOULDN'T
BE GOOD IF THEY'RE
GOING TO SURGERY."

RIGHT? SO YOU WANT TO
BE CAREFUL TO KNOW

WHAT KIND OF BLOOD THINNERS
PEOPLE ARE ON.

HEPARIN IS SUBCUTANEOUS AND IT'S
GIVEN OBVIOUSLY AS A SHOT,

BUT ANY TIME WE START SOMEONE
ON A BLOOD THINNER
THAT'S AN INJECTIBLE,

WE'RE GOING TO GET QUICK ACTION.

WE ALWAYS SIMULTANEOUSLY PUT
THEM ON AN ORAL ANTl-COAGULANT,

WHICH IS USUALLY COUMADIN
OR IT'S GENERIC WARFARIN.

ARE YOU WITH ME HERE?

WHAT HAPPENS IS THE WARFARIN
ACTS A LITTLE DIFFERENTLY

THAN THE HEPARIN ON A
LITTLE DIFFERENT CELL.

YOU'LL GET MORE OF THIS IN YOUR
WILL PATHO-CRITICAL CARE.

WHAT YOU NEED TO APPRECIATE
IS THAT THERE'S A LAB VALUE

THAT CHECKS FOR THE CLOTTING
TIME ASSOCIATED WITH THE
COUMADIN OR THE WARFARIN.

AND THAT'S A PT TIME.

NOW HOW DO I KEEP
THESE STRAIGHT?

WELL, A PT BOAT GOES TO WAR,

WARFARIN, THAT HELPS ME
BECAUSE I GET MIXED UP.

BUT, YOU KNOW, YOU WALK
AWAY FROM THIS, IN TWO OR
THREE MONTHS AND YOU ARE GOING,

"PT, PTT. OH, WHAT IN THE HECK?
WHICH ONE GOES WITH WHICH?
I CAN'T REMEMBER."

SO PTT GOES WITH HEPARIN

AND THE PT, PT BOATS GOES
TO WAR, GOES WITH WARFARIN.

THE OTHER THING WITH HEPARIN,
ONE OF THE CUES,

AND I WILL SHOW YOU A FUNNY
LITTLE PICTURE I HAVE.

BUT ON THE H THERE'S TWO STEMS.
SO IT TAKES TWO, SO TWO T'S.

THAT MAY HELP YOU REMEMBER
THAT YOU NEED TO TWO T'S.

BECAUSE THE NEW TEST IS NOW TO
ELIMINATE THE PT AND DO AN INR.

AND SO I DON'T WANT TO CONFUSE
YOU HORRIBLY ON THAT,

BUT THEY'RE DOING A NEW
TEST AND IT'S...A RATIO.

I FORGET WHAT IT MEANS.

INTERNATIONAL SOMETHING RATIO.

AND IT'S THE RATIO OF CLOTTING
TO NOT CLOTTING TIME.

SO YOU'RE GOING TO BE LOOKING
AT INRS WITH YOUR COUMADINS.

BUT YOU REALLY NEED
TO KEEP IN MIND

THAT YOU NEED BOTH LAB
VALUES AND THE APTT

OR THE PTT IS WHAT YOU'RE
CHECKING FOR WITH YOUR HEPARIN.

WE WANT TO KNOW THAT. SO I'VE
GIVEN YOU ALL THAT INFORMATION.

NOW WHEN YOU GO AND MAKE YOUR
MED CARDS, FIND IT YOURSELF.

OKAY. SO SEE WHERE
THAT INFORMATION IS.
WHERE DID I FIND THAT OUT?

DID I FIND IT IN NURSING
IMPLICATIONS, LAB
CONSIDERATIONS?

SO THAT YOUR EYE BEGINS
TO PICK UP ON THE THINGS

THAT ARE REALLY CRITICAL TO THE
ROUTINE MANAGEMENT OF MEDS.
OKAY?

SO I'LL ASK YOU QUESTIONS
RELATED TO THAT WHEN YOU
COME TO GIVE YOUR SHOT.

OKAY, KEEPING ALL THAT IN MIND,
I HAVE MY HEPARIN,

I KNOW LABS ARE GOING TO
BE ORDERED AND SO FORTH.

SO NOW WHAT I WANT TO DO IS
GATHER UP MY EQUIPMENT.

SO I GO TO MY MEDICATION
DRAWER AND I WENT

AND I GOT OUT MY HEPARIN VIAL
THAT PHARMACY SENT UP.

AND I NOTICED THAT
I HAVE HEPARIN 20,000
UNITS PER MILLILITER.

HEPARIN COMES IN ALL
KINDS OF DILUTIONS.

IT COMES IN 5,000 UNITS PER MIL,
10,000 UNITS PER MIL,

20,000 UNITS PER MIL,
ALL SORTS OF THINGS.

WHAT YOU HAVE WILL BE 10,000
UNITS OR 20,000 UNITS,

I DON'T KNOW WHAT GOT THROWN
INTO YOUR DRAWER.

WHAT YOU NEED TO DO IS FIGURE
OUT THEN

HOW MANY CC WILL THAT BE? HOW
MANY MILLILITERS TO GIVE THE
CORRECT DOSE?

IN THE HOSPITALS, PHARMACY'S
USUALLY NICE,

AND THEY PUT A LABEL
ON IT, THEY TELL YOU.

THEY FIGURE IT OUT FOR YOU SO
YOU DON'T HAVE TO FIGURE IT OUT.

BUT YOU ALWAYS WANT TO DOUBLE
CHECK WITH YOUR HEPARINS
TO BE SURE.

SO I CALCULATED, IF 20,000
UNITS EQUALS ONE MILILITER,

THEN 7,500 UNITS EQUALS X
MILLILITERS.

GOT YOUR CALCULATORS?

OH, ALWAYS HAVE CALCULATORS.

IF YOU NEED CALCULATORS TO
FIGURE OUT YOUR MATH
FROM NOW ON,

PUT A CALCULATOR IN YOUR
NURSING UNIFORM AND YOU JUST
CARRY IT WITH YOU EVERYWHERE.

BECAUSE YOU NEVER KNOW WHEN YOU
ARE GOING TO NEED TO USE IT.

AND I FIGURED IT OUT AND
I KNOW AHEAD OF TIME.

I DON'T WANT TO SEE YOU DOING
MATH. I DON'T WANT TO WATCH IT.

I WANT YOU TO COME PREPARED
AND YOU HAVE IT WRITTEN DOWN
ON YOUR MAR READY TO GO.

IT'S 0.38 MILLILITERS
FOR YOUR DOSE

OR WHATEVER IT IS, DEPENDING
ON WHAT YOUR DILUTION IS.

SO I CALCULATED OUT
THE DOSE THAT I NEED.

I GOT MY HEPARIN. I ALSO KNOW
THAT I NEED TO GET A SYRINGE.

WE NEED TO TALK ABOUT SYRINGES
JUST A LITTLE BIT,

BECAUSE THAT'S PROBABLY
THE HARDEST PART
OF THIS WHOLE ACTIVITY,

IS, WHAT SYRINGE DO I GET?

WHEN YOU FIRST WALK INTO THE MED
ROOM AND YOU ARE ON YOUR OWN,

THEY JUST HAVE BOXES AND BOXES
AND DRAWERS AND BOXES

OF EVERY SIZE NEEDLE
AND SYRINGE AVAILABLE

AND YOU GOT TO PICK ONE.

ALL RIGHT, LET ME HELP YOU HONE
IN ON THIS, JUST A LITTLE BIT.

WHENEVER YOUR DOSE IS
LESS THAN A MILLILITER,

YOU CAN USE
A ONE MILLILITER SYRINGE.

THAT'S A GOOD PLACE TO START.

THE RULE OF THUMB IS
WHENEVER YOUR DOSE IS
BELOW 0.5 MILLILITERS

YOU HAVE TO USE A ONE CC SYRINGE
BECAUSE IT'S THE MOST ACCURATE.

IT'S A DOSE THAT IS MARKED
TO THE ONE HUNDREDTH
VERSUS THE TEN.

ALRIGHT, THIS ONE'S
PRE-PACKAGED.

AND THIS IS A SAFETY LOCK,
ONE MILLILITER SYRINGE,

BUT IT ALSO HAS
AN NEEDLE ATTACHED.

SO I KNOW MY DOSE IS WHAT?

0.38. SO IT'S LESS THAN
THE 0.5 CRITERIA, RIGHT?

SO I'VE GOT MY
ONE MILLILITER SYRINGE.

BUT I ALSO NEED TO KEEP IN
MIND WHAT KIND OF NEEDLE

DO I WANT ATTACHED TO THIS
SYRINGE OR DO I NEED TO ATTACH.

YOU CAN DO EITHER WAY. THEY CAN
HAVE THE NEEDLE ON OR OFF,

AND YOU GET THE
NEEDLE SEPARATELY.

THIS ONE HAS A PRE-ATTACHED
SYRINGE TO IT, OR NEEDLE.

AND IT SAYS THAT IT'S A 25
GAUGE 5/8TH INCH NEEDLE.

WHAT DOES THAT MEAN?

TWO PIECES OF INFORMATION YOU
GOT THERE. ONE IS THE GAUGE.

THE GAUGE IS THE WIDTH OF THE
NEEDLE. IT'S THE THICKNESS
OF THE NEEDLE.

THE HIGHER THE NUMBER
THE SMALLER THE WIDTH.

IT'S BACKWARDS IN THINKING
WHENEVER YOU'RE DEALING
WITH GAUGES.

WHENEVER I GIVE A
SUBCUTANEOUS INJECTION,

I DON'T USUALLY GO WITH ANYTHING
LARGER THAN A 25 GAUGE.

USUALLY -- ESPECIALLY WHEN
WE GO TO OUR INSULIN,

THEY GO 27, 28 AND 29. THIN,
THIN LITTLE FINE THINGS.

BUT FOR YOUR AVERAGE
SUBCUTANEOUS INJECTION,

WE'RE JUST GOING INTO THE
FATTY LAYER OF THE BODY.

WE JUST NEED A
5/8THS INCH NEEDLE.

WE'RE GIVING A WATERY SOLUTION
AND THE WATER WILL PASS THROUGH

PERFECTLY FINE WITH THAT
THIN OF A NEEDLE.

THAT'S ANOTHER CONSIDERATION WE
MAKE. HOW THICK OR HOW VISCOUS
IS THE FLUID?

AND ITS NOT WATERY.

ALRIGHT, SO MY GAUGE IS 25

AND MY LENGTH IS 5/8THS INCH.

NOW HOW DID I KNOW THAT
THAT WAS A GOOD LENGTH?

WELL, AGAIN I AM GOING INTO
THE SUBCUTANEOUS LAYER

AND WHEN I STARTED NURSING,
IT WAS JUST THE RULE.

YOU JUST DO 5/8THS INCH
TO GO INTO SUBCUTANEOUS.

AND WE JUST MEMORIZED IT AND
THAT'S ALL THERE WAS TO IT.

BUT NOW WHAT THEY'RE SAYING
IS THAT WHEN YOU GIVE A SHOT,

YOU PINCH UP LIKE A ROLL OF FAT,
SO YOU GRAB AND PINCH UP.

AND YOU WANT YOUR NEEDLE TO
BE AT LEAST HALF OF THE ROLL.

SO SOME PEOPLE CAN HAVE
A LITTLE LONGER NEEDLE

AND STILL BE IN THE FATTY LAYER.

BUT YOU'RE STILL GOING
TO BE IN FATTY LAYER EVEN
WITH THE 5/8THS INCH.

PEOPLE DON'T HAVE 5/8THS
INCH WORTH OF SKIN.

WE'VE GOT TO PASS THROUGH
SKIN AND GET TO FAT.

IF THEY'RE REALLY LEAN,
THEN YOU MAY NEED TO GO TO
A HALF INCH NEEDLE.

AND THAT WOULD BE REALLY THE
ONLY EXCEPTION,
WOULD BE LEAN PEOPLE.

BUT HEAVIER PEOPLE COULD
STILL USE SHORT.

SO I'M HAPPY.
I'VE GOT MY SYRINGE,

I'VE GOT MY NEEDLE.
AND I'M GOOD TO GO.

LET'S TALK A LITTLE BIT
ABOUT THE SYRINGE.

YOU HAVE A PEEL-BACK PACKAGE.

AND INSIDE THE PACKAGE
EVERYTHING IS STERILE,
UNLESS I TOUCH IT.

SO THAT'S NICE TO KNOW BECAUSE
THEN I CAN USE THAT

TO SET MY CAP AND STUFF DOWN
SO I DON'T CONTAMINATE.

ALRIGHT, LET'S TALK A LITTLE
BIT ABOUT THE SYRINGE.

THE SYRINGE HERE HAS A
LOT OF DIFFERENT PARTS.

THIS IS THE PLUNGER RIGHT HERE

AND YOU'RE GOING TO MEASURE
YOUR DOSE BY THE BOTTOM
OF THE PLUNGER.

THE BOTTOM OF THE BLACK,
NOT THE TOP OF THE BLACK.

THEN YOU HAVE YOUR PHALANGES,
I CALL THEM.

AND THAT'S THE PLACE I LIKE TO
HOLD WHEN I'M PUSHING
ON MY SYRINGE.

THIS IS THE BARREL
OF THE SYRINGE

AND THIS IS WHAT HAS YOUR
MARKINGS FOR THE DOSE AMOUNT.

OKAY, SO WHEN YOU'RE LOOKING AT
IT, THE 0.1 IS 0.1 MILLILITERS

AND THEN THE LITTLE MARKS
IN BETWEEN,

THERE'S 10 MARKS
AND THAT'S YOUR 100.

SO IF I NEED 0.38, I'M
GOING TO GO TO THE 0.3,

AND THEN UP 8,
OF THE LITTLE MARKS.

THIS IS THE CAP OF MY NEEDLE

AND YOU OUGHT TO BE CAREFUL
IN HANDLING THE SYRINGE

SO THAT YOU DON'T GET STUCK.
THIS IS VERY IMPORTANT.

I THINK, ANYWAYS.

SO THIS IS HOW I WANT TO SEE
YOU PULLING YOUR CAPS OFF.

SEE HOW MY HANDS ARE SEPARATE
FROM EACH OTHER.

AND I GRAB ON TO THE CAP AND
I GRAB ON TO THE PHALANGE

AND I PULL AWAY FROM ME
LIKE THIS.

