INJECTIONS One of the routes for medication administration is thru PARENTERAL or via INJECTIONS Definition of Terms: Parenteral - entering

the body not by the alimentary tract but rather by another means (such as the intradermal, subcutaneous, the intramuscular, or often the intravenous route). Injection - mechanism of introducing an element or medicine for the purpose of prevention and curative thru the parenteral route Syringe - a device use to inject fluids into or withdraw them from something (as the body or its cavities)

CAP the plastic covering of the syringe ; covers the needle before it is used which also protects the health care givers from needle-prick NEEDLE is sharp, short and thin and covered with a fine layer of silicone to allow it to pass through the skin easily BARREL is the long, thin chamber that holds the syringe; marked with lines to measure the calibration of the fluid or medicine to be injected PLUNGER is a long, thin rod that fits snugly inside the barrel of the syringe; It easily slides up and down to push the medicine/fluid out through the needle; it has a rubber seal at the lower end to prevent leakage; the rubber seal is matched with the line on the barrel to measure the correct amount to be infused Note: BEVEL the slanting part of the edge of the needle

Different sizes of syringes:

Parts of Syringe:

3. Right Route 4. Right Time 5. Right Drug History (Allergies) 6. Right Drug to Drug Interaction Types of Injections: 1. Intradermal (ID) 2. Subcutaneous (SC) 3. Intramuscular (IM) 4. Intravenous (IV) (not applicable to students) COMPARISON OF DEGREE OF ANGLE OF SPECIFIC ROUTE OF INJECTIONS: 7. Right Documentation 8. Right Approach 9. (Patients) Right to know &/or Refuse

Preparation of parenteral medications: 1. AMPULE

2. VIAL

Before giving an injection, all measures against infection should be taken into consideration. THE 10 RS OF MEDICATION ADMINISTRATION For Medications on ampule: 1. When the medication is inside an ampule, break its tip, protecting your

1. Right Drug 2. Right Dosage

fingers with a gauze as seen in picture.

protective cap. DO NOT remove the

stopper. 2. Attach the needle onto the syringe without removing the protecting cap. Remove the cap from the needle 2. Sterilize top , Wipe the top of the vial with an alcohol swab.

3. Inject air into the vial 3. Slide it inside the ampule 4. Draw air into the syringe equal to prescribed dose. Put the needle through the rubber top of the vial and push the plunger to inject the air into the vial.

For medicines on a vial: Preparing the dose: 1. Remove the cap If you are using a new vial, remove the

8. Tap to release If bubbles are in the medicine, hold the syringe straight up and tap the side of the syringe until the bubbles float to the top.

5.Draw up dose 6. Leave the syringe in the vial and turn both upside down. Hold the syringe and vial firmly in one hand. Make sure the tip of the needle is in the fluid. With your free hand, pull the plunger to withdraw the correct dose into the syringe.

or

7. Check for bubbles Before you take the needle out of the vial, check the syringe for air bubbles.

10.Eject air Push the bubbles out with the plunger and draw the fluid back in until you have the correct dose.

dissolved.

10.When the medication is given as powder, it has to be mixed with the solvent.

or 12. Pull the plunger to aspirate the contents. Before injecting, place the syringe in an

Load the solvent and pierce the needle through the rubber lid of the vial, squirting the solvent inside. 11. Roll in between palms the vial slowly until the powder has completely upright position. 13. Remove the needle from the vial. Do not let the needle touch anything. You are now ready to inject.

Administering Intradermal Injection Intradermal Injection - in or into the skin; is given into the skin Indications for ID Injections:

1. Skin testing for medication allergies prior to starting antibiotic therapy 2. Skin testing to assess for the likelihood of previous exposure to tubercule bacilli. - Tuberculin purified protein derivative (5 TU PPD) or Mantoux Test SITE: Intradermal layer of the volar surface of the forearm.

EQUIPMENT Medication Other ID sites: dorsal forearm upper back upper chest (MAR) Medication Administration Record Sterile syringe and needle ( size depends on medication being administered and patient ) Alcohol swab Dry Sponge Acetone and 2x2 sterile gauze square (optional) Disposable clean gloves PROCEDURE: 3 PHASES PREPARATORY PERFORMANCE AFTER CARE

PREPARATORY PHASE : 1. Assemble equipment and check the physicians order

7. Use non dominant hand to spread the skin taut over injection site.

2. Explain procedure to the patient. 3. Perform hand washing

Don clean disposable gloves PERFORMANCE PHASE 4. If necessary, withdraw medication from ampule or vial. 5. Select an area on inner aspect of forearm (or other sites) that is not heavily pigmented or covered with hair. PERFORMANCE PHASE (cont.) 6. Cleanse the area with an alcohol swab by wiping with a firm circular motion and moving outward from the injection site. Allow skin to dry. If skin is oily, clean area with pledget moistened with acetone. 8. Remove needle cap with nondominant hand by pulling it straight off. 9. Place needle almost flat against the patients skin, bevel side up. Insert needle into the skin so that point of needle can be seen through skin. Insert needle only about 1/2 inch.

