Nursing 112 Performance Checklist: Administering Injections

Pre-Administration Safety and Patient Verification

  • Compare the MAR with the physicians order and verify patient allergies.
  • Review drug information, medical history, and preassessments mandated by medication protocols.
  • Use two identifiers to identify the client (checking armband against MAR).
  • Verify the 8 Rights8 \text{ Rights}: patient, med, dose, route, time, reason, refusal, and documentation/action.
  • Evaluate the client's response and the injection site appearance within 10 to 30 minutes10 \text{ to } 30 \text{ minutes} post-administration.

Medication Preparation and the Three Checks

  • The Three Checks:
    1. Compare vial/ampule label against the MAR; check expiration.
    2. Read concentration, calculate dose, select syringe, and compare to MAR again.
    3. Remove air from syringe and recheck dose with label and MAR.
  • High Alert Medications: For meds like heparin or insulin, a second nurse must independently calculate and verify the dose.
  • Labeling: Syringes must be labeled with drug name, dose, concentration, and required assessments.

Drawing from Vials and Ampules

  • Vial Technique: Inject an amount of air equal to the medication volume. Keep the needle tip below the fluid level during aspiration.
  • Ampule Technique: Snap the neck away from the body using an ampule breaker. Use a filter needle to draw medication. MUST change the needle to a sterile one appropriate for the route before injection.

Injection Techniques by Route

  • Intramuscular (IM): Insert at a 90 degree90 \text{ degree} angle using a darting motion. Use at least a 1"1" needle for adults. Inject slowly at 1 mL/10 seconds1\,mL/10\,\text{seconds}. Aspiration is recommended for penicillin and allergy meds, but not vaccines.
  • Subcutaneous: Use a 3/8"3/8" to 5/8"5/8" needle. Bunch tissue and insert at a 45 or 90 degree45 \text{ or } 90 \text{ degree} angle. Do not massage site after withdrawal.
  • Intradermal (ID): Hold syringe at a 5 to 15 degree5 \text{ to } 15 \text{ degree} angle, bevel up. Insert superficially until the bevel is covered to create a wheal or bleb. Typical volume: 0.1 mL to 0.2 mL0.1\,mL \text{ to } 0.2\,mL.
  • Z-Track IM: Used for irritating/staining medications. Add a 0.2 mL0.2\,mL air-lock. Pull skin laterally before insertion (90 degree90 \text{ degree}). Pause for 10 seconds10\,\text{seconds} after injection before withdrawing needle and releasing skin.

Anatomy and Maximum Administration Volumes

  • Ventrogluteal: Max volume 3−5 mL3-5\,mL. Form a "V" with the index and middle fingers between the anterior superior iliac spine and the iliac crest.
  • Vastus Lateralis: Max volume 3 mL3\,mL. Located in the middle third of the thigh (one handsbreadth below greater trochanter and above knee).
  • Deltoid: Max volume 1 mL1\,mL. Location is 2−4 finger breadths2-4\text{ finger breadths} below the acromion process.
  • Subcutaneous Sites: Abdomen (avoid 2 finger breadths2\text{ finger breadths} from umbilicus), thighs, back, and upper arms. Max volume is routinely 1 mL1\,mL (occasionally 2 mL2\,mL).
  • Intradermal Sites: Most common is the inner aspect of forearms (handsbreadth above wrist and below antecubital fossa).

Performance Standards and Criteria

  • Unsatisfactory performance results from 3 contaminations3\text{ contaminations}, 2 or more OSHA violations2\text{ or more OSHA violations}, or an error in a double-starred checklist item.
  • Proper nouns and institutional standards as per Louisiana Tech University Division of Nursing Revised 11/202211/2022.