SO THE NEEDLES IS OUT HERE
AND THE CAP'S OUT HERE.

AND THEN I JUST SET MY CAP IN
THAT STERILE PACKAGING
TO KEEP IT SAFE.

THIS IS WHAT I DON'T WANT
TO SEE.

OKAY? BECAUSE WHAT HAPPENS WHEN
YOU PULL THE NEEDLE OUT?

SLICE, YOU HAVE A SPAZ POKE.

SO YOU DON'T COME DOWN
YOUR HAND.

SOME PEOPLE ARE STEADY AND MAYBE
THEY'LL NEVER STICK THEMSELVES.

MAYBE?

YOU'RE JUST MUCH SAFER TO COME
AWAY FROM YOURSELF AND PULL
HARD, OKAY?

SO I HAVE MY NEEDLE.

WHAT YOU HAVE HERE IS
THE HUB OF THE NEEDLE.

THEN YOU HAVE YOUR NEEDLE,
WHICH IS THE 5/8THS INCH.

AND IT'S PROBABLY IMPOSSIBLE
TO SEE FROM HERE,

BUT YOU HAVE A BEVEL OF THE
NEEDLE AND THAT'S THE SLANT OF
THE NEEDLE.

WE ALWAYS TALK ABOUT HAVING THE
BEVEL A CERTAIN DIRECTION.

IF YOU GO IN AT A 45 DEGREE
ANGLE YOU WANT THE BEVEL
TO BE UP,

SO THAT THE POINT IS DOWN
AND IT GOES IN SMOOTHLY.

BECAUSE IF THE BEVEL IS
DOWN AND YOU GO IN,

YOU TEND TO DRAG DOWN AND THAT
MAKES FOR A LITTLE MORE
PAINFUL SHOT.

SO YOU WANT THE VERY TIP OF
THE NEEDLE TO GO IN FIRST

AND THAT'S WHY WE SAY BEVEL UP.

WE'RE GOING TO GIVE OUR SHOT
GOING AT A 90 DEGREE ANGLE,

SO IT REALLY DOESN'T MATTER
WHERE THE BEVEL IS, RIGHT?

BECAUSE IT SHOULD
GO STRAIGHT DOWN.

BUT THEY DID SOME RESEARCH
ON HOW WE GIVE SHOTS

AND THEY FOUND THAT
WHEN WE GIVE 90 DEGREE SHOTS,
WE GIVE THEM AT 80..

..OKAY, OR 75, BECAUSE WE'RE
NOT USUALLY SO STRAIGHT.

SO I STILL TRY TO
GET MY BEVELS UP

IN CASE, I DO A LITTLE TWINK OF
A LOW, YOU KNOW WHAT I MEAN?

SO BEVEL'S UP PRIMARILY.

ALRIGHT.

I'M GOING TO GO AHEAD AND RECAP.

THE OTHER RULE FOR INJECTIONS,

YOU CAN RECAP STERILE, YOU
CANNOT RECAP CONTAMINATED.

RIGHT? BECAUSE IF I STICK MYSELF
WITH A STERILE NEEDLE,
IT JUST HURTS.

BUT IF I STICK MYSELF WITH
A CONTAMINATED NEEDLE,

OH, MAN. YOU GOT A LOT OF STUFF
TO DO FOR BOTH YOURS AND
THEIR SAFETY AND SO FORTH.

ALRIGHT, WHEN I GO TO RECAP..

..I HAVE SHAKY HANDS.
BECAUSE I JUST DO.

AND MOST OF YOU DO TOO AND IT
JUST MAKES ME FEEL SO GOOD.

BECAUSE ALL OF MY NURSING LIFE,
I THOUGHT I WAS THE ONLY
PERSON TH-A-T SHO-O.

- AND I'M NOT. - OK.

SO, I PUT MY LITTLE SHAKY HANDS
DOWN ON THE TABLE
AND STEADY THEM UP.

AND IF YOU ARE REALLY JUST
HAVING A TIME OF IT,

GET YOURSELVES STEADY
AND GET THIS IN HERE,

AND THEN PRESS
WITH THE PHALANGE.

OKAY, NOW I NEED TO SHOW
YOU ONE OTHER THING.

AND THAT IS, THIS IS THE
SAFETY LOCK SYRINGE.

I'VE TALKED TO YOU ABOUT
THE BARREL,

BUT WE ALSO HAVE THIS
SHIELD THAT SLIDES.

THAT'S WHY I HANDLE IT ALL
THE TIME BY THE PHALANGE.

AND YOU GOT TO GET A REALLY
GOOD VISUAL UNDERSTANDING
OF THESE PHALANGES,

AND NOT MIX IT UP WITH YOUR
PLUNGER.

IF YOU DO MOST OF YOUR
STUFF BY THE PHALANGE,

YOU DON'T INADVERTENTLY
SLIP THIS OFF.

THE POINT OF THE SAFETY FEATURE
IS THAT WHEN WE GO
TO GIVE AN INJECTION..

..YOU PUT THE NEEDLE IN,
YOU GIVE YOUR INJECTION

AND THEN SO THAT YOU'RE NEVER
EXPOSED TO A DIRTY NEEDLE,

YOU HOLD ON TO THAT OUTER
BARREL AND PULL UP,

SO THAT YOU'RE NEVER EXPOSED

AND GET STUCK BY A DIRTY NEEDLE.

THEN THIS LOCKS INTO PLACE.

DO I HAVE ANY EXTRAS
AROUND HERE?

DON'T KNOW WHAT I DID
WITH MY EXTRAS.

SO, VOILA! STERILE AGAIN.

OKAY. THAT'S THE SYRINGE.

OKAY, KNOWING ALL OF THAT,
I HAVE MY SYRINGE READY,

I'VE GOT MY STUFF PICKED. I'M
STILL GATHERING UP SUPPLIES.

SO THERE IS A COUPLE OF OTHER
THINGS YOU NEED TO HAVE.
ALCOHOL SWABS.

ALL GOOD NURSES HAVE 20 ALCOHOL
SWABS IN THEIR POCKETS.

ALL THE TIME. AND AT LEAST
FIVE BAND AIDS, RIGHT?

SO GRAB A BUNCH WHEN YOU COME
ON, STUFF THEM IN YOUR POCKET.

GRAB THREE OR FOUR BAND AIDS,
STUFF THEM IN YOUR POCKET,
YOU NEED THEM.

I'LL TELL YOU MORE SUPPLIES YOU
NEED. YOU'RE GOING TO FEEL LIKE
YOU NEED A UTILITY BELT.

YOU'LL SEE SOME NURSES THAT ARE
CARRYING AROUND -- WEARING THESE
LITTLE HIP PACKS ON.

AND MAN, BLESS THEM. YOU THEY
WILL NEED ALL THAT STUFF.

THE OTHER THING YOU NEED
IS A 2X2,

IT DOESN'T NECESSARILY HAVE TO
BE STERILE. I HAVE A STERILE ONE
TODAY. THIS IS FOR CONVENIENCE.

AND I HAVE A PIECE OF TAPE
TO LABEL MY SYRINGE,

SO YOU NEED JUST A LITTLE
PIECE OF PAPER TAPE

AND YOU CAN PUT A LABEL ON
THAT SAYS WHAT WE'VE GOT
IN OUR SYRINGE.

ALRIGHT, I HAVE ALL MY SUPPLIES.

I'VE WASHED MY HANDS AND NOW
WHAT I WANT TO DO IS DRAW UP
MY DOSE.

I'VE ALREADY CALCULATED IT.
I ALREADY KNOW ITS HEPARIN.

AND I'VE ALREADY DONE
ONE OTHER DOUBLE CHECK.

I'VE CHECKED THE EXPIRATION
DATE OF THE VIAL.

VIALS HAVE A DATE ON THEM
THAT YOU MUST CHECK

TO MAKE SURE THAT
IT'S ACCEPTABLE.

ONCE I POP THE LID OFF OF THIS,

THEN IT IS CONSIDERED STERILE.

IF IT'S MORE -- IF IT'S A MULTI
DOSE VIAL FOR 30 DAYS,

UNLESS THE MANUFACTURER
SAYS DIFFERENTLY.

BUT THE RULE OF THUMB
IS 30 DAYS, OKAY.

SO ONCE I POP THE LID
OFF OF THIS,

THIS IS STERILE, UNLESS
I GET IT CONTAMINATED.

ALRIGHT, SO AT THIS MOMENT I'M
JUST GOING TO GO AHEAD
AND WRITE ON HERE.

ONCE IT'S OPEN HOW WILL I KNOW
30 DAYS HAS PASSED, RIGHT?

SO I'M GOING TO WRITE ON HERE,
4/2/03, THE DATE,

THE TIME, 10:20,
AND MY INITIALS DB.

SO WE KNOW AT THIS POINT

THIS IS ONLY GOOD NOW UNTIL
MAY 2ND AT 8 O'CLOCK.

AND THEN IT GETS PITCHED NO
MATTER HOW MUCH IS IN HERE,
OKAY?

ALRIGHT, I AM GOING TO POP
THE LITTLE CAP OFF.
YOU JUST FLICK THEM OFF.

AND THEN WHAT YOU HAVE HERE
IS A VIAL WITH A RUBBER STOPPER.
OKAY, ITS STERILE AT THIS POINT

SO I CAN TAKE MY STERILE NEEDLE
AND PUT IT INTO THIS VIAL AND
NEVER THINK ABOUT IT AGAIN.

HOWEVER, IF I WERE TO SET
IT AND LEAVE THE AREA

I DON'T KNOW WHAT'S HAPPENED
TO IT.

ANY TIME IT LEAVES MY SIGHT,
THEN IT IS NO LONGER STERILE.

BY THE SAME TOKEN, IF
IT'S A MULTI DOSE VIAL

AND YOU'RE USING IT AND IT
DOESN'T HAVE THAT
PROTECTIVE CAP ON IT,

THEN YOU HAVE TO CLEAN
THE VIAL WITH AN ALCOHOL SWAB
PRIOR TO DRAWING UP.

OKAY, SO YOU WIPE OFF YOUR
STOPPER TO GET IT CLEAN.

ALRIGHT, I NEED TO GET 0.38
MILLILITERS OUT OF THIS VIAL.

TO DO THAT, WHAT I NEED
TO DO IS DRAW UP 0.38 CC
OF AIR INTO MY SYRINGE

SO THAT I CAN PUT
IT INTO THE VIAL.

THE REASON IS I COULD PROBABLY
GET ONE OR TWO DOSES OUT OF HERE
WITHOUT PUTTING AIR IN HERE.

BUT IF I KEEP TAKING FLUID
OUT WITHOUT REPLACING

THAT VOLUME IN THIS CONTAINER,
IT STARTS TO BE LIKE A VACUUM.

AND IT STARTS SUCKING MY PLUNGER
BACK IN AND I CAN'T GET
MY FLUID OUT.

SO YOU HAVE TO
REPLACE THE VOLUME.

NOW THIS DOESN'T HAVE TO BE AN
EXACT SCIENCE FOR AIR, OKAY?

I SEE SOMETIMES PEOPLE GOING,
"OKAY, I GOT TO GET
MY EXACT 0.38."

LIKE IT'S MAGIC. IT DOESN'T
REALLY MATTER THAT MUCH.

IF YOU PUT 0.35 OR YOU PUT
0.4, WHO REALLY CARES?

WHAT DOES MATTER IS IF YOU PUT
2 CC AND ONLY TAKE OUT 0.2,

AND EVERYONE KEEPS PUTTING
IN 2 CC OF AIR.

THEN THE PRESSURE GETS
SO GREAT IN HERE

THAT WHEN YOU STICK A NEEDLE
IT SPITS THE MEDICINE OUT.

BECAUSE THERE IS TOO MUCH
PRESSURE IN THE VIAL.

SO YOU WANT TO BE SORT OF CLOSE.
IT DOESN'T HAVE TO BE LIKE
PERFECT TO PUT AIR IN.

ALRIGHT, SO I'VE CLEANED
MY VIAL.

I'M TAKING MY LITTLE CAP OFF.

I DON'T LIKE TO
SET MY CAPS ON THE TRAYS.
THESE TRAYS ARE NASTY.

WHO KNOWS WHERE THEY'VE BEEN.
SO I USUALLY LIKE TO SET THEM IN
MY LITTLE STERILE CONTAINER.

I NEVER SET MY CAPS DOWN LIKE
THIS. BECAUSE YOU WANT THEM
TO BE STERILE.

SO EITHER TO THE SIDE OR IN
YOUR LITTLE STERILE WRAPPER.

NOW, AGAIN SHAKY HANDS
AND THE GOAL HERE IS

THAT I HAVE GOT TO GET INTO
THE MIDDLE OF THIS STOPPER.

SO TWO WAYS TO DO IT. YOU CAN
HOLD IT UP LIKE THIS AND STICK

OR YOU CAN COME DOWN HERE AND
STEADY YOUR LITTLE HANDS DOWN

AND PUT YOUR NEEDLE
IN TO THE STOPPER.

PUSH THE AIR IN AND NOW YOU
HAVE TO TURN IT UPSIDE DOWN

SO THAT YOU CAN GET
THE FLUID OUT.

SO YOU WANT TO MAKE SURE
YOUR NEEDLE IS IN FLUID

AND THEN YOU JUST PULL BACK.

NOW, I DON'T KNOW IF YOU
COULD SEE VERY WELL,

BUT THERE IS.. THE HUB OF
THE NEEDLE HAS AIR IN IT.

AND SO YOU'RE ALWAYS GOING
TO GET A DAB OF AIR

WHEN YOU FIRST PULL FLUID
INTO THE SYRINGE.

SO WHAT I ALWAYS DO IS, I
JUST DRAW UP A WHOLE BUNCH,

MORE THAN WHAT I NEED.

THEN I, KIND OF, TAP
IT A COUPLE OF TIMES,

AND GET THE BUBBLES
LOOSE FROM HERE.

KIND OF STABILIZE THIS
AGAINST YOUR PALM

AND TAP AND GET
THOSE BUBBLES OFF.

AND THEN HOLDING IT STRAIGHT UP,

YOU'RE GOING SQUIRT THE AIR AND
THE SOLUTION BACK INTO THE VIAL.

AIR GOES TO THE TOP,
IT'S LIGHTEST

AND FLUID IS HEAVIEST
IT COMES TO THE BOTTOM.