Degree of ID injection: 15 degrees 10. Slowly inject agent while watching for a small wheal or blister to appear. If

none appears, withdraw needle slightly.

24-72 hour periods. Inform the patient of this inspection. > 30 minutes for allergic reaction INTERPRETATION OF TST RESULTS

Reaction
induration)

Assessment of Reaction

AFTER CARE 12. Do not massage the area after removing the needle.

0 - 4 mm

No sensitivity No previous exposure to TB Weakened immune system Weak sensitivity: Previous exposure Previous BCG vaccination **Previous PPD

13. Do not recap the needle. Discard 5 - 9 mm needle and syringe in the appropriate receptacle.

10 mm or

Sensitivity: Previous or active infection Previous BCG vaccination Administering Subcutaneous Injection Subcutaneous Injection

14. Assist patient into a position of comfort. 15. Remove gloves and dispose of them properly. Perform hand hygiene. 16. Chart administration of medication as well as the site of administration. Charting may be documented on the MAR, including location. Some agencies recommended circling the injection site with ink. 17. Observe the area for signs of reaction at ordered intervals, usually at

The needle is inserted under the subcutaneous. After the injection, the drug moves into small blood vessels and the bloodstream. Indication : The subcutaneous route is used with many protein and polypeptide drugs such as insulin which, if given by mouth, would be broken down and digested in the intestinal tract.

Common sites for subcutaneous injection a. Outer aspect of the upper armPatients arm should be relaxed and at the side of the body.

EQUIPMENT Medication (MAR) Medication Administration Record Sterile syringe and needle ( size depends on medication being administered and patient ) Alcohol swab

b. Anterior thighs- Patient may sit or lie with leg relaxed.

Dry Sponge Acetone and 2x2 sterile gauze square (optional) Disposable gloves PROCEDURE: 3 PHASES PREPARATORY PERFORMANCE AFTER CARE

c. Abdomen- Patient may lie in a semi recumbent position. d. upper back e. upper ventral or dorsogluteal

1. Assemble the equipment and check the physicians order. 2. Explain the procedure to the patient. 3. Perform hand hygiene. 4. If necessary, withdraw medication from ampule or vial. PERFORMANCE PHASE 5. Identify patient carefully. Close curtain to provide privacy. Don disposable gloves.

area

6. Have patient assume apposition appropriate for the most common used sites. 7. Locate site of choice. Ensure that the area is not tender and is free of lumps or nodules. 8. Clean area around injection site with alcohol swab. Use a firm circular motion while moving outward form the injection site. Allow antiseptic to dry.

Subcutaneous

12. After needle is in place, release tissue. If you have a large skin fold pinched up, ensure that the needle stays in place as the skin is releases. Immediately move your non-dominant hand to steady the lower end of the

Leave alcohol swab in a clean area for reuse when withdrawing the needle. 9. Remove needle cap with non dominant hand, pulling it straight off. 10. Grasp and bunch are surrounding injection site or spread skin at site. 11. Hold syringe in non-dominant hand between thumb and forefinger. Inject needle quickly at an angle 45 degree, depending on the amount and turgor of tissue and length of needle.

syringe. 13. Aspirate, if recommended, pulling back gently on the plunger of the syringe to determine whether the needle is in a blood vessel.

If blood appears, the needle should be withdrawn, the medication syringe and needle discarded, and a new syringe with medication prepared. Do not aspirate when giving insulin or heparin. 14. If no blood appears, inject solution slowly.

appropriate receptacle.

