Naltrexone Pellet Injection Procedure
Naloxone Challenge - 1 mg IV and observe for signs of withdrawal
Administer prophylactic antibiotic
Wash hands with antimicrobial soap
Apply antimicrobial handcream
Apply non-sterile gloves
Cleanse skin with antimicrobial wipe
Cleanse skin with isopropyl alcohol
Local Anesthesia
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Choose a site on the posterolateral aspect of the upper arm. |
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Insert a 25 gauge needle at the proximate end of the site and inject 5cc of 2% Lidocaine with Epinephrine and Bicarbonate as the needle is advanced. |
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Apply pressure with the syringe so that the hub of the needle causes an indentation to mark the site. |
Open packet of sterile supplies
Prepare Area with 3 sterile betadine swabs
Apply sterile gloves
Apply sterile drapes
More Local Anesthesia
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Approximately One half inch distal to the mark left by the hub of the previous injection, inject 5cc of 2% lidocaine with epinephrine and bicarbonate buffer in 5cc syringe with a 18g x 1 ½" needle. |
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Advance the needle distally anesthetizing a tract through which to insert the pellet insertion device may be inserted. |
Make ~1cm incision with sterile #15 scalpel
Insert the entire sterile pellet insertion device and inject the pellet pellet then withdrawal the device
Close wound with staples from a disposable stapler
Clean wound
Dress wound
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Apply a bandaid. |
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Apply a pressure dressing by encircling the upper arm with elastic gauze. |
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Dressing to be removed within 12 hours and wound left open. |
Provide wound care instruction sheet to patient
This is the simplest method for injecting the pellet which minimizes invasiveness and encourages patient acceptance.
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