FSCh37AdministeringInjections

Chapter Overview

• Title: Administering Intradermal, Subcutaneous, and Intramuscular Injections

• Authors: Burton, Smith, Davis

• Edition: Fourth Edition

• Publisher: F.A. Davis Company

Introduction to Injections

• Definition: Injections are administered via the parenteral route and not through the gastrointestinal tract.

• Types of Parenteral Routes:

  • Intradermal (ID)

  • Subcutaneous (subcut)

  • Intramuscular (IM)

  • Intravenous (IV)

Advantages of Injections

• Rapid Onset: Faster medication effects compared to oral route.

• Administration Ease: Suitable for uncooperative or unconscious patients.

• Absorption: Better for drugs poorly absorbed orally.

• Gastrointestinal Tract Bypass: Avoids first-pass metabolism.

Disadvantages of Injections

• Invasive and Discomfort: Injections can cause pain and anxiety in patients.

• High Cost: More expensive than oral medication.

• Resource Intensive: Requires more supplies and trained personnel.

• Infection Risk: Risk of introducing pathogens at the injection site.

• Nerve Injury: Potential damage to surrounding nerves.

Supplies and Equipment

• Syringes:

• Sizes: Various volumes available.

• Parts:

  • Barrel

  • Plunger

  • Flange

• Types:

  • Regular

  • Tuberculin

  • Insulin

  • Prefilled

• Needles:

• Components:

  • Plastic hub

  • Bevel

  • Cannula/Shaft

  • Safety guard

• Gauge Measurement: Higher numbers indicate smaller diameter.

• Length: Available from 1/4 inch to 2 inches.

Handling Syringes and Needles

• Preparation Steps:

  • Confirm healthcare provider's order and medication details.

  • Ensure route of administration is clear.

• Aseptic Techniques: Critical to maintain asepsis and prevent needlestick injuries.

Medication Assessment Before Administration

• Allergies: Assess if the patient is allergic to the medication.

• Classification and Mechanism: Understand medication classification and action.

• Need for Medication: Rationale for the patient requiring the medication.

• Safe Dose Parameters: Verify dosage is appropriate for patient’s specifics.

• Admin Route Appropriateness: Is the route suitable for medication and individual?

Reconstitution and Drawing Up Medications

• Formulation: Injectable medications may be in liquid or powder form requiring mixing.

• Label Instructions: Follow guidelines for diluent volumes for varying concentrations.

Vials and Ampules

• Vials:

• Container type for medication, often requiring puncturing.

• Types: single-dose and multiple-dose.

• Ampules:

• Sealed glass containers that must be broken for access.

• Preparation Method: Clean with alcohol, break with gauze, use a filter needle for withdrawal.

Mixing Medications

• Compatibility Check: Assess potential drug interactions.

• Cleaning Procedure: Disinfect vial tops before mixing.

• Methods:

• Draw from prefilled cartridges into a separate syringe.

• Mix medications in the cartridge itself.

Routes of Administration - Intradermal (ID)

• Technique:

• Injection of a small fluid amount into the dermis.

• Needle Specifications: 1/4 to 5/8 inch length, 25-30 G gauge, 15° angle.

• Result: Forms a bleb under the skin.

Routes of Administration - Subcutaneous (Subcut)

• Technique:

• Deposits medication in the subcutaneous layer.

• Needle Specifications: 3/8 to 7/8 inch length, 24-29 G gauge, 45°-90° angle.

• Aspiration: Do not aspirate before injecting.

Clicker Questions and Answers

• ID Injection Definition: Small amount of fluid injected into the dermis (Correct Answer: C).

• Medication Monitoring: Insulin and Heparin require specific monitoring protocols for safety.

Insulin and Heparin Administration Tips

• Insulin:

• Monitor blood glucose levels, verify insulin type, avoid aspiration.

• Heparin:

• Assess lab results, triple-check dosage, avoid aspiration.

Routes of Administration - Intramuscular (IM)

• Injection Details:

• Administers directly into the muscle at a 90° angle.

• Suitable for larger volumes and more irritating drugs.

• Needle Specifications: 1 to 1.5 inch length, 20-23 G gauge.

Injection Sites and Volumes

• Site Capacities:

• 2-3 mL for gluteus medius/minimus, vastus lateralis in adults.

• 1-2 mL for ventrogluteal and vastus lateralis.

• 0.5-1 mL for deltoid muscle in small children.

Preventing Injection Complications

• Infection Prevention: Hand hygiene, site cleaning, and bandaging post-injection.

• Documentation: Rotate injection sites and document accordingly.

• Technique: Use the smallest effective gauge and swift needle puncture.

Z-Track Method

• Skin Layer Technique: Ensures medication does not leak out, reducing irritation.

Injection Site Identification

• Ventrogluteal Site:

• Located using anatomical landmarks like the anterior superior iliac spine and iliac crest.

• Deltoid Site:

• Identified using landmarks: Clavicle, acromion process, and humerus.

• Vastus Lateralis Site:

• Effective site for larger volume injections, particularly in children or when gluteal site cannot be used.