METHODS OF

INJECTION
DELIVERY
MDSC 3203
Department of Child &
Adolescent Health
OBJECTIVES

• To become familiar with different modes of parental injections

• To be familiar with the methods of administering
• To be familiar with the complications of injections
• To identify vaccines that are administered by different parenteral routes
INJECTIONS

• An injection is a process by which a small area of the skin is pierced by a syringe and needle to
insert a substance for prophylactic or curative purposes.
• Injections allows for a parenteral route of administration; that is, medicines are administered
not through the digestive tract.

• A Safe Injection
– Does no harm to the recipient (e.g. no abscess formation),
– Does not expose the health worker to any risk (e.g.: needle stick injuries) and
– Does no harm to the community (e.g.: unsafe disposal of waste)
INJECTION DEVICE

• These should be single use devices

• There are 3 parts to a syringe & needle:

– The needle: pierces the patient’s skin and muscle
– The barrel: holds the medicine ,
– The plunger: used to get medicine into and out of the syringe.
PREPARING THE VIAL & SYRINGE
• This is an aseptic technique
• In a single use vial clean the rubber stopper with an alcohol swab.
• Remove the cap from the syringe. Draw air into the syringe by pulling back the plunger. Fill the
syringe with air up to the same level as the medication dose.
• Remove the cap from the needle and push it through the top of the vial. Inject all the air into
the vial.
• Turn the vial and syringe upside down so that the needle points upward. Draw back the plunger
to fill the syringe with the correct amount of medication.
• Remove air bubbles by gently tapping the syringe and pressing the plunger. Avoid touching the
needle to ensure it stays clean.
PARENTERAL METHODS

• Commonly included among the injection methods of drug administration are:

– Subcutaneous (beneath the skin),
– Intramuscular (within the substance of the muscle),
– Intradermal (within the dermis)
INTRAMUSCULAR INJECTIONS

• An intramuscular injection is a technique used to deliver a medication deep into the muscles.
– Allows the medication to be absorbed into the bloodstream quickly.
– Absorbed faster than subcutaneous injectionsand larger volume can be injected.
• Muscle tissue has a greater blood supply than the tissue just under the skin.
– Vaccines given by IM route eg influenza vaccine, pentavalent vaccine, medications (ceftriaxone)
 IM
INJECTION
SITES

MDSC 3203
Department of Child &
Adolescent Health
 • Prepare vial & syringe

ADMINISTERING • Perform hand hygiene and don non-sterile gloves

• Identify muscle to be used, clean with alcohol and
AN IM INJECTION allow to air dry
• Remove needle cap
• Hold syringe between thumb & forefinger in
dominant hand
• With non-dominant hand hold skin around the
injection site
• Using a 90-degree angle insert the needle into site
with a steady smooth motion
• Once entered use the non-dominant hand to
stabilize the syringe
• Inject the medication slow and steady
• Remove needle at same angle as inserted
• Cover injection site
• Discard needle in a “sharp” container
SUBCUTANEOUS INJECTIONS
• Subcutaneous (SC) injections are administered into the adipose tissue layer just below the
epidermis and dermis. This tissue has few blood vessels, so drugs administered by this route
have a slow, sustained rate of absorption.

• The preparation for subcutaneous use must be a sterile liquid capable of complete absorption
or it will irritate the tissues.

• Sites for SC injections include the outer aspect of the upper arm, the abdomen (from below
the costal margin to the iliac crest) within one inch of the belly button, anterior aspects of the
thighs, upper back, and upper ventral gluteal area
• Vaccine administered by this routes: MMR
 SUBCUTANEOUS INJECTION SITES

To administer an SC injection, a 25 to 30 gauge, 3/8 in. to 5/8

in. needle is used
 ADMINSTERING A SC INJECTION
• Prepare vial & syringe
• Perform hand hygiene and don non-sterile gloves
• Identify area to be used, clean with alcohol and allow to air dry
• Remove needle cap
• Grasp or pinch the area surrounding the injection site. The decision ot create e a skin fold is based on the
assessment of the patient and needle length. Pinching is advised for thinner patients
• Hold the syringe in the dominant hand between the thumb and forefinger. Insert the needle quickly at a 45- to
90-degree angle.
• Inserting quickly causes less pain to the patient. Subcutaneous tissue is abundant in well-nourished, well-hydrated
people. For patients with little subcutaneous tissue, it is best to insert the needle at a 45-degree angle
• After the needle is in place, release the tissue. Move your non-dominant hand to steady and lower the end of the
needle. With your dominant hand, inject the medication at a rate of 10 seconds per ml. Avoid moving the syringe.
• Withdraw the needle quickly at the same angle at which it was inserted, while supporting the surrounding tissue
with your non-dominant hand.
• Cover injection site
• Discard needle in a “sharp” container
INTRADERMAL INJECTIONS

• These are administered into the dermis, just below the epidermis.
• The ID injection route has the longest absorption time of all parenteral routes.
• These types of injections are used for sensitivity tests, such as TB, allergy, and local anesthesia
tests.
• The advantage of these tests is that the body reaction is easy to visualize, and the degree of
reaction can be assessed.
• The most common sites used are the inner surface of the forearm and the upper back, under
the scapula. Choose an injection site that is free from lesions, rashes, moles, or scars, which
may alter the visual inspection of the test results
 INTRADERMAL INJECTIONS SITES

• Equipment used for ID injections is a

tuberculin syringe calibrated in tenths and
hundredths of a millilitre, and a 1/4 to 1/2
in., 26 or 27 gauge needle.
• The dosage of an ID injection is usually
under 0.5 ml.

MDSC 3203
Department of Child &
Adolescent Health
ADMINISTERING
• Prepare vial and syringe & needle
• Perform Hand Hygiene

AN ID INJECTION: • Clean site with alcohol and allow to dry

• Remove needle cap
• Using non-dominant hand spread the skin taut ove the chosen
site
• Hold the syringe in the dominant hand between the thumb
and forefinger, with the bevel of the needle up
• Hold syringe at a 5- to 15-degree angle from the site. Place
the needle almost flat against the patient’s skin, bevel side up,
and insert needle into the skin. Insert the needle only about
1/4 in., with the entire bevel under the skin.
• Once syringe is in place, slowly inject the solution while
watching for a small weal or bleb to appear
• Withdraw the needle at the same angle as insertion, engage
safety shield or needle guard, and discard in a sharps
container.
• Do not massage area after injection
COMPLICATIONS OF INJECTION

• Pain at site
• Abscess formation
• Tissue necrosis, or tissue death
• Muscle fibrosis, or scarring of muscle tissue
• Haematoma, where blood seeps out of blood vessels into the surrounding tissue
• Injury to blood vessels and nerves
• Extravasation injury
• Allergic response