inj med stud

8/13/2019 Inj Med Stud

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Principles and

practice ofsafe and

effectiveadministration

of injections


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OBJECTIVE 1

Equipment

Route

Site

Technique

Safety


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Equipment

Luer Lok: For Secure Connection

Eccentric Luer slip: Allows one to get closer

to the skin

Concentric Luer slip: For all other applications


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What needle should I use for IM

injections?

21G or 23G

Green or blue hub

Length depends on patient and site


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What needle should I use for SC

injections?

25g or 26g

Orange or brown hub

Length depends on patient and site


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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 andsubsequent embolism,formation of

granulomas and septicaemia.


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They are for use when withdrawing

drugs

from vials and glass ampoules.

Blunt Fill Blunt Filter


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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


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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.


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Sites for IM Injections

Deltoid

Vastus Lateralis

Ventrogluteall

Dorsogluteal


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DELTOID

Place fingers on the patients shoulder;

Locate the acromion process landmark; lateraltriangular projection of the spine of the scapula,

forms point of shoulder, articulates with the clavicle

Place index & middle finger on landmark, creating aninverted triangle.

Inject 1 - 2 inches below the acromion process incenter of triangle


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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


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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.


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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


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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 theiliac crest

The center of the formed triangle is the ventroglutealsite


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Free of major blood vessels & nerves

Less fatty tissue distribution

Position patient sitting or lateral (sidelying)

Considered safest & least painful site


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Vastus lateralis

Safe, rapid absorption

Location:

one handbreadth above the knee

one handbreadth below the greater trochantermediallateral portion of the thigh

Can be used for infants, children & adults

Needle length usually 1 inch or less


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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


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Subcutaneous Route


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Speed of Absorption in Injection

Sites


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Lift skin fold

Puncture skin at 90 degrees

Do not aspirate

Inject slowly and remove needle

Release lifted skin fold


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No lifted skin fold Lifted skin fold


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Potential Complications

Infection

Incorrect location of injectate

Pain

Anaphylaxis


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Long and short term nerve damage

Intramuscular haemorrhage

Hitting a blood vessel

Sterile abscess

Lipodystrophy


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Standard Precautions

Skin: Cuts or abrasions in any area of exposedskin should be covered.

Gloves: Well fitting clean gloves must be worn

during procedures where there may becontamination of hands by blood/body fluids.

Hand Washing: The use of gloves does notpreclude the need for thorough hand washingbetween procedures.


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