Administration of Injections Presentations

8/3/2019 Administration of Injections Presentations

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Preparing for theAdministration of Injections

Sue Cressey

Clinical Nurse Trainer


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Aims of this session

To understand the reasoning behind theprocess of

collecting the correct equipment administering the correct drug in the correct

form

at the correct time to the correct person

in the correct manner


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Objectives of this session

The safe administration of drugs via

intramuscular injection - in a safe andcontrolled manner - having assessed risks-and - causing minimal physical andpsychological harm, but, maximum benefit tothe patient


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What is an injection?

Injections are sterile solutions, emulsions orsuspensions.

They are prepared by dissolving, emulsifyingor suspending an active ingredient and anyother substances in water for injection.

Injecting is the act of giving medication by useof syringe and needle to obtain the desiredtherapeutic effect taking into account thepatients safety and comfort


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How are drugs for injectionspresented?

Single dose preparationsa pre - prepared volume of measured drug, in asyringe for single dose usei.e. Flu vaccines, Pneumovax and B12.

Multidose preparationsmulti-dose preparations contain a antimicrobiacteralpreservative, are used on more than the oneoccasion and great care is required for itsadministration but especially its storage between

successive withdrawals

i.e Insulin


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Where are injectable drugskept

The label on the packet should in most cases giveguidance about storage conditions for individualpreparations

Drugs should be stored away from light

The Cold Chain involves preparations being storedbetween 2 and 8 degrees and has a traceable record

Best Practice ensures all medication is stored in alocked cupboard or fridge

If you are in any doubt about the storagerequirements for any preparation you should checkwith the lead nurse, Dr or pharmacist


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Why give drugs in injectionform

Injections usually allow rapid absorption

Can produce blood levels comparable to

those of intravenous bolus injections Injections can be given from 1ml and up to

2mils in the Deltoid and up to 5mls in thegluteal muscle in adults

Drugs that are altered or not absorbed by

other methods of administration


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Needle length and size

For intramuscular injections e.g flu, pneumonia andB12, the needle should be long enough to penetratethe muscle and still allow a quarter of the needle toremain external to the skin (Workman 1999)

When choosing the needle it is important to assessthe amount of muscle, subcutaneous fat and weightof the patient - which in the majority of cases will be ablue needle


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Which is which needle?

The correct needle is the key to delivering the drug to the correctarea for the maximum effect with the least amount of discomfort

The colour at the top of the needle reflects its size

the higher the number the smaller the lumen (bore)

Orange needles = 25 guage = 10mm long (3/8 inch)or 16mm long(5/8 inch) or 25mm long (1 inch)

Blue needles = 23 guage = 25mm long 9 (1 inch)

Green needles = 21 guage = 38mm long (1.5 inches)


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How do assess the depth ofmuscle and subcutaneous fat

The deltoid and vastus lateralis muscles

should be grasped between the thumb andforefinger to determine the depth of muscleand/or the amount of subcutaneous fat at the

injection site


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Intramuscular Injections andPain

Factors that can cause pain are

The needle

The technique

The speed of the injection

The solution and composition of the drug

The volume of the drug The approach and attitude of person

administering the injection(Workman 1999 and Torrence (1989)


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Asepsis and reducing the riskof infection

Good hand washing

Good hand drying

Aseptic technique

Good observation and questioning of the client

Skin preparation if required


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Clinical room preparation forthe administration of injections

Protocols/procedure/standards information isavailable

Hand basin for washing hands and/or alcohol handrub.

Area for the client to lie down if unwell

Panic button/phone to call for assistance

sharps container Gloves

Resuscitation /anaphylaxis equipment/drugs

Oxygen and appropriate mask if available

adequate time for procedure


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Equipment for theadministration of injections

Clean tray or receiver in which to place drug and equipment

21g needle to ease reconstitution and drawing up (23g if from a

glass ampoule

Syringe of appropriate size

Swabs saturated with isopropyl alcohol 70%

Sterile topical swab if drug is presented in ampoule form

Drug to be administered Patients prescription to check dose, route and timing

Notes available to record administration in accordance with law

Gloves, Apron


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Procedure for preparation ofinjections in adults

Action Collect and check all equipment

Check the the packaging of allequipment is intact and druginformation leaflet is available

Wash hands with soap and

water or bactericidal hand rub

Prepare the needle, syringe etcon a tray or receiver

Inspect all equipment

Rationale To prevent delays and enable

full concentration on procedure

To ensure sterility. If seal or

packaging isdamageddiscardinformation leaflet for guidanceand prescriptive information

To prevent contamination of

medication and equipment

To check that none is damaged,if so discard


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Preparation cont:

Action Consult the patients

prescription and ascertain the

following : Drug

Dose is appropriate for the ptsage

date and time (if applicable) of

administration Route and method of

administration

Diluent as appropriate (ifnecessary)

validity of prescription Signature of doctor

Rationale To ensure that the patient is

given the correct drug in the

prescribed dose using theappropriate diluent (if required)and by the correct route


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Preparation cont:

Action check all details with nurse

mentor - select the drug in the

appropriate volume dilution ordosage and check expiry date

Proceed with the preparation ofthe drug using protectiveclothing if necessary

Evaluate the patientsknowledge of the medicationbeing offered. If this knowledgeappears to be faulty or incorrectrefer to nurse mentor

offer explanation of the use,

action, dose and potential sideeffects of the drug involved

Rationale To minimise any risk of error - to

reduce wastage and expiry date

ensures drug is safe to give andis still pharmacologicallyeffective

The patient has a right toinformation about treatment


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Prefilled Syringes

Action Check storage conditions

check name and expiry date or

signs of damage to the packaging on removing from packaging check

name expiry date and syringe forany damage

check vaccine is free from particlesand colour is correct

If you feel that the fixed needlelength is not appropriate discusswith lead nurse, do not transfer druginto another syringe

expell air from syringe

place in receiver until ready to

administer

Rationale To ensure the drug is kept in the

appropriate manner

to ensure sterility

to ensure client/patient does notreceive unstable or contaminatedmedication

vaccine not given into the musclecan be painful and have a reducedeffect

to ensure the correct amount ofdrug is in the syringe

to ensure sterility is maintained help

reduce risk of needlestick


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Single Dose Ampoules ofSolution

Action Inspect solution for particles and

colour if either or both present

discuss appropriate methods fordiscarding with nurse mentor

Tap the neck of the ampoulegently

Cover the neck of the ampoule

with a sterile topical swab andsnap top off. If difficult use a file

Check solution for glassfragments discard if present

Rationale Ensure the patient does not

receive contaminated or

unstable drugs

To ensure the solution is at thebottom of the ampoule

To aid asepsis. To prevent

aerosol formation or contactwhich may lead tosensitivity/reaction, preventinjury to the nurse

To ensure risk of injectingforeign material into the patient


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Ampoules continued

Action Withdraw the solution, the

ampoule can be tilted if required

with a needle with a gauge nolarger than 21G

Re sheath needle, tap syringeto dislodge any air bubbles.Expel air

place in receiver until ready touse

Note replacing sheath onneedle should NOT be confusedwith resheathing needles

AFTER use

Rationale To avoid drawing up air and any

glass particles

prevent aerosol formation andensure correct amount of drugis in the syringe

maintains sterility and preventsdropping the syringe andreduces potential risk of needlestick injury


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Anxious Patients and Fainters

Adopt a calm and sympathetic approach

Prepare the vaccine if possible out of the sight of the patient

where possible keep the conversation going to distract the

patient If possible ask nervous friends to leave, discourage large groups

of supporters

explanation that an injection is not the same as having a bloodsample taken

The bigger they are the harder they fall

Fainting more common in those who have not eaten

If in doubt lay them down


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Skin Preparation

Should the skin appear dirty it should becleaned with soap and water.

Should the client/patient have reducedimmunity the skin can be cleaned with analcohol preparation prior to the injection - but- the alcohol must be allowed to evaporate asit can affect the preparation and/or sting onadministration of the preparation


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Just before you give the injection

Action fully expose the limb fully

Encourage the patient to relaxthe muscle, by hanging the arm

by their side or on their lap

Patients should sit or lay downfor their injection

Quickly review the pre injection

Rationale The injection may be given to

low and end up as subcut. A

tight sleeve can have the sameeffect as a tourniquet andencourage bleeding at theinjection site

To reduce discomfort andpromote distribution of the drug

Reduce risk of injury to thepatient and the HCA/nurse fromfalls and needle stick injury

To reduce the risk of error and

promote patient safety


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When not to give an injection

The client/patient is unable to confirm their identity using avariety of methods

The client is unsure and records cannot confirm if the client has

received the vaccine previously The Client withdraws or refuses to consent

Incorrect storage of vaccine, past expiry date

There is no prescription for the patient

The prescription does not state the clients name, drug, time,dose or route of administration or the writing is illegible

If patients have a temperature

Pregnancy

If clients report a severe local reaction or systemic reaction to

the preceding dose refer to nurse mentor


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Technique for Intramuscular (IM)Injection

Action Hold the skin firmly (not

bunched) with the free hand

Introduce the needle at a 90degree angle leaving a third ofthe shaft exposed

Aspirate (draw back) theplunger to ensure a bloodvessel has not been penetrated.If blood is aspirated remove theneedle, change it and startagain

Rationale To allow easy entry of the

needle through the skin and

displace the subcutaneous fat To ensure the needle

penetrates the muscle andfacilitate removal of the needleshould it break

To ensure the needle is in theright place.


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IM injection continued

ACTION

Inject the drug slowly

Withdrawn the needle quicklyand evenly and apply pressureto any bleeding point

Record the administration of thedrug according to policy andprocedure

Dispose of needle and syringeaccording to policy andprocedure

Ensure patient is feeling well

prior to discharge

RATIONAL

To prevent pain. To ensureeven distribution of the drug

To prevent Haematomaformation (bruising)

To maintain records, complywith law, prevent duplication,promote continuity of care

To ensure safe disposal andreduce risk of injury to self andothers

To reduce risk of injury


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Site on the Deltoid for

Intramuscular Injections


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An Intramuscular Injection


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When It Goes Wrong

You give the wrong drug

You give the right drug to the wrong person

The client/patient faints

The client remembers a previous badreaction to a previous injection

The client/patient complains The client/patient tells you post injection that

they may be pregnant/on steroids/havingchemotherapy or radiation


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REFERENCES

Kassianous George, (2001) Immunization Childhood and TravelHealth. Forth Edition. London. Blackwell Science.

Nursing and Midwifery Council

Jane Mallett and Lisa Dougherty, (2000) The Royal MarsdenHospital Manual of Clinical Nursing Procedures 233-236.FifthEdition. London. Blackwell Science

UK Guidance on Best Practice in Vaccine Administration (2002)

www.google.com. Intramuscular Injection

Documents

Administration of Injections Presentations