AND SO THE ONLY WAY THAT YOU'RE
GOING TO BE ABLE TO GET
THE AIR OUT OF THE SYRINGE

IS GET THAT AIR BUBBLE CENTERED
TOWARDS THE MIDDLE

AND GO STRAIGHT UP AND SQUIRT
IT BACK INTO THE VIAL.

I.. YOU CAN GO BACK AND FORTH
A GILLION TIMES UNTIL
YOU GET IT SET RIGHT.

KEEP YOUR NEEDLE AND
YOUR VIAL CONNECTED.

DON'T DRAW UP THE WHOLE BUNCH,
TAKE YOUR NEEDLE OUT AND THEN
SQUIRT MEDICATION INTO THE SINK.

ITS NOT LIKE LIFE OR DEATH
OR REALLY USUALLY WRONG.

IT'S JUST THAT YOU WASTE
A LOT OF MEDICINE.

AND THEN IF YOU NEED
TO GET MORE YOU GOT TO STICK
THE VIAL AGAIN AND OH.

IT JUST GETS, KIND OF,
OUT OF CONTROL.

DO ALL OF YOUR ADJUSTING
CONNECTED TO THE VIAL.

ALRIGHT, SO I'M LOOKING HERE AND
I'M GOING TO SET IT AT MY 0.38

AND EACH LITTLE --

AND EACH LITTLE MARK
IS 100 ON HERE.

I AM GOING TO DOUBLE CHECK THIS
0.38.

AND THEN WE HAVE THIS
RULE IN NURSING.

THE TWO MOST COMMON MED ERRORS
IN NURSING, THE RESEARCH STILL
BEARS THIS OUT,

I JUST READ AN ARTICLE
LAST MONTH ON THIS,

THAT HEPARIN AND INSULIN ARE
STILL THE TWO MOST COMMON MED
ERRORS THAT NURSES MAKE,

WHICH IS AMAZING TO ME. I
DON'T SEE HOW THIS COULD BE

BECAUSE WE HAVE THIS RULE THAT
WHEN YOU DRAW UP HEPARIN
AND INSULIN,

YOU HAVE TO HAVE ANOTHER
NURSE VERIFY IT.

IT'S AN UNWRITTEN RULE,
BUT THAT'S THE DEAL.

SO, I'D COME OVER HERE
TO JENNIFER AND SAY,

"JENNIFER, I'M SUPPOSED TO GIVE
0.38 OF HEPARIN, 75 UNITS

THAT'S WHAT I FIGURED
WITH MY 20,000 UNITS."

I SHOW HER THE 20,000 UNITS

AND I SHOW HER THE SYRINGE,
WHILE IT'S ALL CONNECTED.

OTHERWISE, SHE DOESN'T KNOW
WHERE I TOOK THIS MEDICINE FROM,

IF SHE DOESN'T SEE THE VIAL.

AND SO SHE BLESSES IT
AND THEN I GO ON.

AND WE DO THIS FOREVER.

I MEAN, RN TO RN.

STUDENTS, GET EVERYTHING
BLESSED, YOU KNOW,
BEFORE YOU GO,

BUT RN TO RN, INSULIN AND
HEPARIN MUST BE VERIFIED
BY ANOTHER NURSE.

NOT A NURSE AID,
A NURSE FOR THIS.

OKAY, ONCE IT'S BEEN CHECKED, I
AM GOING TO DOUBLE CHECK AGAIN

AND MAKE SURE I DIDN'T HIT
MY PLUNGER INADVERTENTLY.

OH, AND SOMETIMES WE
WRECK THESE DOSES.

SEE THAT LITTLE SQUIRT, NOW.

OKAY, THIS IS STILL STERILE
SO I CAN RECAP.

I STEADY MY HANDS DOWN
AND TOUCH ON THERE

AND THEN HOLD IT WITH
THE PHALANGES.

OTHERWISE, YOU TEND TO SHIFT
THAT BARREL OFF TILL IT LOCKS.

AND THEN CLEAN UP YOUR MESS.

I AM SO PARTICULAR ABOUT MESSES.

THERE'S JUST NO REASON FOR
NURSES TO LEAVE ALL THE SLOP
THEY LEAVE AROUND.

PICK UP YOUR PAPERS.

ALRIGHT, I KNOW THIS IS HEPARIN
BECAUSE I JUST DREW IT UP,

BUT I WANT TO MAKE SURE THAT
IT'S LABELLED CORRECTLY

SO THAT I'M VERIFYING
IT IN THE ROOM.

SO I GO AHEAD AND I PUT A
PIECE OF TAPE.. ON MY CAP.

AND IT JUST SAYS HEPARIN
75,000 UNITS ON HERE.

I DON'T WRITE THE 0.38,
I CAN SEE THE 0.38.

AND I HAVE IT WRITTEN ON MY MAR,
WHICH I'M GOING
TO TAKE IN THE ROOM.

SO IT JUST VERIFIES WHAT
I'VE GOT IN HERE..

..FOR MY DOSE.

ALRIGHT, I DID WANT TO
MENTION ONE THING BEFORE
I FORGET ABOUT IT.

ONE OF THE THINGS
YOU'LL READ ABOUT,

I THINK IT'S IN YOUR TEXT
IS ABOUT SCOOPING YOUR CAP

IN CASE YOU HAVE TO RECAP,
BECAUSE THEY DON'T WANT US TO
RECAP ANYTHING.

BUT HERE'S THE DEAL,
WHEN YOU SCOOP,

THE POINT IS THAT YOU'RE DOING
IT SO THAT YOU NEVER
STICK YOURSELF.

BUT IF YOUR NEEDLE IS
STERILE AND YOU SCOOP,

YOU COULD INADVERTENTLY HIT THE
TABLE AND CONTAMINATE
YOUR NEEDLE.

AND SO WE DON'T WANT
YOU TO SCOOP STERILE.

I ONLY WANT YOU TO
SCOOP CONTAMINATED,

IF YOU HAD TO RECAP
FOR SOME REASON.

ALRIGHT, SO, WE'RE NOT SCOOPING
AND I'M GOING TO RECAP.

ALRIGHT, I HAVE MY LITTLE TRAY.
I HAVE MY HEPARIN. I'M STILL
GATHERING UP MY EQUIPMENT.

I'M DOUBLE CHECKING 0.38.
I HAVE GOT A COUPLE OF ALCOHOL
SWABS. I HAVE GOT MY 2X2.

OKAY.

I THINK I'M READY TO GO.

SO I HAVE MY MAR. I HAVE ME.
I'VE WASHED MY HANDS.

I AM PROVIDING SOME PRIVACY.

I'M GOING TO GO IN THE ROOM AND
I'M GOING TO GREET MY CLIENT.

TELL ME YOUR NAME.

OKAY, I HAVE SALLY SMITH HERE.
DR. FEELGOOD. 777889999.

OH, SALLY, I SEE YOU'RE
ALLERGIC TO PENICILLIN,

BUT THAT SHOULDN'T BE A PROBLEM

BECAUSE HEPARIN ISN'T A
PROBLEM WITH PENICILLIN.

SO, I'VE CHECKED MY ALLERGIES.

I THINK I HAVE JUST ABOUT
DONE EVERYTHING I NEED TO.

ALRIGHT, I NEED TO GIVE YOU
YOUR HEPARIN INJECTION AND

YOU KNOW, HEPARIN GOES
IN YOUR STOMACH.

SO, I'M GOING TO RAISE THE BED
HERE A LITTLE BIT AND GIVE
YOU YOUR INJECTION.

AND IT IS WHERE HEPARIN GOES.
HEPARIN GOES IN THE
ABDOMINAL PATH.

SO WE'RE GOING TO GIVE
ALL OUR INJECTIONS
THIS WEEK IN THE ABDOMEN,

JUST SO I CAN DESENSITIZE
YOU TO ABDOMEN SHOTS.

DOESN'T THAT SEEM WIRED? TO
GIVE A SHOT IN THE ABDOMEN,

BUT IT ACTUALLY IS THE MOST
STABLE AREA FOR THE BODY AS
FAR AS ABSORPTION GOES.

IF YOU GIVE SHOTS IN THE ARMS
AND LEGS, DEPENDING ON THEIR
EXERCISE AND ACTIVITY LEVEL,

IT AFFECTS THE
RATE OF ABSORPTION.

BUT IF YOU'RE GOING
TO BE ACTIVE,

IT'S GOING TO ABSORB THE
SAME FROM THE STOMACH.

THE STOMACH IS THE FASTEST
ACTING OR FASTEST ABSORBING
PART OF THE BODY,

BUT AT LEAST IT'S THE
MOST CONSISTENTLY ABSORBING
PART OF THE BODY,

WHERE THESE CAN CHANGE.

SO, WHAT WE WANT TO DO,
IS WE WANT TO COME ABOVE
THE ILIAC CRESS.

YOU'RE NOT GOING TO GIVE
THE SHOT DOWN HERE IN
THE PUBIS AREA.

SO, WE'RE GOING TO COME ABOVE
THE UMBILI -- THE ILIAC CRESS,

AND WE'RE GOING TO GO WITHIN
TWO INCHES OF THE UMBILICUS.

IT HAS TO BE IN SUBCUTANEOUS
TISSUE. IT HAS TO BE IN FAT.

WE DON'T WANT TO BE
IN THE UMBILICUS AREA

BECAUSE THERE'S NOT FAT
AS IT CAVES IN HERE.

SO, WE'RE GOING TO GO
TO THESE OUTER EDGES.

THE OTHER THING WE WANT
TO KEEP IN MIND IS THAT WE WANT
TO ROTATE IN THE ABDOMEN.

SO IF GIVE IT ON THE RIGHT SIDE,
THEN THE NEXT ONE WE GIVE
ON THE LEFT AND SO FORTH.

SO MOVE IT AROUND, SO YOU'RE
NOT JUST, YOU KNOW,

KEEPING -- PUTTING THAT THING,
THAT SHOT IN THE SAME PLACE.

WHAT ARE SOME OF THE
SIDE-EFFECTS

YOU MIGHT EXPECT FROM HEPARIN
BEING A BLOOD THINNER?

- BLEEDING. - BLEEDING.
BRUISING. OKAY.

SO, WHAT WE WANT TO
DO IS BE VERY CAREFUL

WHEN WE'RE LOOKING AT THE
ABDOMEN, TO NOT KEEP PUTTING
IT INTO BRUISED PLACES

AND BY THE SAME TOKEN NOT
TO BE CAUSING BRUISES.

THAT'S ANOTHER REASON FOR GOING
WITH THE SHORTER
AND THE THINNER NEEDLES,

BECAUSE BIGGER NEEDLES ARE
GOING TO CAUSE MORE TRAUMA TO
THE TISSUE AND CAUSE BRUISING.

AND WE'RE WANTING TO AVOID AS
MUCH TRAUMA AND NEEDLE
STICKS AS POSSIBLE.

SO, CERTAINLY WE'RE GOING TO..
AFTER HAVING CHECKED OUR LABS

TO MAKE SURE THAT THEIR
BLEEDING TIME...IS GREATER
THAN THE CONTROL?

BECAUSE I'D CALL THE PHYSICIAN
IF WE'RE OUT OF
THAT CONTROL PARAMETERS.

WE'RE GOING TO BE LOOKING FOR
SIGNS AND SYMPTOMS OF BLEEDING.

SO, LOOK THROUGH WHEN YOU'RE
LOOKING AT YOUR DRUGS,

THINGS RELATING TO
BLEEDING PRECAUTIONS.

AND WE'LL GO OVER THOSE
HERE IN A MINUTE.

ALRIGHT, BEFORE I PLUNGE ALONG..
OH, I ALREADY DID THAT.
I FORGOT.

OKAY, I DID CHECK YOU NAME BAND,
DIDN'T I, SALLY? YES.

OKAY, I THOUGHT SO.

ALRIGHT, I'M GOING
TO GET SOME GLOVES.

AND I WANT TO CHECK ON MY MAR TO
SEE WHERE THE LAST SHOT
WAS GIVEN

OR I CAN JUST ASK THE CLIENT,
"DO YOU REMEMBER WHERE
THE LAST SHOT WAS."

AND WHEN I COME TO THE STOMACH,

I CAN LOOK HERE AND SEE HOW
THE STOMACH'S LOOKING.

AND I WANT TO AVOID PLACES.
I WANT TO AVOID SCARS.

IT'S NOT GOING TO ABSORB
WELL IN SCAR TISSUE,

I WANT TO AVOID BRUISES,
RASHES, HAIRY AREAS

AND SO FORTH ON THE STOMACH,

SO THAT I CAN PUT IT
IN A NICE PLACE.

ALRIGHT, ONCE I'VE IDENTIFIED
THE PLACE THAT I'M GOING
TO PUT THIS IN,

I'M WANT TO COME OVER HERE
AND I JUST WANT TO CLEAN IT

EVER SO GENTLY IN A CIRCULAR
MOTION WITH ALCOHOL.

DON'T SCRUB UP THAT STOMACH HARD

BECAUSE IF THEY'RE ALREADY
BRUISING EASILY AND IF YOU GO..

YOU'RE GOING TO CAUSE BRUISES.

I'VE GONE INTO PUT SHOTS
INTO PEOPLES STOMACHS

AND THEY HAVE THE BIGGEST
OR UGLIEST BRUISES I'VE EVER
SEEN ON THOSE POOR STOMACHS

AND I THOUGHT, "DID I DO THAT?"

SO, ONE OF MY MISSIONS
THROUGHOUT MY CAREER WAS,

I'D GIVE A SHOT ONE DAY
AND I'D GO BACK, WHETHER THAT
WAS MY PATIENT OR NOT

AND LOOK AND SEE HOW
THAT STOMACH LOOKED THE NEXT
DAY, TO SEE IF MY TECHNIQUE

WAS CAUSING THOSE BRUISES TO
HAPPEN. I'LL HAVE YOU KNOW,
IT'S NOT.

WE JUST NEED TO BE MORE GENTLE
WITH THEIR SKIN AND NOT BE
TRAUMATIZING IT.

ALRIGHT, I'M GOING TO PUT
THIS INJECTION IN, AND I'M GOING
TO GIVE MY INJECTION,

BUT I'M NOT GOING TO MASSAGE OR
WIPE OR ANY THING AFTERWARDS.

IF THEY OOZE A LITTLE, I'M JUST
GOING TO DAB IT WITH THIS 2X2.

