Principles and practice of safe and effective administration of injections

OBJECTIVE 1
Equipment Route

Site
Technique Safety

Equipment

Luer Lok: For Secure Connection

Eccentric Luer slip: Allows one to get closer to the skin

Concentric Luer slip: For all other applications

What needle should I use for IM injections?

21G or 23G Green or blue hub Length depends on patient and site

What needle should I use for SC injections?

25g or 26g Orange or brown hub Length depends on patient and site

Particle Contamination
Blunt Filter/ Fill Needles Filter out subvisible particles of glass, rubber, fibre and other residues. The infusion of these particles has been linked with phlebitis,vascular occlusion and subsequent embolism,formation of granulomas and septicaemia.

They are for use when withdrawing drugs from vials and glass ampoules.

Blunt Fill

Blunt Filter

OBJECTIVE 2
Reasons for Giving Medication by Injection Rapid action required Drug altered by intestinal secretions Drug not absorbed by alimentary tract Patient cannot take oral drug Drug unavailable in oral form

OBJECTIVE 3
Intramuscular Route How many sites can be used to give an I.M. injection?

1) The Deltoid.
2) The Ventrogluteal site. 3) The Dorsogluteal 4) The Vastus Lateralis.

Sites for IM Injections

Deltoid

Ventrogluteall

Dorsogluteal

Vastus Lateralis

DELTOID
Place fingers on the patients shoulder; Locate the acromion process landmark; lateral triangular projection of the spine of the scapula, forms point of shoulder, articulates with the clavicle Place index & middle finger on landmark, creating an inverted triangle.

Inject 1 - 2 inches below the acromion process in center of triangle

 Used for immunizations & non-irritating meds Risk of injury to the brachial artery & radial nerve

Limit volume of medication based upon size of muscle - 0.5 - 2 ml / cc

DORSOGLUTEAL
Locate the superior iliac spine & the greater trochanter of the femur. Draw an imaginary diagonal line between the two landmarks.

Site is superior & lateral to this line, several inches below the iliac crest.

Risks associated with Dorsogluteal Site

Must avoid the sciatic nerve Must avoid the superior gluteal artery Increased incidence of injecting into fatty tissue

Not used in infants

Not used in toddlers until walking

VENTROGLUTEAL SITE
Palpate greater trochanter, place palm of hand there Palpate anterior superior iliac spine with index finger

Spread middle finger to palpate the bony ridge of the iliac crest
The center of the formed triangle is the ventrogluteal site

 Free of major blood vessels & nerves

Less fatty tissue distribution Position patient sitting or lateral (sidelying) Considered safest & least painful site

Vastus lateralis
Safe, rapid absorption Location: one handbreadth above the knee one handbreadth below the greater trochanter medial lateral portion of the thigh

Can be used for infants, children & adults

Needle length usually 1 inch or less

Recommended medication volumes per muscle site Ventrogluteal: Up to 4ml in a well developed muscle Up to 2ml in less developed muscle Vastus lateralis: Up to 4ml in a well developed muscle Up to 2ml in less developed muscle

Deltoid: Up to 1ml in a well developed muscle Up to 0.5ml in less developed muscle

Subcutaneous Route

Speed of Absorption in Injection Sites

 Lift skin fold Puncture skin at 90 degrees

Do not aspirate
Inject slowly and remove needle Release lifted skin fold

No lifted skin fold

Lifted skin fold

Potential Complications
Infection
Incorrect location of injectate Pain Anaphylaxis

 Long and short term nerve damage

Intramuscular haemorrhage Hitting a blood vessel Sterile abscess Lipodystrophy

Standard Precautions
Skin: Cuts or abrasions in any area of exposed skin should be covered. Gloves: Well fitting clean gloves must be worn during procedures where there may be contamination of hands by blood/body fluids. Hand Washing: The use of gloves does not preclude the need for thorough hand washing between procedures.