VenipunctureVenipunctureVenipunctureVenipuncture

And InjectionsAnd Injections

Needle parts• Hub• Cannula (shaft)• Bevel• Point

Needle Selection• Length ¼ - 6”

• Gauge 13 – 30g

Syringe Parts• Plunger• Barrel• Tip

Prepared Medications• Ampule: Sterile prefilled

container; single dose• Cartridge-Needle Unit: Disposable

sterile cartridge w/ premeasured amount.

• Vial: Sterile prefilled bottle

Flip top

Drawing Medications• Ampule• Vial• Never remove ………• Never touch ………..

Draw measured amount of air and

exchange

INJECTIONSSite Selection

• Intramuscular

• Subcutaneous

• Intradermal

Intramuscular• Used when meds given subcu are

irritating; faster absorption; larger amount needed

• 90 degree insertion• Gluteus medius: Z-trak• Middeltoid• Ventrogluteal• Vastus Lateralis

Intramuscular Injections

• Wipe surface in circular pattern from center to 2”

• Let dry• Spread skin and insert needle 3/4• Do NOT insert needle to hub• Draw plunger to look for blood• Remove needle and massage muscle

Sites to Avoid• Scar tissue• Burned areas• Edematous• Traumatized• Areas near large vessels• Change in skin texture or pigment• Areas with a mole or wart

Gluteus Medius• Draw line from greater trochanter

to PSIS.• Injection given above and outside

this line.• Watch out for sciatic nerve &

gluteal artery.

Gluteus Medius

Z-Trak• Upper outer quadrant of buttocks• Slide skin and gluteal muscle to side• Inject• Slide muscle back• Better absorption; less painful; less

irritation; no discoloration due to leaking

Middletoid• 3 fingers below edge of acromion

and above axilla• Can only tolerate small amounts of

meds• Major vessels, nerves and bones to

be avoided here.

Middletoid

Ventrogluteal• No major vessels or nerves here• Patient on side or supine• Palpate greater trochanter, iliac

crest, ASIS.• Place your right palm on pts left

troch, index finger on ASIS and middle finger along iliac crest.

Ventrogluteal

Vastus Lateralis• Free of major blood vessels and

nerves• Divide distance between greater

troch and patella into thirds.• Use middle third.

Vastus Lateralis

Subcutaneous• Small amounts (2> ml)• Absorption through capillaries• Administer slowly• 45 degree insertion• Heparin, epinephrine, insulin,

vaccines

Subcutaneous• Administered below epidermis• Outer surface of upper arm• Lateral aspect of thigh• Upper 2/3 of back• Abdomen (2” around umbilicus)• Front of thigh• Rotate injections

Intradermal• Skin tests for allergies• Sensitivity to drug• TB test (susceptibility to disease)• To aid in diagnosis of parasitic

infection and fungal diseases

Subcutaneous Tips• Avoid edematous or scarred tissue• If patient is thin, grasp skin in a

bunch• Do not aspirate• Do not rub area after injection

Intradermal Injection• Injected between layers of skin• Inner surface of forearm 4” distal

to elbow• Insert bevel up at a 5-15 degree

angle

NEEDLE SELECTIONSubcutaneous

2-3cc ½-5/8”23-25g

Intramuscular

2-5cc or.5-2cc middletoid

1-1½”, 18-22g1”, 22-23g

Intradermal .5>cc ¼ ½ 3/8”

25-27g

Insulin 30,50,100units

½ - 5/8”

27-29”

VENIPUNCTURE• Site Selection

– Short or long term use– Start looking distal

• Needle Selection– Butterfly– Angiocath/Heplock

Venipuncture Insertion

Veins of Arm

Hand Veins

Recommended sites for venous cannulas

Sites To Avoid• Tortuous• Repeatedly used veins• Poor skin condition• Thin, superficial veins• Bifucating veins• Veins affected by surgery

Infiltration• Swelling or redness• Cool skin at the site• Pressure or burning at site• No blood return