SO, I HAVE MY 2X2 READY
AND I'M GOOD HERE.

ALRIGHT, I'M GOING
TO TAKE MY CAP OFF.

THIS IS MY THIRD, FIFTH, 8H
CHECK, WHATEVER, OF HEPARIN
AND I'M GOOD.

I'M GOING TO TAKE ONE
MORE LOOK AND MAKE SURE

THERE'S NO GROSS AIR BUBBLES
OR THAT I'VE HIT THE PLUNGER OR
ANYTHING BEFORE I GIVE THE SHOT.

ALRIGHT, HOW DO YOU GIVE A SHOT?

YOU NEED TO HOLD THIS THING LIKE
A PENCIL OR LIKE A DART
TO GO IN.

AND IT'S MOSTLY WRIST ACTION
TO JUST GET IT IN.

ALRIGHT. NOW, IT'S A LITTLE
SHORT NEEDLE AND IT'S GOING TO
GO IN SOFT TISSUE,

WE'RE NOT HAVING TO GO
INTO HARD MUSCLE. IT'S JUST
GOING INTO THE FAT.

SO, WE CAN BE PRETTY GENTLE WITH
IT AND WE CAN BE SLOW OR FAST,

OR WHATEVER WE WANT TO DO TO
GET IT IN. JUST GET IT IN.

ALRIGHT, I'M GOING TO TAKE THE
SKIN AND I'M GOING
TO VERY GENTLY

PINCH UP SOME SKIN AND
I MEAN, EVER SO GENTLY.

I'VE SEEN NURSES, I'VE GONE
IN TO GIVE MY SHOTS

AND I COULD SEE THEIR FINGER
MARKS ON THEIR STOMACH.

THEY DIDN'T GET BRUISED
FROM THE SHOT,

THEY GOT BRUISED FROM THE
NURSE PINCHING UP SKIN.

EVER SO GENTLY, I'LL
JUST USE TWO FINGERS.

I WANT MY BEVEL UP, MY GOAL IS
TO GO IN AT 90 DEGREE ANGLE.

AND I'M JUST GOING TO DART A
LITTLE. I'M A DARTER,
I'M NOT A PUSHER.

OKAY, SO, I DART. THAT'S
ALL THERE IS TO IT.

NOW, WE DON'T ASPIRATE ON
INSULIN -- OR ON HEPARIN.

AND WE DO ASPIRATE
ON OTHER SHOTS.

NOW, I WANT YOU TO NOTICE
ONE OTHER THING I DO.

I HAVE SHAKY HANDS.

SO I ALWAYS STEADY IT, THE
SYRINGE WITH MY OTHER HAND.

I RELEASE THE PINCH.
I DON'T NEED IT ANY MORE
AND THEN I HOLD.

WE DON'T ASPIRATE. WE PUT THE
MEDICINE STRAIGHT IN SLOWLY.

AND THEN WE SIT
THERE FOR 10 SECONDS,

SO THEN IT'LL ABSORB AND
NOT TRACK UP THE NEEDLE.

SO, YOU HOLD IT
IN YOUR 10 SECONDS.

THEN AFTER THE
TEN SECONDS, PLUNGER.

NOW WHAT HAPPENS IF YOU
PULL THE PLUNGER UP?

YOU JUST SUCK UP EVERYTHING
YOU JUST TRIED TO AVOID

AND YOU TRAUMATIZE THAT SKIN.

SO YOU WANT TO BE SURE AND HOLD
STEADY ONTO THIS OUTER BARREL

AND THEN PULL IT UP BY
THE PHALANGE AND LOCK
IT TILL IT CLICKS.

SO, ONCE IT'S SET LIKE
THIS I CAN SET IT DOWN.

THERE'S NO RISK OF ANYONE
GETTING EXPOSED TO BLOOD.

THEN IF I NEED TO, I TAKE MY 2X2

AND I JUST EVER SO GENTLY DAB,
IF THERE'S ANY OOZE.

BEAUTIFUL. I DO NOT PUT BAND
AIDS ON HEPARIN INJECTIONS

BECAUSE THEN RIPPING OFF THE
BAND AID BRUISES THEM.

SO, I JUST DON'T DO IT.

SIDE RAILS UP, GLOVES OFF,
BED BACK.

WASH OUR HANDS AND GET
RID OF ALL OUR STUFF.

OKAY? ALL OF THIS GOES
INTO THE TRASH.

AND THEN THIS GOES INTO
A SHARPS CONTAINER.

WHEN YOU PUT YOU SYRINGES
INTO A SHARPS CONTAINER,

THE NEEDLE NEEDS TO GO DOWN.

DON'T PUT A NEEDLE UP BECAUSE
IF SOMEONE INADVERTENTLY
STICKS OR FLIPS IT,

THEY CAN GET STUCK JUST GOING
INTO THE SHARPS CONTAINER.

SO, THESE JUST GO IN
AND SO FORTH.

IF YOU FORGOT TO DO YOUR
LITTLE SAFETY LOCK THING,

AND YOU JUST PULLED IT OUT,

THEN JUST TAKE THAT NEEDLE
AND PUT IT IN HERE.

BUT YOU CAN'T SET THAT BARE,
BLOODY NEEDLE DOWN ON
THE TRAY OR THE TABLE

BECAUSE THAT'S JUST PUTTING
SOMEONE ELSE AT RISK

AND YOURSELF FOR GETTING
STUCK WITH THAT NEEDLE.

ANOTHER THING I NEED YOU GUYS TO
PAY REAL CAREFUL ATTENTION TO

IS NEEDLES DO NOT
GO INTO THE TRASH.

REALLY.

WE FIND - EVERY SEMESTER WE
DO THIS, AT LEAST 8 NEEDLES.

WE'VE BEEN KEEPING TRACK,
IN THE TRASH.

IT MAKES ME SO MAD. BECAUSE,
ONE, I'M GOING TO GET STUCK
TAKING OUT THE TRASH.

AND LET ME TELL YOU THAT
WON'T BE A PRETTY THING.

THE HOUSEKEEPERS GET STUCK.

NOW OURS, GRANTED, USUALLY
DON'T HAVE BLOOD ON THEM,

WE DO GIVE EACH OTHER
SHOTS SECOND SEMESTER,

BUT STILL, NO ONE WANTS
TO GET STUCK.

THEY DO NOT GO. IT'S A VIOLATION
OF OSHA STANDARDS,

HOSPITALS CAN GET FINED REALLY
BIG FOR NEEDLES AND TRASH.

ABSOLUTELY DO NOT PUT NEEDLES
IN THE TRASH. ABSOLUTELY.

ALRIGHT.

WHAT WOULD HAPPEN..

SECOND SEMESTER, WHEN WE DO
OUR INTRAMUSCULAR INJECTIONS,

WE ALWAYS ASPIRATE TO MAKE SURE
WE'RE NOT IN A BLOOD VESSEL.

BECAUSE YOU DON'T
MAINLINE DRUGS.

THEY'RE INTENDED TO GO INTO
MUSCLES AND SUBCUTANEOUS TISSUE
FOR ABSORPTION.

SO I ALWAYS ASPIRATE.
IT'S JUST A HABIT I'VE BEEN
IN ALL MY LIFE.

SO I KNOW I'M NOT SUPPOSED
WITH HEPARIN BECAUSE IT COULD
TRAUMATIZE THE SKIN.

WHAT WOULD HAPPEN IF I
INADVERTENTLY DID IT?

AND I JUST FLICKED
THAT PLUNGER UP.

NOTHING. IT'S NOT THAT HUGE OF
A DEAL ON THE SCHEME OF LIFE.

IT JUST CAN CAUSE A LITTLE
TRAUMA AND IT CAN CAUSE
SOME BRUISING.

SO YOU TRY NOT TO DO IT.
THAT'S THE ONLY REASON.

THEY FOUND THAT WE JUST
NEVER HIT BLOOD VESSELS

WHEN WE GO INTO THE
SUBCUTANEOUS TISSUE.

SO, IT'S JUST NOT WORTH
THE CHECK AND THE TRAUMA

AND THAT'S THE ONLY REASON
WE DON'T DO IT.
IT'S NOT WRONG TO DO IT.

SO, I'D RATHER HAVE THE HABIT OF
CHECKING THAN NEVER CHECKING.

SO MY THUMB JUST AUTOMATICALLY
FLICKS THAT PLUNGER UP

IF I'M NOT REALLY FOCUSED
AND THINKING ABOUT IT.

ON THAT. ALRIGHT, NEEDLE STICKS.

WHAT HAPPENS IF YOU DO STICK
YOURSELF?

FIRST, THINGS FIRST.
WASH YOUR HANDS.

GIVE YOURSELF A GOOD BETADINE
SCRUB AND WASH YOUR HANDS.

THEY USED TO TELL US THAT
WE SHOULD MILK IT

AND TRY TO SQUEEZE
THE BLOOD OUT.

THEY FOUND THAT DIDN'T MAKE
ANY DIFFERENCE WHATSOEVER

SO THERE IS NO REASON TO
MILK AND SQUEEZE AND
ALL THE STUFF WE USED TO DO.

WASH YOUR HANDS REALLY GOOD, DO
A TWO-THREE MINUTE SCRUB
WITH BETADINE.

AND THEN YOU'RE GOING TO HAVE TO
DO FOLLOW UP WITH YOUR
HEALTH SERVICES,

WHATEVER THAT IS IN
QUALITY ASSURANCE.

YOU NEED TO FILL OUT INCIDENT
REPORT, THAT'S THE
LAST THING I DO.

MY FIRST THING I DO IS GO GET
MYSELF FOLLOWED UP
WITH THE NURSE.

THEY'RE GOING TO WANT TO FOLLOW
UP WITH THE CLIENT TO SEE

IF THE CLIENT HAS HIV OR
HEPATITIS AND THEN
THEY'RE GOING TO..

IF THEY CAN'T GET THE
INFORMATION
FROM THE CLIENT,

THEN THEY WILL FOLLOW UP
WITH YOU AND THEY'LL
DO FOLLOW UP BLOOD.

IF THEY DON'T KNOW ABOUT THE
CLIENT, THEY DO HAVE MEDICATION

THAT THEY PUT YOU ON THAT DAY,
JUST TO PREVENT HIV.

SO YOU WANT TO MAKE SURE AND
TAKE CARE OF YOURSELF.

DON'T PIDDLE AROUND WITH IT.

AS FAR AS THE RULES GO
FOR WORKMEN'S COMP,

YOU NEED TO REPORT WITHIN
THREE DAYS OF ANY INJURY.

SO DON'T MESS AROUND WITH IT,
SAY, "OH, I'M TOO BUSY.
I'LL GET AROUND TO IT.

OH, I HURT MY BACK TODAY,
I'LL GET AROUND TO IT."

DO IT THAT DAY. YOU GOT TO
DO IT THAT DAY TO MAKE SURE

THAT YOU GET THE APPROPRIATE
COVERAGE AND FOLLOW UP, OKAY?

IF IT'S A STERILE NEEDLE,
LIKE I SAID,

YOU DON'T REALLY NEED
TO WORRY ABOUT IT,
JUST WASH YOUR HANDS GOOD.

YOU CAN FILL OUT AN INCIDENT
REPORT AND THEY CAN FOLLOW UP AS
FAR AS THAT,

IN CASE YOU GOT A LITTLE
INFECTION OR SOMETHING
FROM YOUR OWN FLOOR,

BUT OTHERWISE FOLLOW UP WITH ANY
KIND OF NEEDLE STICK
THAT'S BLED.

ALRIGHT, LET'S DOCUMENT.

TIM, CAN YOU HIT THAT FIRST OR..
AND SECOND LIGHT OUT.

OKAY, SO IT IS 10:40

AND I GAVE HEPARIN, OKAY.

I CHECKED MY MED EARLIER TO KNOW
IT WAS RIGHT ON THE CHART.

SO THAT'S LET'S JUST SAY IT'S
1700 AND KEEP THINGS KOSHER
HERE.

OOPS, SO IF IT'S 1700,
IT'LL BE OVER HERE.

1700, I GAVE A HEPARIN SHOT.

NOW WHEN WE GAVE OUR PILLS, THEY
SAID TO GIVE PILLS BY MOUTH,
RIGHT?

SO YOU DIDN'T HAVE TO
WORRY ABOUT THE ROUTE.

IT WAS ALREADY IN THE ORDER
AND IT'S A DONE DEAL.

SO YOU JUST DID THE TIME
IN WITH YOUR INITIALS.

BUT WHEN YOU GIVE AN INJECTION,
THERE'S A LOT OF
SUBCUTANEOUS AREAS.

STOMACH, BACK OF ARMS,
SIDES OF THIGHS,

TOP OF BUTTOCKS, ALL ARE
SUBCUTANEOUS TISSUES.

SO I HAVE RIGHT, LEFT AND
ALL OF THESE EXTREMITIES

WITH WHICH TO CHOOSE
TO GIVE MY SHOT.

SO THE CHART NEEDS TO KNOW
WHERE I GAVE THE SHOT

AND YOU NEED TO KNOW,
SO THAT YOU KNOW WHERE
TO PUT THE NEXT ONE.

SO WE HAVE TO TELL THE
CHART WHAT WE DID.

SO IF YOU COME DOWN
HERE TO THE BOTTOM,

IT SAYS, "IN CARE." AND IT
SAYS LOCATIONS AND CODES.

SO IS IT RT, RIGHT THIGH,
RD, RIGHT DELTOID, NO,
RIGHT GLUTEAL, NO.

RIGHT LOWER ABDOMEN. THAT
WOULD BE SOUNDING LIKE ME.

SO, I'M GOING TO COME OVER HERE

AND UNDER MY 1700,
PUT RIGHT LOWER ABDOMEN
AND THEN MY INITIALS.

SO ALWAYS WITH AN INJECTION
YOU HAVE TO DOCUMENT WHERE AND
WHEN, WHEN YOU HAVE CHOICE.

SO THE NEXT ONE WILL GO LEFT
IN THE LOWER ABDOMEN.

OKAY, AGAIN MAKE SURE YOU
HAVE SIGNED IN DOWN HERE.

AND THEN MY SIGNATURE IS GOOD
FOR THE REST OF MY SHOTS.

OKAY. I JUST WANTED TO SHOW
YOU MY FUNNY LITTLE...

..CHART HERE FOR HEPARIN
AND COUMADIN LAB TEST.