18. Assist the patient in position of comfort. 19. Remove gloves and dispose of them properly. 20. Chart the administration of the medication. 21. Evaluate the response of the patient to medication within appropriate time frame. Accurate documentation is necessary to prevent medication error. 15. Withdraw needle quickly at the same angle at which it is inserted. 16. Massage the area gently with alcohol swab. (do not massage a subcutaneous heparin or insulin injection site). AFTER CARE 17. Do not recap the used needle. Discard needle and syringe in the

ADMINISTERING OF INTRAMUSCULAR INJECTION Intramuscular (IM) Injection The needle is inserted into the muscle. The muscles should be as relaxed as possible. Indications: Vit. K administration in newborn Heap B injections

Common sites for IM Injections a.Ventrogluteal- the patient may lie on the back or side with the hip and knee flexed.

c. Deltoid - the patient may sit or lie with arm relaxed.

d. Dorsogluteal- the patient may lie prone with toes pointing inward or on the side with the upper leg flexed and placed in front of the lower leg. b. Vastus Lateralis- the patient may lie on the back and assume a sitting

EQUIPMENT Medication position (MAR) Medication Administration Record Sterile syringe and needle ( size depends on medication being administered and patient ) Alcohol swab Dry Sponge

 Acetone and 2x2 sterile gauze square (optional) Disposable gloves PROCEDURE: 3 PHASES PREPARATORY PERFORMANCE AFTER CARE

7. Locate the site of choice and ensure that the area is non tender and free of lumps or nodules. Don disposable gloves. 8. Clean the area thoroughly with an alcohol swab, using friction. Allow alcohol to dry.

PREPARATORY PHASE: 1. Assemble equipment and check the physicians order. 2. Explain the procedure to the patient. 3. Wash your hands. 4. If necessary, withdraw medication from the ampule or vial. 9. Remove the needle cap by pulling it straight off. 10. Tout the skin at the site using your non dominant hand.

5. Do not add air to the syringe. 6. Provide for privacy. Have the patient assume a position appropriate for the selected site.

11. Hold the syringe in your dominant hand between the thumb and forefinger. Quickly dart the needle into the tissue at a 90-degree angle.

Use your non dominant hand to hold the end of the plunger. Slide your dominant hand to the tip of the barrel.

13. Aspirate by slowly (for at least 5 seconds) pulling back on the plunger to determine whether the needle is in a blood vessel. If blood is aspirated, discard the needle, syringe, and medication prepare a new sterile setup, and inject another site.

12. As soon as the needle is in place, complete release your grasp to the

14. If no blood is aspirated, inject the solution slowly (10 seconds per ml of

muscle.

medication)

15. Remove the needle slowly and steadily. 16. Apply gentle pressure at the site with a small, dry sponge.

Client may be positioned sitting, standing, supine, or prone. Locate site by measuring 2 - 3 fingerbreadths below the acromion process on the lateral midline of the arm. Dorsogluteal (Upper Outer Quadrant) Do not use this site in children < 2 yr or emaciated clients. Position client in side-lying or supine position, with knee flexed on injection side, or prone with toes pointed inward to rotate femur. Locate site by palpating the posterior iliac spine where the spine and pelvis meet. Imagine a line from the posterior iliac spine to the greater trochanter. Administer medication above imaginary line at midpoint Locate greater trochanter to identify dorsogluteal site.

17. Do not recap the used needle. Discard the needle and syringe in the appropriate receptacle.

18. Assist the patient in position of comfort. Encourage patient to exercise leg if possible. 19. Remove gloves and dispose of them properly. Wash your hands. 20. Chart the administration of the medication. 21. Evaluate the response of the patient to the medication within the appropriate time frame. Assess site, if possible, within 2-4 hours after administration. Locating Specific Sites for IM injections Deltoid (Upper Arm)

Locate posterosuperior spine of iliac crest. Draw imaginary line between trochanter and iliac spine. Inject medication directly into dorsogluteal site at 90 angle. Ventrogluteal This is the preferred site for adults and children < 7 months Position client in supine lateral position. Locate site by placing the hand with heel on the greater trochanter and thumb toward umbilicus. Point to the anterior iliac spine with the index finger

(forming a "V"). Injection of medication is given within the "V" area. Place palm on greater trochanter, and point to anterior iliac spine Inject medication at 90 angle within "V" area Anterolateral Thigh (Vastus Lateralis) This is the preferred site for infants and children < 7 months Position client in supine or sitting position.

Safe administration of an intramuscular injection into an infants vastus lateralis may require use of 1-inch needle rather than the commonly used 5/8 inch needle. A 1-inch needle consistently allows penetration into the muscle and safe administration of the medication.

Locate by identifying the greater trochanter and lateral femoral condyle. Injection site is the middle third and anterior lateral aspect of the thigh The vastus lateralis muscle of the upper thigh. Identify greater trochanter and lateral femoral condyle. Select site using middle third and anterior lateral aspect of thigh. Inject medication at 90 angle directly into muscle. Z-Track Method Use this method when administering injection in ventrogluteal or dorsogluteal sites. Displace skin to one side (laterally) before inserting needle. Z-track is used to prevent backflow of medication into subcutaneous tissue.