Injections

right patient

right medication

right indication

right time

right route

right dosage

What is the rule of “rights”?

right of refusal

right of support (friends/family)

right of way (site)

What are the patient’s “rights”?

deliver a substance through the skin with a needle

Injections are used to….

areas of dermatitis/cellulitis

allergies

live vaccines in immunocompromised and pregnant pts

What are some contraindications to injections?

MMR, varicella, BCG, smallpox, yellow fever

What live vaccines are contraindicated in immunocompromised and pregnant patients?

coagulopathy

What is a relative contraindication to injections?

explain purpose of injection

describe expected discomfort

review possible side effects

discuss post-procedure care

advise when to seek medical attnetion

Universal patient education to provide with injections?

smaller syringes

What type of syringes are more finely calibrated?

smaller gauge

With viscous fluid what needle gauge do you want?

larger gauge

With watery fluid what needle gauge do you want?

blunt fill needle

What do we use to draw up medication?

when people recap

Most needle sticks happen when?

immediately

When should you throw used needles?

users and patients

Needle safetys protect who?

med being given

volume

speed of absorption

Site selection is determined by what?

IV

What is the fastest absorption site for injection?

IM

What is the intermediate absorption site for injection?

SQ

What is the slowest absorption site?

rx, dose, site, route, reaction

manufacturer

lot number

expiration date

Always document…

intramuscular

medication delivered deep into skeletal muscle

vaccinations

abx

corticosteroids

vitamin B12

antipsychotics

pain medications

hormonal medications

Uses for IM injections?

faster absorption than SQ

larger medication volumes

suitable for irritating medications

depot medication administration possible

Advantages for IM injections?

more painful

risk of neovascular injury

requires accurate landmarking

more difficult in obese/cachectic patients

Disadvantages of IM injections?

½ to 1 inch

IM injection for child <2 years, small or emaciated adult, deltoid

1-1 ½ inches

IM injection for well developed adult

2 inches

IM injection for for obese adult

90 degree angle

Angle of IM injections?

axillary nerve

What nerve is at risk if you do an IM injection at the deltoid?

the area 2-3 fingerbreadths down from humeral head

the area 2-3 fingerbreadths from the posterior axillary crease

Avoid injury to axillary nerve by giving injection in the main body, at the intersection defined by….

axillary nerve injury

limited volume

Risks of IM deltoid injection?

no more than 2 mL

For IM deltoid injection how many mL can you inject?

21-25 gauge needle

Needle for IM deltoid injection?

ventrogluteal

dorsogluteal

What are the types of gluteal injections?

ventrogluteal

What is the preferred gluteal site?

dorsogluteal

What gluteal spot is generally avoided?

sciatic nerve injury, superior gluteal artery injury, inconsistent fat thickness

Why is the dorsogluteal area generally avoided (IM)?

3 mL

Max volume for IM gluteal injection?

large muscle mass and can accommodate numerous injections

preferred in infants

fewer major nerves/vessels

Advantages of IM injection at vastus lateralis?

fascia lata

Why is the vastus lateralis IM injection more painful in adults?

90 degree

Angle of IM injection at vastus lateralis?

draw plunger back before injecting IM medications (except vaggines)

To avoid intravascular injection what must you do?

reposition needle, re-aspirate and finish injection

remove and discard used needle and replace with sterile needle and repeat injection

If blood appears in syringe, depending on protocl what should you do?

subcutaneous or intradermal injections

It is not necessary to draw back before giving _______ or _______ injections

insulin

heparin/enoxaprin

GLP-1 agonists

hormone therapy

biologics

Subcutaneous injection uses?

easier administration

self-administered

slower sustained absorption

less painful than IM

Advantages of subq injections?

limited volume capacity

slower onset than IM

variable absorption in poor perfusion states

Disadvantages of subq injection?

½ to 5/8 inches

Length subq injection for child, small or emaciated adult?

25-32 gauge

Needle gauage for subq injection?

45 degree if needle + syringe

90 degree if pen needle

Angle for subq injection?

0.5-1mL

volume for subq injection?

abdomen

posterolateral upper arm

anterior thigh

upper buttocks

subq injection preferred site?

rotate injection sites

avoid scars, bruises, lipodystrophy, infection

consider patient dexterity for self-injection

Selection principles for subq injection?

intradermal

medication delivered into dermis just below epidermis

creates small wheal or bleb

PPD

hypersensitivity to extrinsic allergens

Uses for intradermal injections?

slow absorption

localized response

useful for immune response testing

Advantages for intradermal injections?

small medication volume only

technically challenging

incorrect depth easily alters results

Disadvantages of intradermal injections?

hairless

free of lesions

minimal pigmentation

easy visualization

Site selection for intradermal injections?

½ to 5/8 inches

Length for intradermal injections?

25-27

gauge for intradermal injections?

0.01-0.1 mL

volume for intradermal injections?

bevel up, 15 degrees

Angle for intradermal injections?

neural damage, necrotic lesion formation, intravascular infiltration and pain

Complications of injections?