COUMADIN PT, WARFARIN
PRODUCT PT BOAT

AND THEN THE HEPARIN WITH
YOU TWO H'S FOR THE TT.

MAYBE THAT WILL HELP YOU
BECAUSE THEY'RE GOING TO
ELIMINATE THE PT.

FOR THE COUMADIN TO GO
WITH THE INR.

BUT IT'S THE PTT, PARTIAL
THROMBOPLASTIN TIME

THAT ACTIVATED PARTIAL
THROMBOPLASTIN TIME
FOR THOSE LAB RESULTS.

VERY IMPORTANT.
AND IT REPLAYS ON HEPARIN.
THAT DOCTOR WILL ASK...

..WHAT IT IS. AN INR IS
INTERNATIONAL
NORMALIZED RATIO.

INTERNATIONAL NORMALIZED RATIO.

ALRIGHT, CLEANING PRECAUTIONS.

THINGS THAT YOU WANT TO THINK
ABOUT ON SOMEONE WHO IS
GETTING AN ANTl-COAGULANT.

RAZORS OUT, ELECTRIC IN, OKAY?

BECAUSE YOU DON'T WANT
TO NICK THEM

AND THEN THEY JUST
BLEED AND BLEED.

ASPIRIN, NO. NEEDLES,
SMALLEST GAUGE.

D IS TO DECREASE
THE NEEDLE STICKS.

AND WE WANT TO DO ANYTHING
WE CAN TO PREVENT INJURIES.

SO WE'RE GOING TO MAKE SURE
THAT THEY'RE NOT DOING
A LOT OF HOUSEWORK,

MOVING FURNITURE, NOT GOING BACK
TO THEIR CONSTRUCTION JOB
FOR A WHILE.

IT'S JUST CONTRAINDICATED.

WE'RE GOING TO OBSERVE FOR BLOOD
IN URINE, NOSE BLEEDS.

PROBABLY MOST COMMONLY SEEN
IS BRUISING AND GUMS
THAT ARE BLEEDING

AND SO YOU'D BE WATCHING
FOR THOSE.

I THINK I HAVE PRETTY MUCH
COVERED EVERYTHING.

RANDI IS YOUR ACRONYM FOR
BLEEDING PRECAUTIONS.

THAT'S MY HUSBAND,
IF IT HELPS YOU.

I LOVE HIM, WOULDN'T WANT
HIM TO BLEED TO DEATH.

ALRIGHT, SO THERE WE HAVE
HEPARIN PRETTY MUCH.

SO THAT'S ONE SHOT,

YOU'RE DONE. WASH YOUR HANDS.
DOCUMENT. YOU'RE DONE.

OKAY, SECOND SHOT.

INSULIN.

WHAT WAS I DOING?

INJURY, PREVENT INJURY.

MOVING..

IT'S MEMORY. I THOUGHT
I'D MEMORIZED IN THE
BACK OF MY BRAIN.

LET'S GIVE SOME INSULIN.

NOW...

..WE WILL HAVE THE VIALS AT OUR
STATIONS FOR YOU TO DRAW FROM.

ITS JUST EASIER. THERE'S NOT
ENOUGH AND EVERYONE WILL BE
SCRAMBLING TO BRING VIALS.

BUT YOU HAVE TO GATHER UP YOUR
OWN SYRINGES AND YOUR OWN
SUPPLIES TO GIVE THE SHOTS.

WE'LL KEEP THE VIALS
AT OUR STATIONS

AND YOU'LL BE DRAWING
UP IN FRONT OF US

BECAUSE WE WANT TO MAKE SURE
THAT YOU ARE CHECKING DATES,

THAT YOU ARE CLEANING TOPS,
PUTTING AIR IN,

GETTING RIGHT DOSING
AND SO FORTH.

ALRIGHT. I'VE CHECKED
MY DOCTOR'S ORDERS,

I AM GOING TO GIVE REGULAR
INSULIN, 8 UNITS

AND MPH INSULIN, 14 UNITS, SUBQ,
EVERYDAY, AC BREAKFAST.

WHAT DOES THAT MEAN?

BEFORE BREAKFAST. OKAY.

SO YOU WANT TO KEEP A COUPLE
OF THINGS IN MIND HERE.

I HAVE TWO KINDS OF INSULIN.

ONE IS A SHORT-ACTING INSULIN

AND ONE IS AN
INTERMEDIATE-ACTING INSULIN.

YOU GUYS DONE INSULIN
STUFF YET? OKAY.

THERE IS ALL KINDS OF INSULIN
AND YOU NEED TO KNOW THIS.

SO WHEN YOU LOOK UP INSULIN,
YOU MIGHT AS WELL
START MEMORIZING IT.

IT WILL BE ON INPLEX SOMEWHERE.
IT WILL FOLLOW YOU FOR
THE REST OF YOUR DAYS.

INSULIN, VERY IMPORTANT.

THERE'S FOUR KINDS THAT WE'RE
MOSTLY CONCERNED WITH

AND THAT'S RAPID, ONSET,
SHORT-ACTING,

INTERMEDIATE AND LONG, OKAY?
YOU'LL SEE THOSE FOUR.

I KNOW THAT I HAVE A SHORT
AND AN INTERMEDIATE.

REGULAR INSULIN IS A
SHORT-ACTING INSULIN.

AFTER YOU KNOW WHAT KIND
OF INSULIN YOU HAVE,

WHAT IS THE CRITERIA?
WHAT DOES THAT MEAN?

THERE'S THREE THINGS THAT YOU
NEED TO LOOK UP AND KNOW
ABOUT YOUR INSULIN.

AND THAT IS THE ONSET. WHEN
DOES IT START WORKING?

WHEN DOES IT PEAK? AND
HOW LONG DOES IT LAST?

BECAUSE EACH OF THESE CATEGORIES
OF INSULIN START AT
A DIFFERENT TIME.

PEAK, ARE MOST EFFECTIVE
AT A PARTICULAR TIME,

AND THEN LAST FOR A CERTAIN
AMOUNT OF TIME.

IT'S VERY, VERY COMMON THAT
WE GIVE A SHORT-ACTING WITH
AN INTERMEDIATE-ACTING,

SO THAT YOU GET RESULTS
RIGHT AWAY.

BUT THEN THROUGHOUT THE DAY
THEY STILL HAVE SOME
COVERAGE FOR THEIR SUGAR,

BLOOD-SUGAR TO KEEP IT NORMAL.
SO, SHORT-ACTING,

IT'S GOING TO ACT WITHIN ONE AND
A HALF.. I MEAN, ONE HALF
TO ONE HOUR

AND KNOWING THAT I NEED TO MAKE
SURE THAT THEY GET BREAKFAST
WITHIN 15 MINUTES OF THIS SHOT.

THEY GOT TO HAVE SOME SUGAR
ONBOARD BEFORE THIS INSULIN HITS

OR THEY'RE GOING TO HAVE
HYPOGLYCEMIC ATTACK, OKAY?

SO DON'T, "OH, I THINK I'LL
GET A LITTLE AHEAD HERE."

AND THEN LUNCH --
OR BREAKFAST IS LATE.

OH MAN, YOU GOT TO FEED THAT
DIABETIC AND GET SOMETHING
GOING FOR THEM,

SO THAT SOMETHING'S ONBOARD.

ALRIGHT. INTERMEDIATE. I'VE
GOT TO TELL YOU THE PEAKS.

THE PEAK IS 2 TO 4 HOURS
WITH YOUR SHORT-ACTING,

AND IT'S ANYWHERE, 5 TO 7 OR 6
TO 8 HOURS FOR ITS DURATION.

IT DEPENDS ON WHAT'S AUTHOR
YOU READ. THEY'RE ALL
A LITTLE BIT DIFFERENT.

I DON'T REALLY LIKE TO KNOW MY
PEAKS AND ONSETS PRETTY WELL.

INTERMEDIATE ON THE OTHER HAND
DOESN'T EVEN START WORKING FOR 2
TO 3 HOURS,

UP TO 4 HOURS.

SO YOU GOT THIS BIG SPAN OF
IT THAT DOESN'T EVEN WORK.

THEN IT'S GOING TO PEAK OUT
SOMEWHERE BETWEEN 6 TO 12 HOURS

AND LAST ANYWHERE
FROM 18 TO 28 HOURS,

DEPENDING ON THE PARTICULAR
BRAND IT IS.

PROBABLY, REGULAR AND MPH
ARE THE MOST COMMON.

THERE IS A FASTER ACTING. IT'S
CALLED RAPID INSULIN.
IT'S CALLED LISPRO.

AND IT ACTS IN LESS THAN
15 MINUTES, BOOM.

SO THEY GOT TO HAVE SOME
FOOD ONBOARD OR THERE IS SOMEONE
THAT'S REALLY HYPOGLYCEMIC

AND WE'RE NEEDING SOME IMMEDIATE
RESPONSE FOR THEM

TO GET THEIR BLOOD-SUGAR
ON DOWN.

ALRIGHT. SO I KNOW WHAT
I HAVE GOING.

I KNOW I HAVE TO GET MY
CLIENT READY TO EAT.

I KNOW WHAT KIND
OF INSULINS I HAVE.

NOW I'VE GOT TO GATHER
UP MY EQUIPMENT.

I HAVE WASHED MY HANDS
TO PREPARE SHOTS

AND I'M GOING TO GET
MY STUFF TOGETHER.

I HAVE TWO KINDS OF INSULIN,
THE REGULAR AND THE MPH.

YOUR SHORT AND RAPID-ACTING
INSULINS ARE CLEAR INSULINS

AND YOUR LONG-ACTING INSULINS
ARE CLOUDY INSULINS,

WHICH MEANS THEY'VE ACTUALLY..
THEY PUT A ZINC PRODUCT
IN THERE,

AND THAT'S WHAT PROLONGS THE
ACTION OF THE MEDICINE ITSELF.

SO CLOUDY AND CLEAR,

THAT'S HOW YOU'LL HEAR THEM
REFERRED TO ALL THE TIME.

ALRIGHT, I CHECKED EXPIRATION
DATES AND THERE'S NONE ON HERE

AND I AM HOPING THEY'RE GOOD.

I'LL PUT MY DATE AND TIME
AND INITIALS ON IT,
IF THEY'RE BRAND NEW.

ACTUALLY, IF I FOUND
INSULIN LIKE THIS

WITH NO EXPIRATION DATES,
TOPS OFF, I'D CATCH THEM.

AND I CALL PHARMACY
AND GET SOME MORE.

I HAVE NO IDEA ABOUT THIS,
IF IT IS IN THE HOSPITAL.

IF IT WAS IN MY HOME, WELL, THEN
I'D KNOW, I'D BE THE DIABETIC
USING IT.

NOW MAYBE THAT'D BE DIFFERENT,
BUT I DON'T USE THINGS

I DON'T KNOW ABOUT THEM
IN THE HOSPITAL.

GET MORE. AND MAKE SURE
THAT YOU'RE A LABELLER

OR WE'RE WASTING A LOT
OF GOOD STUFF HERE.

ALRIGHT, I NEED A SYRINGE.

AN THIS TIME WHAT I'M GOING TO
DO IS GET AN INSULIN SYRINGE.

AND THIS IS A HALF CC SYRINGE,

BUT THEY ALSO HAVE INSULIN
SYRINGES THAT ARE 1 CC SYRINGES.

BECAUSE INSULIN IS A UNIT DRUG.

AND YOU'LL SEE THAT
IT'S CALLED U100,

THERE'S A 100 UNITS
PER MILLILITER.

AND IT'S THE SAME WITH THIS,
IT'S A U100 PRODUCT.

ITS PURPOSE IS TO BE
CALCULATED IN UNITS.

SO THAT'S WHY WE NEED INSULIN
SYRINGE BECAUSE IT'S MEASURED
IN UNITS.

ONE DAY, I WAS OUT WORKING
AND I WENT TO GIVE A SHOT
TO A DIABETIC.

AND THEY DIDN'T HAVE ANY
NEEDLES, THEY'D RUN OUT.

I AM NOT A DIABETIC, I
DIDN'T HAVE ANY EITHER.

SO, I HAPPENED TO HAVE MY BAG
WITH ME AND I DON'T USUALLY
CARRY AROUND SYRINGES,

BUT I HAPPENED TO HAVE A
1 CC SYRINGE IN MY BAG.

CAN YOU SUBSTITUTE A 1 CC
SYRINGE AND A UNIT SYRINGE?

YES.

THE HUNDREDTHS
ARE ACTUALLY UNITS

AND SO 1 CC,

0.1 CC OF A REGULAR SYRINGE
IS ACTUALLY 10 UNITS.

SO YOU CAN DO THE EQUIVALENT
THERE AND IF YOU GO THROUGH YOUR
MATH BOOKS,

AND YOU GO TO THE PAGES WHERE
IT TALKS ABOUT DRAWING UP
FROM AN INSULIN SYRINGE,

IT WILL TELL YOU HOW TO DO
EITHER THE INSULIN
OR THE 1 CC SYRINGE.

SO, YES, YOU CAN INTERCHANGE
THEM, IT'S JUST EASIER.

THE MARKINGS ARE EASIER TO READ
ON THE INSULIN SYRINGE
THAN ON THE 1 CC SYRINGE.

ALRIGHT. I HAVE MY
INSULIN SYRINGE

AND THE ONES THAT I'M GOING
TO GIVE YOU TO PRACTICE WITH

DO NOT HAVE A SAFETY
DEVICE ON IT

BECAUSE I ORDERED THEM AND
THEY DIDN'T COME IN.

THERE IS A NEW SYRINGE
THAT'S JUST COME OUT,

LIKE, IN THE LAST YEAR FOR
INSULIN. AND EVERYTHING OSHA..

I THINK IT WAS IN 2000. CAN'T
REMEMBER NOW 1 OR 2, TIME FLIES,

REQUIRED THAT EVERY SYRINGE HAVE
SOME KIND OF SAFETY DEVICE
ON IT.

AND INSULIN WAS THE LAST ONE TO
GET ANYTHING, I DON'T KNOW WHY.

BUT WHAT THEY CAME UP WITH..

EVERYTHING ABOUT THIS IS THE
SAME AS FAR THE PLUNGER,
THE PHALANGES,

THE BARREL, THE HUB, THE
NEEDLE AND SO FORTH.

IT JUST SO HAPPENS THAT
THIS IS A 28 GAUGE,

VERY THIN, HALF INCH NEEDLE.

