1.NJECTION TECHNIQUE PAOLO M. ZABAT, RN

2. INJECTION TECHNIQUE Giving an injection safely is considered to be aroutine activity. However, it requires knowledge of anatomy and physiology, pharmacology, psychology, communication skills and practical expertise. A safe injection is one that does not harm the recipient, does not expose the provider to any avoidable risks and does not result in waste that is dangerous for the community. 3. INJECTION It is an infusion method of putting fluid intothe body, usually with a syringe and a hollow needle which is pierced through the skin to a sufficient depth for the material to be administered into the body. Syringe a device made of a hollow tube anda needle that is used to force fluids into or take fluids out of the body 4. PARTS OF THE SYRINGE PlungerBarrelTipHubShaft BevelKeep sterileMeasure dose hereAvoid touching 5. SKIN 6. RULES IN NEEDLE SYRINGE SELECTION When looking at a needle package, the first number is the gaugeor diameter of the needle (ex: 18, 20) and the second number is the length (ex: 1, 11/2) As the gauge number becomes larger, the size of the needlebecomes smaller. The length of the needle is directed by the size of the patient, the selected insertion site and the tissue you are trying to reach. (Ex: An IM injection in an emaciated person would require a shorter needle than the same injection in an obese patient.) The size of the syringe is directed by the amount of medication to be given. If the amount is less than 1ml, use a 1ml syringe. If the amount of the medication is equal to the size of the syringe, you may go up to the next size to prevent awkward movements when deploying the plunger. 7. GAUGE OF THE NEEDLE SYRINGEThe larger the gauge, the smaller the size 8. INJECTION TECHNIQUEINTRADERMAL INJECTIONSUBCUTANEOUS INJECTION INTRAMUSCULAR INJECTION 9. INJECTION TECHNIQUE 10. INTRADERMAL INJECTION It is the introduction via needle of tiny amounts of fluidinto layers of skin. It provides a local, rather than systemic effect. Syringe used is 1ml tuberculin syringe because of a very small amount of drug needed. Needle used is a short (1/4 to 5/8 inch), fine gauge (g25-27). Indications: For diagnostic purposes (allergies and sensitivities to drugs) For administering tuberculin testing 11. INTRADERMAL INJECTION Intradermal literally means betweenthe skin layers and injection is administered just under the epidermis . Syringe is positioned at15 angle. Small volumes, usually 0.01 to 0.05ml, are injected because of the small tissue space. 12. INTRADERMAL INJECTION Most commonly used site: Inner surface of theforearm Subscapular region of the back can be used as well as the deltoid region. 13. INTRADERMAL INJECTION REMEMBER: Mixture of drug and water for skin testing: 0.9cc of distilled water/sterile water and 0.1cc of the drug. Inject the solution intradermally and just enough to form a wheal. Encircle the site correctly and write the time when to check the injection site to determine reaction to the drug. Check the site after 30 minutes for signs of reaction. If negative, document it as ANST (-); if positive, ANST (+) 14. INTRADERMAL INJECTION REMEMBER: A positive result may be manifested by any of the following: Reddening of the site accompanied with marked elevation Increase in circumference of the wheal Presence of itchiness on the site 15. PROCEDURE: ID Prepare all the equipment needed: 1cc syringe,disposable needle (aspirating needle), sterile water, drug to be tested, wet and dry cotton balls and ballpen. Wash hands and observe appropriate infection control measures. Introduce yourself and verify the clients identity. Explain to the client what you are going to do, why it is necessary and how the client can cooperate. Prepare needed materials aseptically. Check the label of the drug three times. 16. PROCEDURE: ID Prepare the medication to be used for skin testing(e.g ampule or vial) Aspirate 0.9cc of distilled water/sterile water and 0.1cc of the drug using the tuberculin syringe with the aspirating needle. Mix the drug and the distilled water in the syringe. Replace the aspirating needle with g25 needle. Expel excess air. Place the syringe on the tray together with the wet and dry cotton balls. 