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How to Administer Injections?

Dr.U.P.Rathnakar
MD. DIH. PGDHM

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Communication
Good communication habits: Initial greeting (friendly & helpful way) Seating - conducive. Body posture -non threatening Maintain eye contact Warmth - questioning style (see below) Clarity of expression End of interview
(GATHER- in Family Planning Practice)

G = Greet patient in a friendly and helpful way.

A = Ask about complaints

T = Tell them about methods available.

H = Help patients to decide. E = Explain use. R = Plan return visits.

Injections
IM SC ID IV Gather equipment Preparationmedication Prepare yourself Prepare patient Technique

INTRAMUSCULAR (IM) INJECTION Preferred parenteral route -Fairly rapidacting and long-lasting. Medications that are irritating [mild] may be given into the deep muscle tissue. Absorbed gradually
Safest, easiest, and best tolerated

Gather Equipment. Needle and syringe,

Antiseptic pads, Adhesive bandages (such as Band-Aid),

Emergency Tray [with medications!]

Gather Equipment. The needle -Not less than one inch[i.m.] Not more than one and one-half inches long (20 to 22 gauge).

Wash Hands

Preparation

Check Expiration Date of Medication

Identify Patient Ref Case Record

Ask one question to patient "What is your name?"

Draw Medication into Syringe

Prepare the Patient.

H/o allergies Females pregnancy Provide privacy for the patient if injecting in the buttocks or lateral thigh. Tell the patient about the injection procedure.

Prepare the Patient.

Be sure to wake up a patient if he has

been sleeping.

A patient may be frightened and/or

violent. If this is the case, you must seek assistance.

Select Injection Site and Position the patient I.M.usually given in the buttocks, thigh, or the upper arm area. More than 1 cc- give the injection in the buttocks. If >5 cc - 2 doses and into separate sites Buttocks- The muscles (gluteal) of this area
are thick and are utilized frequently in daily activities, thus causing complete absorption of drugs. Turned to one side

IM injection-Other sites

Deltoid muscle Vastus lateralis

IM Injection- Buttocks

Expose the buttocks [Completely visualize buttocks] The patient will lie face down[Or sideways] with toes together and heels apart. This position relaxes the muscles of the buttocks

IM Injection- Buttocks

Draw an imaginary horizontal line across the buttocks from hip bone to hip bone. Then divide each buttock in half with an imaginary vertical line The four imaginary sections of the buttock are referred to as quadrants. Location for an injection is in the upper outer quadrant of either buttock.

IM Injection- Buttocks

Other quadrants- injury to the sciatic nerve or gluteal artery

If the patient is receiving a number of intramuscular injections over a prolonged period, the site of injection should be rotated.

A record of sites must be kept on the patient's chart for this purpose.

Upper arm (deltoid muscle)

Safe area for injection -about 3 fingers below the shoulder joint. Needle length of 1 inch is used because of the size of the deltoid muscle.

Upper arm (deltoid muscle)

Maximum of one cc per injection for an adult. The shoulder should be completely exposed The clothing should not be rolled up to attempt to administer an injection. Patient is in a standing or sitting position, with the arm at side and muscles relaxed. Direct the patient to hang the arm loose.

Prepare Injection Site.

Clean the skin at the injection site thoroughly with an antiseptic pad (sponge with alcohol or Betadine).

Use a circular motion from the center of the injection site outward.[Clean to dirty]
Place the antiseptic pad between the last

two fingers of your hand for use later when you complete the injection.

Procedure
Remove Needle Guard or Cover.
Pull the cover straight off, NOT sideward motion because you may bend the needle. Avoid bending or touching the needle. Load the syringe

Stabilize Injection Site

Firm the tissue at the injection site with the thumb and forefinger[or ulnar border of free hand] so that it is taut. The needle enters more easily into taut or firm skin than into loose skin. Help the patient relax his muscles by distracting his attention by asking a question or having the patient do something like blow a breath out or look at an object on the wall.

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Administration

Hold the barrel of syringe firmly between the thumb and index finger of the dominant hand

).

Hold the barrel of syringe firmly between the thumb and index finger of the dominant hand

Move the needle tip to about one-half inch from the injection site, with the bevel up, and position the needle at a 90-degree angle to the skin surface.

(All intramuscular injections are inserted at a 90-degree angle into the muscular layer below the skin.)

).

Hold the barrel of syringe firmly between the thumb and index finger of the dominant hand Move the needle tip to about one-half inch from the injection site, with the bevel up, and position the needle at a 90-degree angle to the skin surface.

Plunge the needle firmly and quickly into the muscle to the depth of the needle with a steady straightforward motion. A quick insertion of the needle will minimize the pain for the patient.

Aspirate
Pull back the plunger until slight resistance is felt. Check for blood entering the syringe. If blood appears in the syringe, do not inject CAUTION: Aspiration avoids injecting medication into a blood vessel, Which would endanger the life of the patient.

Inject Medication.
Stabilize the syringe with one hand. Place the thumb of the dominant hand on the plunger and the index and middle fingers under the hook of the syringe barrel. Push the plunger into the syringe barrel with a slow, continuous downward movement as far as the plunger will go. Make sure that all the medication is injected. Any medication that is left in the needle at the end of the injection may dribble into the subcutaneous tissue as it is withdrawn. Tissue injury may result.

IM injection Finish
Place the alcohol pad just above the injection site Remove the needle straight out in same direction as the injection with a quick, outward motion. Massage Injection Site. Rub the injection site with the alcohol pad with a firm, circular motion for about five seconds. Massaging helps to disperse the medicine so that it can be absorbed more quickly. Cover Injection Site. Place an adhesive bandage over the injection site to protect clothes from possible bloodstains and protect the injection site from possible infection.

Disposal of syringes & Recording

Place the needle and syringe in a nonpermeable container or destroyer. Proper disposal -prevents cross contamination, drug abuse, and injury by needles. Record Administration of i.m. Injection. Record the information in the patient's medical record Prompt recording prevents other personnel from administering the same

Post injection Patient Care

Observe the patient for unusual reactions. Any medication can cause anaphylactic reactions. Give appropriate information regarding the medication and required waiting time to the patient

Intradermal injection

Sites of intradermal injection

1. 2. 3.

Palmar (inner) forearm Subscapular region of the back Upper chest

Intradermal

Position of needle-Intradermal
i.m.90o s.c.45o i.v.30o

i.d.15o

Preparation Procedure
Equipments 1. For injection 2. Emergency Check medication Identify and explain Cleanse skin Load medication 26G[1/4 inch] Stabilize the site Inject at 150 angle into dermis Raises a wheal Aspiration not required no large BV in dermis Mark the site Dispose the needle

Wash

Subcutaneous injection

Preparation Procedure[s.c]
Equipments 1. For injection 2. Emergency Check medication Identify and explain Wash Cleanse skin Load medication 23-25G[1/2 inch][0.53cc] Stabilize the site Pierce at 450 angle Aspiration Inject Massage Dispose the needle

Subcutaneous injectionSites and needle position

Vastus lateralis area

Deltoid area

Venipuncture

Venipucture IV administration and drawing blood sample

Sites
Veins of fore arm Ante-cubital fossa Veins over back of hand Feet Thigh Scalp-Children

Steps
Assessment-Vital signs, history, Identification, status of vein Equipment Wash Prepare pt and medication Procedure Dispose needle Record and report

Venipucture Procedure

Apply tourniquet 4-6 inches above Position arm below the level of heartCapillary filling Cleanse the area, Needle bevel up Pierce skin until backflow is visible Remove tourniquet[Retain if drawing blood] Slowly push Watch for bulging