WE JUST HAVE TO BREAK THROUGH
THE SKIN HERE ON THIS.

VERY THIN, BUT THEY DIDN'T PUT
THE LITTLE SLIDE THING ON.

WHAT THEY DID WAS PUT THIS
LITTLE JOB ON HERE.

SO YOU GIVE YOUR SHOT, BOOM,
IT GOES INTO THE SKIN

AND THEN YOU PRESS ON THIS AS
IT COME OUT AND THAT COVERS UP
THE NEEDLE FOR YOU.

THEY CALL IT SAFETY GLIDE.
PRETTY COOL.

BUT ONCE YOU'VE LOCKED IT OFF,

YOU CAN'T PRACTICE WITH IT
ANY MORE, ONCE IT'S LOCKED.

SO, WE'RE GOING TO USE THESE
OTHERS SO YOU CAN PRACTICE

AND PRACTICE AND DART
AND SO FORTH.

BUT HOPEFULLY, WHEN YOU'RE OUT
IN THE FIELD YOU'LL SEE THESE.

SO USE THE LITTLE BUTTON.

ALRIGHT. I HAVE MY INSULIN
SYRINGE, HALF CC.

I ALREADY TOLD YOU THAT THESE
ARE THE MUCH SMALLER GAUGE,

AND THEY'RE SHORTER,
USUALLY HALF INCH.

ALRIGHT. I NEED TO DRAW THIS UP,

SO WHAT I'M GOING TO DO IS CLEAN
MY VIAL TOPS BECAUSE..

..THEY WERE OPEN.

NOW..

..WHEN WE'RE GOING
TO GIVE INSULIN,

WE NEED TO BE CAREFUL
THAT WE DON'T CONTAMINATE
BOTH THE BOTTLES.

IF WE GET EITHER INSULIN INTO
THE OTHER, IT DILUTES IT

AND IT BECOMES SOMETHING THAT
IT'S NOT SUPPOSED TO BE.

SO WHAT WE WANT TO DO IS, TAKE
YOU LITTLE CAP OFF YOUR PLUNGER.

I ALWAYS, KIND OF, RELEASE
IT A LITTLE BIT HERE.

I WANT TO PUT AIR INTO BOTH
VIALS, BUT I'M ONLY GOING TO
DRAW UP FROM ONE FIRST.

BECAUSE ONCE I GET FLUID IN
HERE, I CAN'T PUT AIR IN
THE OTHER VIAL, RIGHT?

SO I GOT TO PUT THE AIR INTO
BOTH AND THEN DRAW UP.

I WANT TO DRAW UP MY REGULAR
FIRST BECAUSE I DON'T
WANT THE CLOUDY,

I DON'T WANT ZINC GETTING
INTO MY REGULAR.

IT JUST TURNS IT INTO THEN
NOT A PURE PRODUCT.

SO, ACTUALLY MPH IS REGULAR
WITH ZINC IN IT.

SO IF I GOT A LITTLE REGULAR
IN IT,

IT'S NOT GOING TO DILUTE IT UP
AS MUCH AS IF I GET THE
LONG-ACTING IN.

IT DOESN'T REALLY CONVERT
IT TO A LONG-ACTING,
IT JUST DILUTES IT

AND SO THEY TRY TO
KEEP THEM SEPARATE.

SO WHAT I WANT TO DO THEN IS I
WANT TO PUT MY AIR IN MY CLOUDY
VIAL FIRST,

WHICH IS ABOUT 14 UNITS,
SO I DRAW UP MY 14 UNITS.

AND I JUST PUT THE AIR IN
WITHOUT MY NEEDLE EVER
TOUCHING THE VIAL

AND TAKE IT OUT. SO THIS
ONE'S READY TO GO.

NOW I'M GOING TO PUT 8 UNITS
WORTH OF AIR IN HERE

AND I JUST HOLD ON TO THESE.
MOST OF THE TIME,
THAT'S MY HABIT.

AND NOTICE HOW I PUT THE
OPENING,
LIKE, OUT, SO I'M NOT
CONTAMINATING IT.

AND I'M GOING TO PUT MY
NEEDLE IN, PUT MY AIR IN

AND THEN I AM GOING
TO DRAW UP A LOT

BECAUSE I ALWAYS GET THAT LITTLE
HUBS
WORTH OF AIR INTO THE BARREL.

SO I DRAW UP A WHOLE BUNCH, IT
DOESN'T MATTER HOW MUCH
I PUT IN.

AND THEN I FLICK IT A LITTLE
BIT, BUT YOU NEED
TO BE PRETTY GENTLE.

OTHERWISE, YOU BEND THE NEEDLE
BECAUSE IT'S SO THIN.

SO HOLD THIS STEADY AND THEN LET
THIS SIT RIGHT ON THE PAD OF
YOUR PALM.

KNOCK THAT AIR UP TO
THE TOP OF THE CENTER AND
THEN SQUIRT IT OUT.

YOU'LL GET IT CENTERED AND OUT.

AND THEN SET YOUR 8.

OKAY. IF IT WASN'T SET, AND I
SAW A BIG, OLD BUBBLE HERE
ON THE SIDE,

THEN WHAT I DO IS I PULL REAL,
KIND OF, HARD AND FAST.

AND LOOSEN THAT BUBBLE OFF
OF THE SIDE. WHOOSH!

AND THEN GET IT CENTERED AND
SQUIRT IT BACK UP, OKAY?

LITTLE TINY LIKE
CHAMPAGNE BUBBLES,

LITTLE, TINY BUBBLES THAT ADHERE
TO THE BARREL DON'T MATTER,

THEY'RE JUST THERE. AND THEY'RE
GOING TO GET STUCK IN THE HUB,

AND IT'S JUST NOT GOING
TO MATTER.

THE BIG OLD BUBBLES THAT SIT AND
CHANGE THE UNIT DOSE,
THOSE MATTER.

SO THAT'S THE DIFFERENCE IN THE
SIZE OF BUBBLE YOU WANT
TO FIGHT ABOUT.

SOMETIMES IT HURTS MY FINGER
TO KEEP FLICKING ON IT

SO IF YOU GRAB A PEN AND YOU,
KIND OF, WHACK ON IT
A COUPLE OF TIMES,

THAT'LL LOOSEN UP THAT BUBBLE.

THE KEY IS YOU GOT TO GET THE
AIR CENTERED TO SQUIRT
IT UP STRAIGHT.

ALRIGHT, JUST LIKE HEPARIN, I
HAVE TO GET SOMEONE
TO DOUBLE CHECK.

I NEED TO GIVE REGULAR
INSULIN TO SALLY,

HERE'S MY REGULAR 8 UNITS.

REGULAR. REGULAR. 8. 8.

ALRIGHT. AND SHE SAYS, "OKAY."

SO, TAKE THIS OUT,

SET IT ASIDE. AND I WALKED
AWAY FROM THIS,

SO I'M GOING TO GO AHEAD AND
CLEAN IT.

AND I DID IT INADVERTENTLY
AND I DIDN'T MENTION IT,

BUT ON YOUR CLOUDY INSULINS, THE
ONLY WAY TO REALLY MIX IT
IS TO ROLL IT.

YOU DON'T WANT TO SHAKE IT.
BECAUSE IF YOU SHAKE IT, YOU ADD
MORE BUBBLES TO THE VIAL.

AND YOU GET A LOT OF THOSE
CHAMPAGNE BUBBLES AND THEN IT
CHANGES THE DOSE.

SO JUST ROLL IT TO
GET A GOOD MIX

AND NOW I WANT TO PUT
MY SYRINGE IN.

AND AT THIS POINT, YOU CAN'T
BE BACK AND FORTH IN IT.

YOU SHOULDN'T HAVE ANY AIR
IN YOUR SYRINGE, RIGHT?

BECAUSE YOU'VE CLEARED OUT THAT
HUB AND YOU'VE GOT IT SET.

SO NOW WHEN YOU PULL FLUID IN
IT WILL COME STRAIGHT IN,

AND YOU WON'T HAVE
ANY AIR BUBBLES.

WHAT I NEED TO PAY ATTENTION
TO IS WHAT IS 8 PLUS 14.

22. SO WHEN I DRAW UP, I'VE
GOT TO STOP EXACTLY ON 22.

I CAN'T GO TO 23. I CAN'T GO
TO 25 AND SQUIRT BACK IN.

SO YOU'VE GOT TO PAY
CLOSE ATTENTION HERE.

SO I PULL BACK, PULL BACK,
NO AIR.

20. 21. 22.

COME BACK TO STACY WHO
ALREADY SAW MY 8 UNITS

BECAUSE IT WOULDN'T DO ME ANY
GOOD TO HAVE SOMEONE
ELSE CHECK IT.

SO I HAVE ADDED MY MPH,
SORED MY THUMB'S ON IT.

THERE IS MY MPH, NOT EXPIRED,
22 IS MY CALL ON IT.

OKAY.

SHE BLESSED IT. I'M GOOD TO GO.

ALRIGHT.

I PULL IT UP AND I ALWAYS
GIVE MY NEEDLE A CHECK

TO SEE AFTER ALL THAT
TAPPING AND POKING.

"DID I BEND THE THING TO
SMITHEREENS?"

SO MAKE SURE YOUR NEEDLE IS
IN GOOD SHAPE AND THEN RECAP.

AGAIN, BE CAREFUL OF THAT
PLUNGER.

ALRIGHT, I AM HAPPY.

I'M GOING TO TAPE ON HERE, THAT
I HAVE INSULIN REGULAR,

8, MPH 14 AND THEN I ADDED UP
SO I KNEW I HAD NEEDED 22.

THAT'S WHY I DID MY MATH.

ALRIGHT. THESE CAN GO
BACK INTO STORAGE.

I DO WANT TO MENTION

THAT IT USED TO BE THE THINKING
FOR YEARS THAT..

WELL, WE REFRIGERATED
FOR THE LONGEST TIME

AND THEN ABOUT 10, 15 YEARS
AGO THEY SAID, "OH, YOU DON'T
NEED TO REFRIGERATE IT.

YOU JUST KEEP IT AT ROOM
TEMPERATURE BELOW 80 DEGREES,
IT WILL BE FINE.

WELL, IN THE LAST YEAR OR
SO THEY'VE COME OUT WITH SOME
RESEARCH STUDIES THAT SAID,

YOU KNOW, YOU REALLY NEED
TO REFRIGERATE IT.

WHAT WE FOUND IS THAT
WITHIN A MONTH'S TIME,

IT ACTUALLY DETERIORATED ABOUT
1.5%. I AM THINKING THAT'S NOT
VERY MUCH.

BUT THEY THOUGHT IT WAS
SIGNIFICANT ENOUGH

THAT THEY REALLY HAVE US BACK
TO REFRIGERATING INSULIN.

SO YOU'LL EITHER FIND INSULIN
IN THE DRAWERS FOR YOUR CLIENT

OR IN THE REFRIGERATOR
WHERE THEY STORE MEDS,

DEPENDING ON YOUR
HOSPITAL POLICY.

ONE OF THE THINGS
THAT YOU'LL RUN INTO

WHEN YOU GO TO DO INSULIN AND
ESPECIALLY WHEN YOU'RE TEACHING
YOUR CLIENTS TO DO IT.

BECAUSE YOU HAVE TO TEACH
YOUR CLIENTS HOW TO DRAW
UP THEIR MEDICINE

TO MAKE SURE THAT THEY'RE SAFE
AND THEN THEY CAN BE
INDEPENDENT.

BECAUSE DIABETES IS GOING
WITH YOU WHEREVER YOU GO.

AND ONE OF THE THINGS IS THAT
YOUR GERIATRIC CLIENTS IN
PARTICULAR

HAVE A HECK OF A TIME
SEEING THESE.

I MEAN, AND I'M BEGINNING TO
APPRECIATE THAT AT THIS TIME.

I AM NOT SEEING
VERY WELL MYSELF.

SO WHAT YOU CAN DO IS GET
THIS LITTLE MAGNIFIER

AND IT FITS IN LIKE THIS.

I HOPE THIS WILL..

YOU KNOW WHAT? THIS IS
PROBABLY GOING TO WORK.

OKAY, MY TOP IS CLEAN.
IT FITS IN HERE.

AND THEN YOU PUT YOUR
NUMBERS TO THIS SIDE

AND THEN THEY CAN SEE A LITTLE
BIT BETTER TO DRAW UP THEIR OWN
MEDS, OKAY.

SO THERE ARE GADGETS AND THINGS
OUT THERE TO HELP YOUR CLIENT.

IT'S REALLY IMPORTANT IN THE
HOSPITAL THAT YOU WATCH THEM DO
SOME OF THESE..

OH, SEE I LOCKED IT.

THAT WOULD BE GREAT.
GET IT ALL DRAWN UP AND THEN
LOCK YOURSELF OUT.

THESE NEW-FANGLED SYRINGES.

WATCH YOUR CLIENT. SEE
THEIR TECHNIQUE.

SEE HOW ACCURATE THEY ARE IN
GETTING THEIR INSULIN DRAWN UP

BECAUSE IF THEY'RE NOT GETTING
THE RIGHT DOSING,

THEY'RE NOT GOING TO BE FILLED
UP AS FAR AS THEIR MANAGEMENT
AT HOME.

OKAY. I HAVE MY INSULIN.

I HAVE SOME ALCOHOL SWABS.

I DON'T REALLY NEED A 2X2 ON
THIS ONE. I THINK I'M OKAY.

I'VE CLEANED UP MY AREA,
PUT EVERYTHING BACK.

ONE OF THE THINGS I WANTED
TO MAKE SURE AND MENTION

BEFORE I GET AWAY
FROM MY THOUGHT

IS ON YOUR INSULIN, WHEN YOU'RE
LOOKING AT YOUR CLOUDY,

MAKE SURE IT DOESN'T HAVE
PRECIPITANT IN IT.

WHAT IS THAT?

CLUMPS, THINGS THAT ARE NOT
NATURAL.

THIS SHOULD JUST BE..
IT SHOULD BE CLOUDY,

BUT IT SHOULD BE WITHOUT
PARTICLES AND WITHOUT
CLUMPS IN IT.

IF YOU HAD PRECIPITANT OR IF
YOU HAD CLUMPS IN THE INSULIN

WHAT WOULD YOU DO?

THROW IT AWAY. IT'S NO GOOD.