17. PROCEDURE: ID Confirm again patients identity. Locate the appropriate site for skin testing. Cleanse the medial surface of the forearm by usingfirm, circular motion from inner to outer portion. Allow the skin to dry before injecting the drug. Place hand in non-dominant hand of the patient. Remove needle cap and holds syringe at 15 degrees angle from skin with bevel up. Stretch the skin and tell the patient that he/she will feel a prick as needle is inserted. 18. PROCEDURE: ID Inject the solution intradermally andjust enough to form a wheal. Remove the needle quickly but gently at the same angle used for injection. Wipe with dry cotton ball but do not press the injection site. Encircle the site correctly and write the time when to check the injection site to determine reaction to the drug. Check the site after 30 minutes. 19. SUBCUTANEOUS INJECTION Subcutaneous tissue lies between the epidermis andthe muscle. Subcutaneous route is used for slow, sustained absorption of medication. SC or SQ Indications: Used commonly for insulin injections Heparin 20. SUBCUTANEOUS INJECTION Common sites used for SQroute: Outer aspect of the upper arm Abdomen(from below the costal margin to the iliac crests) Anterior aspects of the thigh Upper back Upper ventral or dorsogluteal area 21. SUBCUTANEOUS INJECTION REMEMBER: Hold syringe in the dominant hand between the thumb and forefinger. Inject the needle quickly at an angle of 45 to 90 degree, depending on the amount and turgor of the tissue and the length of the needle. 22. INTRAMUSCULAR INJECTION The intramuscular (IM) route injection deliversmedication into well perfused muscle, providing rapid systemic action and absorbing relatively large doses. Gastric disturbances do not affect the medication. Clients does not need to be conscious to receive the medication. Absorption occurs even more rapidly than with SQ route because of greater vascularity of muscle tissue. Irritating drugs are commonly given IM because very few nerve endings are in deep muscle tissues. 23. 5 SITES ACCEPTABLE FOR IM INJECTION muscle of the upper arm Preferred site for vaccinations in adults. Dorsogluteal Performed by entering through the gluteus maximus muscle. Care should be given to avoid damage to the sciatic nerve and vessels surrounding this area. Ventrogluteal Safer option which accesses the gluteus medius muscle. (Primary location for IM use as it avoids all major nerves and blood vessels) Deltoid 24. 5 SITES ACCEPTABLE FOR IM INJECTION Vastus Lateralis A quadriceps muscle situated onthe outer side of the femur and is used as a primary site for children. It does have risks associated to it due to overuse but has been suggested safe for children up to seven months old. Rectus Femoris Anterior quadriceps muscle which is rarely used by physicians/nurses but is easily accessed for self- administration, or for infants. 25. SITES ACCEPTABLE FOR IM INJECTION 26. INTRAMUSCULAR INJECTION REMEMBER: 3cc syringe can be used for IM injection with g22 or 23 needle; 1-2 inches long Position the needle at 90 angle. Do not forget to aspirate the plunger once injected to check for blood. (To determine if a blood vessel was hit) Inject medication slowly (To minimize pain) 27. INTRAMUSCULAR INJECTION REMEMBER: Apply pressure to site and massage after (To prevent hematoma on the injection site and prevent oozing of blood and for proper absorption of the medicine) 28. PROCEDURE: IM Prepare needed materials aseptically. Check the label of the drug three times. Prepare the medication. Position the patient and locate the site correctly. Cleanse the site using circular motion from inner toouter portion and allow it to dry. Place a swab between fingers of non-dominant hand. Pinch or spread tissue and insert needle quickly at 90 degrees angle in a dartlike position. 29. PROCEDURE: IM Pull back the plunger to check for blood. Inject the medication slowly if no blood appears. Withdraw needle quickly. Apply pressure and dry cotton ball to the site andmassage. Leave the client in a comfortable position. Dispose the syringe and other materials used properly, wash hands and document the procedure. 30. Z TRACK INJECTION 31. Z TRACK INJECTION