YOU CAN'T UNCLUMP IT. YOU
CAN'T RUN HOT WATER ON IT.

YOU CAN'T DILUTE IT.
IT'S NO GOOD.

SIMPLE AS THAT. YOU GET RID
OF IT AND YOU GET SOME MORE.

ALWAYS MAKE SURE
THAT YOUR DIABETICS

HAVE AN EXTRA BOTTLE OF BOTH
KINDS OF INSULIN THAT THEY TAKE

AND PLENTY OF SYRINGES BECAUSE
YOU NEVER KNOW WHAT WILL HAPPEN

IF THIS WENT BAD OR IF
THEY BROKE A BOTTLE.

THEY CAN'T BE WITHOUT INSULIN,
SO THEY SHOULD
ALWAYS HAVE A SPARE.

- IS THERE A REASON THEY JUST
DON'T HAVE THE SOLUTION
ALREADY MIXED UP,

SO YOU DON'T HAVE TO DO THIS?

- THEY DO HAVE SOME MIXED UP.

AND THERE'S TWO SCHOOLS
OF THOUGHT ON THIS.

THERE IS AN INSULIN
CALLED 70/30,

AND IT'S A MIX OF INSULIN
AND THEY DO USE THAT.

ONE REASON IS, THEY USED TO
THINK IT WOULDN'T BE STABLE.

THEY THOUGHT THAT IF YOU
PUT MPH WITH REGULAR

THAT THEY WOULD MIX TOGETHER AND
IT WOULD LOSE ITS POTENCY.

BUT THEY FOUND THAT
IF YOU MIX REGULAR WITH
LONG-ACTING TOGETHER

THAT THEY'RE ACTUALLY
STABLE FOR ONE MONTH.

SO, YOU JUST.. IT'S NOT
EASY TO CREATE A PRODUCT

THAT HAS ALL OF THE FEATURES
IN IT AS SHORT AND LONG,

OTHER THAN THIS 70/30 PRODUCT
THAT THEY CREATED.

SO, YES THERE IS ONE, BUT THIS
IS ALSO CHEAPER AND EFFECTIVE.

- JUST ANOTHER THING, BEING
SOMEONE THAT'S USED 70/30 --
YOU HAVE HORRIBLE CONTROL.

JUST AWFUL, I MEAN, JUST TYPE 1,
I DON'T KNOW ABOUT TYPE 2,
BUT...

- YEAH.

- YOU'RE BETTER OFF USING
TWO DIFFERENT ONES.

- UH-HUH. AND THE OTHER THINKING

IS ESPECIALLY FOR PEOPLE
THAT ARE YOUNG

AND WANTING TO KEEP THEIR
BLOOD-SUGAR
AS NORMAL AS POSSIBLE.

NOW IF THEY JUST GIVE REGULAR
ALL DAY LONG, MIMICING

A REAL PANCREAS, THAT THEY
WOULD GET BETTER COVERAGE

THAN HAVING TO JUGGLE THIS
LONG-ACTING

AND NOT KNOWING ACCORDING
TO THEIR ACTIVITY LEVEL

WHEN THEY'RE GOING TO PEAK AND
WHEN THEY'RE GOING TO PLUMMET.

BECAUSE ACTIVITY BURNS UP SUGAR
FASTER SO A HARDER GROUP
TO MANAGE.

AND THERE IS SO MUCH ON DIABETES
THAT'S JUST FASCINATING
ACTUALLY, SUBJECT.

SO THANK YOU FOR THAT.

CAN YOU THROW THOSE AWAY
IN A REGULAR TRASH CAN?

- YES.
- THERE ARE NO OTHER
INSTRUCTIONS?

- UH-HUH. YEAH, THESE YOU CAN.

BECAUSE THEY'RE NOT BLOODY,
YOU CAN'T FLUSH THEM.

- YEAH, BUT I'M JUST SAYING
ANYBODY GET INTO A TRASH CAN.

THAT'S A GOOD POINT. YOU MIGHT
WANT TO DRAW IT OUT,

SQUIRT IT OUT IN THE SINK,
BUT IF IT'S CLUMPY

DO YOU HAVE ANY THOUGHTS ON
THAT?

WHAT DO YOU DO WITH YOUR
INSULIN IN A VIAL,
YOU JUST THROW IT OUT?

NO. WE'RE GOING TO TALK ABOUT
WHAT TO DO WITH NEEDLES
HERE IN A MINUTE.

ALRIGHT. YOU'RE GOING TO
HAVE YOUR DRINK OF WATER.

OKAY, WHAT'S NEXT? WE'RE GOING
TO GO GIVE THE SHOT.

ALRIGHT.

I HAVE CERTAINLY CHECKED
ABOUT ALLERGIES.

THE RISK OF ALLERGY WITH HEPARIN
AND INSULIN IS REALLY
SLIM AND NONE

BECAUSE MOST OF THEM
ARE HUMAN PRODUCTS.

WHERE YOU'LL RUN INTO SOME
TROUBLE IS SOME OF YOUR INSULINS

WERE MADE FROM ANIMAL PRODUCTS.

THEY USED TO MAKE IT FROM
PORK AND FROM BEEF,

BUT THEY DON'T DO THAT TOO MUCH
ANY MORE, THEY'RE ALL HUMAN
PRODUCTS

AND SO WE DON'T REALLY RUN INTO
ANY PROBLEM RELATED
TO ALLERGIES.

ALRIGHT, I'VE WASHED MY HANDS.
I'VE IDENTIFIED MY CLIENT.

COULD YOU TELL ME
YOUR NAME PLEASE?

GREAT. SALLY SMITH. 777889999.

I SHARED WITH PEOPLE IN MY GROUP
WHEN THEY WERE TESTING,

THAT THERE'S.. THEY'RE ALWAYS
TRYING TO FIGURE OUT A WAY FOR
US NOT TO MAKE MED ERRORS,

BUT THEIR NEWEST PUSH IS
THAT WE FIND TWO IDENTIFIERS
FOR OUR CLIENT,

NOT ONE OF THEM
NOT BEING A NAME.

SO WHEN YOU'RE LOOKING AT
ID BANDS YOU NEED TO
CHECK AN ID NUMBER

AND A NAME, NOT JUST NAME NAME.

BECAUSE THERE COULD
BE TWO SALLY SMITHS.

YOU KNOW, THAT'S WHY I HAVE
TWO SMITHS IN MY LABS,

SO THAT WE'RE AWARE THAT
NAMES CAN MATCH UP.

SO MAKE SURE THAT YOU'RE
CHECKING SOMETHING ELSE
BESIDES THAT.

AND THEY'RE RECOMMENDING
AN ID NUMBER.

ALRIGHT, PROVIDED PRIVACY
AND WE'RE READY TO GO.

SO, MRS. SMITH, I HAVE
YOUR INSULIN FOR YOU.

CAN YOU GIVE YOUR OWN SHOT?

I WOULD LOVE TO WATCH YOU.

NO, YOU GIVE IT.
I DO IT ALL THE TIME

AND THEY DO BOTH. AND IF
I NEED TO SEE THEM, FINE.

IF I DON'T, IF I'VE SEEN IT,
THEY JUST DON'T WANT TO DO IT
FOR THE DAY,

I DON'T CARE, I'D GET TIRED OF
DOING IT MYSELF SO WHATEVER,
I DON'T CARE.

WE'RE GOING TO GIVE THIS
ONE AGAIN IN THE STOMACH

SO WE WANT TO ROTATE OUR SITES.

ON YOUR DIABETICS..

IT USED TO BE RECOMMENDED THAT
WE ROTATE TO ALL THE
SUBCUTANEOUS SITES

I REVIEWED OVER THERE
A MINUTE AGO.

BECAUSE WHAT THEY FOUND WAS
THEY GOT SOME LIPOATROPHIES,

THEY GOT DIMPLING ON THE HARD
PLACES IN THEIR SKIN
FROM THE INSULIN.

WELL, THEY FOUND OUT THAT THOSE
WERE ACTUALLY CAUSED BY
THE BEEF AND PORK INSULINS

AND THAT IF THEY INJECTED
THOSE ATROPHIED PLACES
WITH HUMAN INSULIN,

THEY PUFFED RIGHT BACK UP,
BECAME NORMAL LOOKING.

SO WHAT THEY FOUND WAS THAT THEY
ACTUALLY GOT BETTER COVERAGE

AND MORE CONSISTENT COVERAGE

IF THEY WOULD GIVE THEIR SHOT
IN THE SAME BODY AREA

AND THEN ROTATE WITHIN
THAT BODY AREA.

THE OTHER REASON IS, IT'S JUST
PLAIN HARD TO HIT SOME OF THESE
ON YOUR SELF.

YOU KNOW, AND SO YOU'RE STANDING
BY DOORS AND ALL KINDS OF THINGS

TO GET SOME FAT UP ON YOUR OWN
SELF IF YOU CAN'T HOLD
YOUR THING.

SO MOST OF THE TIME DIABETICS
LIKE TO GIVE IN THE FRONT,

IT IS EASIER TO HIT THEIR THIGHS
AND IT IS EASIER TO HIT STOMACH.

IF SOMEONE IS REALLY ACTIVE,
AGAIN, THE SAME CRITERIA
IS WITH HEPARIN.

THEY RECOMMEND THAT THE ABDOMEN
IS THE PLACE OF INJECTION

BECAUSE IT DOESN'T INCREASE OR
CHANGE THE ABSORPTION OF THE
INSULIN ITSELF.

SO ONCE AGAIN, WE'RE GOING
BACK TO THE ABDOMEN.

DO YOU REMEMBER WHERE
YOUR LAST SHOT WAS?

IN YOUR STOMACH? RIGHT, LEFT,
OH, YOU HAD HEPARIN ON THE RIGHT
LEFT SIDE,

WELL THEN WE WILL JUST COME OVER
HERE TO THE LEFT HAND SIDE.

I AM GOING TO INSPECT THE
ABDOMEN, MAKE SURE IT'S
CLEAN AGAIN

OF BRUISES, SCAR TISSUE,
CREASES, HAIRY SPOTS,
SMALL SORES, ANYTHING.

ALMOST BE A HOME STUDY EXCEPT
FOR THE ACTUAL PRACTICE
AT TESTING,

WOULDN'T THAT BE COOL?
- I THINK SO.

OTHER THAN I JUST REALLY DON'T
WANT YOUR FAMILY MEMBERS
WATCHING ME.

IF I COULD SPEAK TO
JUST YOU.. YOU KNOW.

ANYWAY, ALRIGHT. WE'RE BACK --
OH, I SHOULD HAVE GOT
THESE OUT FIRST.

OKAY, SO I'VE CLEANED MY SKIN,

I'VE GOT MY NEEDLE. I'M DOING
MY LAST CHECK, OKAY.

I HAVE YOUR INSULIN, I'M GIVING
YOU 8 UNITS REGULAR.

THAT'S YOUR FAST-ACTING AND..
YOUR SHORT-ACTING

AND THEN YOUR MPH, YOUR
LONG-ACTING, 14 UNITS.

I ALWAYS LIKE TO TELL MY
DIABETICS WHAT THEY'RE GETTING,

BECAUSE THEY KNOW WHAT
THEY'RE GETTING NOW

AND WHAT THEY GET AT HOME AND SO
FORTH AND HOW TO ADJUST
ACCORDINGLY.

OKAY, TAKE YOUR CAP OFF,
SET IT DOWN.

ALRIGHT, ON HERE I'M GOING
TO PINCH UP A LITTLE SKIN.

YOU DON'T HAVE TO BE QUITE
AS GINGER AS WITH HEPARIN

BECAUSE YOU'RE NOT GOING TO
BRUISE THEM UNLESS THEY'RE
STILL ON HEPARIN.

I WANT TO PUT THE NEEDLE IN

AND AGAIN YOU CAN
JUST DART IT IN.

YOU DON'T HAVE TO DART HARD,
IT'S JUST SOFT SKIN,
SOFT TISSUE.

I'VE RELEASED THE HOLD, YOU
DON'T NEED TO ASPIRATE,

JUST PUT IT STRAIGHT IN,

PULL STRAIGHT OUT,

DAB IT IF YOU NEED TO.

THERE IS NO SAFETY DEVICE. SEE
WHAT I DO WITH MY NEEDLE.

IT'S OUT HERE.

AND IT GOES STRAIGHT IN THERE.

I LOOK AT THEIR STOMACH, THERE'S
NO NEED FOR A BAND AID.

DO NOT MASSAGE.

WHY WOULDN'T.. HOLD YOUR
THOUGHT. WHY WOULDN'T
WE MASSAGE?

IT IS GOING TO INCREASE THE
ABSORPTION OF THE INSULIN.

WE JUST WANT INSULIN TO BE IN
THERE AND TO ACT AS
IT NORMALLY WOULD,

SO YOU DON'T WANT TO INCREASE.
ALRIGHT, ROBERT.

- YOU HAVE TO LEAVE THE
NEEDLE IN FOR 10 SECONDS?

- RIGHT. FOR ABSORPTION
BUT WE DON'T WANT TO DO
THAT WITH THE INSULIN.

SO IT'S NOT GOING TO TRACK IT.
SO IT ABSORBS BETTER.

SO WE DON'T HAVE THE BRUISING
AND THE SIDE-EFFECTS
OF THE BLEEDING.

WHEREAS, WITH INSULIN IT
DOESN'T REALLY MATTER.

ALRIGHT. GET RID OF MY GLOVES.
I PUT MY CLIENT DOWN.

I WASHED MY HANDS AND DOCUMENT.

ALRIGHT, LET ME SEE IF I'VE
HIT EVERYTHING HERE.

THERE'S SO MUCH STUFF.

ALRIGHT. OH, YES. OKAY.

WHAT IN THE WORLD DID I
START WRITING TO MYSELF?

ALRIGHT, REUSE OF SYRINGE.

DIABETICS TEND TO LIKE TO
REUSE THEIR SYRINGES.

I DON'T KNOW IF YOU NOTED, AFTER
WE DID OUR BLOOD GLUCOSE
MONITORING,

HOW EXPENSIVE THAT IS, OKAY.

SO YOU'RE CHECKING YOUR
BLOOD-SUGAR, 4, 6, 8
TIMES A DAY,

DEPENDING ON HOW TIGHTLY
YOU'RE MANAGING YOURSELF.

AND THEN YOU'VE GOT SYRINGES.
YOU'VE GOT ALCOHOL.
YOU'VE GOT ALL THE STUFF OF IT.

SO YOU'LL FIND THAT MANY
OF YOUR DIABETICS

LIKE TO REUSE THEIR PRODUCTS
UNTIL THEY'RE JUST
TOO DULL TO USE ANY MORE

SO THEY'LL USE THEIR
FINGERSTICKS OVER AND OVER

AND THEY WILL USE THEIR
SYRINGES OVER AND OVER.

THERE IS A COUPLE OF THINGS THAT
YOU NEED TO KNOW ABOUT THAT.

ONE IS, THE MANUFACTURER
RECOMMENDS ONE TIME USE.

THAT'S THE MANUFACTURER, THEY
WANT YOU TO BUY THEIR PRODUCT

AND THEY WANT TO
GUARANTEE STERILITY.

HOWEVER, WHAT THEY FOUND IS THAT
IF A CLIENT REUSES THE SYRINGE,

IT'S THEIR FLOOR AND THEY
TEND TO NOT GET INFECTED.

SECOND, MOST INSULIN HAS A
BACTERIAL STATIC COMPONENT TO
THE INSULIN

AND SO IT PREVENTS BACTERIA
FROM GROWING ON THE SYRINGE

AND SO THEY CAN REUSE
AND REUSE THE SYRINGE

UNTIL THE NEEDLE IS JUST TOO
DULL TO POKE THROUGH ANY MORE.

THE NEEDLES ARE NOT GOING LAST
NEAR AS LONG AS THEY USED TO

BECAUSE THEY'RE SO THIN
THEY'RE GOING TO JUST WEAR OUT,
BUT THEY CAN USE THEM.

THERE IS A COUPLE OF THINGS THAT
YOU WANT TO MAKE SURE
ARE NOT HAPPENING.

AND THAT IS THAT THE CLIENT
ISN'T CLEANING THE SYRINGE
WITH ALCOHOL.

IF THEY'RE.. AS THEY'RE PULLING
UP ALCOHOL TO RINSE IT
AND CLEAN IT,

WHAT HAPPENS IS THAT ALCOHOL
STAYS INTO THE SYRINGE

AND IT ACTUALLY THEN GETS INTO
THE TISSUE AND BREAKS
DOWN THE TISSUE.

AND SO THAT'S A BAD PRACTICE,
THEY'RE BETTER TO DO NOTHING.

AND THE OTHER THING IS NURSES
TEND TO WANT TO MAKE SURE THEY
WIPE OFF THE NEEDLE

TO MAKE SURE THAT
IT STAYS CLEAN.

HOWEVER, MOST OF THE NEEDLES ARE
TREATED WITH THE
SILICONE PRODUCT

AND THAT MAKES THEM HAVE
AN EASY NICE SLIDE IN.

AND IF WE KEEP CLEANING
THEM WITH ALCOHOL,

THEY FOUND THAT IT REMOVED THAT
SILICONE BARRIER OFF
OF THE NEEDLE.

AND THEY DIDN'T GET AS LONG
OF USE FROM THEIR NEEDLE.

SO THEY'RE BETTER JUST
TO GIVE THEIR SHOT,

PUT IT IN THE CAP AND
STORE IN THE SHELF,

OR YOU COULD REFRIGERATE
IT IF YOU WANTED TO AND
THAT WILL KEEP BACTERIA OUT.

AND THAT'S THE RECOMMENDATION
FOR SYRINGES.

YOUR CLIENTS IN THEIR HOMES
SHOULD PUT THEIR NEEDLES,

IF THEY DON'T HAVE A SHARP'S
CONTAINER, INTO SOME
PUNCTURE PROOF CONTAINER.

SO LIKE A CLOROX BOTTLE OR
SOMETHING LIKE THAT AND PUT
ALL OF THEIR NEEDLES IN.

AND THEY'RE STILL LETTING
THEM JUST DISPOSE
THEM IN NORMAL TRASH,

BUT THEY'RE SUPPOSED TO BE IN
A PUNCTURE PROOF CONTAINER.

NOW CLIENTS CAN THROW
THEM IN THE TRASH,

HEALTH PROFESSIONALS CANNOT.

AND THAT'S THE DIFFERENCE
RIGHT NOW AS FAR AS BLOOD
AND BODY FLUIDS.

WE HAVE TO DISPOSE OFF
OURS APPROPRIATELY

AND SO WE HAVE, KIND OF,
TO TAKE THEM TO THE
APPROPRIATE INCINERATORS

OR BACK TO YOUR FACILITY TO
HAVE THEM DISPOSED OFF.

OKAY.

I THINK I HAVE HIT
THE GIST OF IT.

THERE IS A NEW INSULIN
THAT'S COMING OUT.
IT'S A 24 HOUR INSULIN.

I DON'T KNOW THE NAME OF IT AND
WE WILL BE HEARING
MORE ABOUT THAT.

THEY WERE ACTUALLY
USING IT IN EUROPE.

IT'S JUST COME TO THE STATES
IN THE LAST FEW MONTHS

AND I GUESS ITS BEEN WORKING
PRETTY GOOD, ESPECIALLY FOR
CLIENTS THAT ARE HARD TO MANAGE.

ALRIGHT. LET'S DOCUMENT.

AND IT'S NOW 8 O'CLOCK IN THE
MORNING,

I AM GOING.. OH, 7:30.

JUST GIVEN OUR INSULIN, SO.

07:30.

I GAVE THAT IN THE LEFT
LOWER ABDOMEN, LLA.

LLA, DB. OKAY.

AND PUT IT IN THAT ORDER,
TIME, SITE, INITIALS,

SO THAT WE CAN DISTINGUISH
BETWEEN THE TWO.

IT GETS A LITTLE...
INITIALLY SOMETIMES

WITH ALL THAT STUFF IN
THAT LITTLE SQUARE.

ALRIGHT.

NOW, AS FAR AS PRACTICING AND
STUFF,

THERE IS JUST A COUPLE OF
GUIDELINES WE WANT TO GIVE YOU.

WE HAVE TWO DIFFERENT KINDS OF
TABS FOR YOU TO PRACTICE IN.

ONE HAS THIS NICE LITTLE LABEL
THAT SAYS, 'INJECT AIR ONLY'.

WE WOULD APPRECIATE YOU
JUST PUTTING AIR IN THESE

BECAUSE THEY GET MOLDY AND THEY
GET NASTY AFTER A WHILE.

AND SO IF YOU JUST USE SOME OF
THEM FOR AIR, THEN THEY WILL
STAY GOOD.

AND THEN WE HAVE SOME THAT
ARE DESIGNATED AS NOTHING.

AND YOU'LL SEE THESE AND THEY'RE
STARTING TO GET OLDER
AND ICKIER.

AND WE PUNCHED HOLES
IN THE BOTTOM OF THEM

SO THAT WHEN THE FLUID COMES OUT
THEY ACTUALLY, KIND OF,
LEAK THROUGH.

AND WE HAVE THEM SET ON
TOWELS AND ON CHUX,

AND SO YOU CAN DRAW UP YOUR
SOLUTIONS OR WHATEVER

AND THEN PUT THEM INTO THESE,

IF YOU WANT TO GET THE
FEEL OF REAL LIQUIDS.

THERE'S PADS EVERYWHERE,
WE HAVE THEM ON CARTS

AND WE STICK THEM IN STOMACHS
AND THEY'RE JUST EVERYWHERE.

SO BE SURE TO PRACTICE ON THOSE.

ONE OTHER THING I JUST WANTED
TO MENTION AS FAR AS SPEED
OF GIVING AN INJECTION.

I WORKED PEDS WHEN I FIRST
STARTED DOING NURSING.

AND I WAS TEACHING THIS
LITTLE FIVE-YEAR-OLD
HOW TO GIVE INSULIN

AND I WAS.. I FELT A
LITTLE INTIMIDATED,

OH, TEACHING A LITTLE
FIVE-YEAR-OLD HOW TO GIVE
INSULIN, YOU KNOW,

BUT SHE'D BEEN GIVEN IT
FOR A WHILE.

AND I WAS SUPPOSED TO OVER
TECHNIQUE WITH HER AND SO FORTH.

SO SHE DREW UP HER SHOT AND SO
WE WERE GOING OVER HOW
TO GIVE IT.

I SAID, "OKAY. NOW HOLD IT LIKE
A PENCIL AND JUST DART IT IN."

AND SHE LOOKED AT
ME AND SAID, "NO."

"WHAT DO YOU MEAN NO?" "I'M
NOT DARTING IT IN."

I SAID "WELL, YOU GOT TO. YOU
GOT TO GET IT IN.
IT WON'T HURT SO MUCH."

SHE SAYS "NO." WELL, YOU KNOW,
IF YOU HAVE EVER TALKED TO A
FIVE-YEAR-OLD,

NO IS NO AND THAT'S ALL
THAT'S GOING WITH THAT.

AND I SAID, "OKAY,
WELL THEN YOU SHOW ME HOW YOU
ARE GOING TO DO IT."

SHE TOOK THAT LITTLE NEEDLE..
I DON'T KNOW IF I HAVE MINE.

AND SHE JUST TOOK
IT AND SHE GOES.

AND SHE JUST PUSHED IT IN AS
SLOW AS YOU COULD EVER PUSH A
NEEDLE IN.

AND I LOOKED AT HER AND I SAID,
"OH, DOESN'T THAT HURT YOU?"

AND SHE GOES, "NO. IT'S STUCK."

I SAID, "ALRIGHT." SHE GAVE A
LITTLE SHOT AND PULLED IT OUT.

WELL, FROM THAT TIME ON I
STARTED WATCHING MY CLIENTS
PUT THEM IN.

AND KIDS, ESPECIALLY, BECAUSE
I WORKED WITH KIDS FOR A WHILE.

AND SLOW, FAST,
IT DOESN'T MATTER.

AS LONG AS YOU GET IT IN AND
THEY SAID IT DIDN'T HURT.

THEY DIDN'T LIKE DARTING IN. AND
WHEN YOU ARE DOING
IT TO YOURSELF,

IT'S, KIND OF, HARD TO WHAM
YOURSELF, YOU KNOW?

BUT.. AND IT JUST DIDN'T
SEEM TO HURT THEM AT ALL.

AND THE NEEDLES ARE
SO THIN AND SO SHARP

THAT YOU DON'T REALLY HAVE
TO BE ALL INTENT ON THAT..

KIND OF THING.

ALRIGHT?
- IS THERE A FAST MIX?

- I JUST DO MODERATELY. I
DON'T PUT IT IN REAL FAST

BECAUSE I JUST THINK IT
WOULD BE UNCOMFORTABLE.

BECAUSE YOU ARE PUSHING FLUID
THROUGH THAT TINY LITTLE GAUGE
SO JUST STEADY.

OTHER MEDS THAT MIGHT BURN OR
SOMETHING, I WOULD GO SLOW

BUT THESE TWO MEDS NOT IN
PARTICULAR. JUST STEADY,
IT'S FINE.

ANY OTHER POINTERS FOR US?

ALRIGHT.

- AT OUR FACILITY WE DISPOSE
OF ALL THE MED VIALS

IN THE SHARP'S CONTAINER SO
NOBODY CAN RETRIEVE IT.

- MM-HMM. - AND THAT YOU DON'T,
LIKE, RISK BREAKING IT

AND THEN HAVING SOMEBODY
TO PICK THEM UP.

AND ALSO, LIKE, IF YOU
DON'T HAVE THE BARREL,

THE SAFETY GLIDER OR WHATEVER,

IF YOU PULL OUT A NEEDLE
AND THERE'S, LIKE,
PEOPLE AROUND YOU,

I JUST LIKE FIND IT EASY TO
JUST SAY IT OUT LOUD.

LIKE, I HAVE A DIRTY NEEDLE, SO
PEOPLE STAY OUT OF YOUR WAY.

IT'S A GOOD IDEA.

KIND OF, LIKE WAITRESSES,
"CORNER."

YOU KNOW, DIRTY NEEDLE.

BUT YOU DON'T WANT TO WALK DOWN
THE HALLS, YOU KNOW,
"DIRTY NEEDLE."

ATTENTION IN THE ROOM, SO
THAT'D BE A GOOD THING.

ABOUT VIALS IN THE SHARP'S
CONTAINER, THAT'S TOTALLY A
POLICY OF THAT HOSPITAL

BECAUSE OTHER HOSPITALS YOU WILL
GO TO WILL BE UPSET ABOUT THAT.

THEY DON'T LIKE
THE EXTRA WEIGHT.

BECAUSE THEY'RE CHARGED BY
WEIGHT ON THEIR SHARP'S
CONTAINERS.

SO DO WHATEVER
THE HOSPITAL SAYS.

I MEAN, I COULD CARE LESS
ONE WAY OR THE OTHER,
WHATEVER THEY WANT.

BUT I'VE BEEN IN HOSPITALS.
MAN, THEY WOULDN'T LET US

PUT ANYTHING IN THERE BUT
NEEDLES, PERIOD BECAUSE
OF WEIGHT ISSUES.

THEY WERE TRYING TO CUT DOWN IN
THESE DAYS OF COST CONTAINMENT.

THERE'S ALWAYS DAYS
OF COST CONTAINMENT.

THANK YOU, GOOD POINT.

ANYTHING ELSE?

ALRIGHT, SHOTS ARE FUN.
MAINLY BE CAREFUL.

PULL THOSE APART, BE CAREFUL.
IF YOU STICK YOURSELF -- LET ME
JUST DO THIS ONE OTHER THING.

IF YOU STICK YOURSELF IN THE
LAB,

OUR NEEDLES OBVIOUSLY
ARE NOT BLOODY.

BUT ONCE YOU'VE STUCK YOU,
THEN IT IS BLOODY.

SO MAKE SURE THAT
THAT GETS PITCHED.

MAKE SURE YOU SCRUB
YOUR HANDS AND THEN CONNIE
AND I WANT TO KNOW,

ONE OF THE TWO OF US,
IT DOESN'T MATTER.

AND WE'RE GOING TO SEND YOU OVER
TO HEALTH SERVICES TO MAKE SURE

THAT YOU GET REPORTED IN,
IN CASE THERE'S A PROBLEM.

AND YOU CAN GET FOLLOWED
UP THROUGH THE SCHOOL

SO WE JUST WANT TO MAKE SURE
ITS REPORTED FOR YOUR SAKES.

OKAY? SO BE CAREFUL.