PARENTERAL MEDICATION

Introduction:
Developing manual dexterity in the administration of parenteral medication before approaching a
patient with a needle and syringe greatly decreases nervousness. Giving an injection means the possibility
of causing pain. Focusing on the beneficial effect that the medication brings to the patient will help ease
apprehension.

The nurse must have the knowledge of parenteral medication, its action and effects. In the nursing
skills laboratory, the student can have a considerable time to learn and practice the correct technique in the
administration of an invasive procedure. The observance of the standard precautions like aseptic technique
and computation of dosages as well as mastery of the procedure, will contribute to ensure that the
medication reaches the proper location.

Definition:
Parenteral medication is the administration of medication into the body tissues other than the
alimentary tract.

General Instruction:
1. Use only sterile needles and syringes.
2. Select the appropriate length of needle to deposit the medication in the proper tissue layer.
3. Select the injection site carefully to avoid major nerves, blood vessels and underlying organs.
4. Select an injection site that is relatively free of hair, lesions, inflammation, rashes, moles, freckles
and the like.
5. Rotate injection sites for patients receiving repeated injections (e.q. insulin) by establishing a
predetermined plan.
6. Obtain, assistance as needed in giving an injection when the patient is a frightened child or an
uncooperative adult.
7. Aspirate by pulling back the plunger to avoid injecting subcutaneous and intramuscular
medications into a blood vessel (exception: heparin).
8. Check for drug allergies before administration of injection.
9. Know the medication you will administer and observe for side effects and therapeutic action.

Common Routes:
1. Intradermal – ID
2. Subcutaneous – SQ, subcut, SC
3. Intramuscular – IM
4. Intravenous – IV
 INTRADERMAL or INTRACUTANEOUS INJECTION
Definition:
It is the introduction of a solution by means of a syringe and needle into the superficial layer of
the skin or just below the epidermis of the skin.

Purposes:
1. To identify allergens to which the patient may be hypersensitive (skin test).
2. To diagnose individuals who have developed antibodies against specific pathogens, such as
tubercle bacillus.
3. To vaccinate, e.g. BCG.

Sites of Injection:
1. Inner surface of the forearm
2. Upper chest if not hairy
3. Upper back beneath the

Equipment:
A. Injection tray lined with sterile towel containing:
1. Medicine ticket
2. Solution prescribed
3. Disposable sterile tuberculin syringe
4. Disposable sterile 2 cc syringe
5. Disposable sterile needle G25 – 26, 5/8”
6. Disposable sterile aspirating needle
7. A jar of CB soaked in 70% ROH (more than two CBs) / alcohol swab
8. Waste receptacle

Procedure:
Action Rationale
1. Check the physician’s order and assemble all To ensure that the patient receives the right medication at
equipment. the right time by the proper route.

2. Assess the patient’s history of allergies and note the Certain substances have similar compositions, the nurse
substances the patient is allergic to and normal allergic should not administer substance if the patient is known to
reactions. be allergic to prevent its occurrence.

3. Wash your hands. Handwashing deters the spread of microorganisms.

4. Follow the basic 5 rights (1st 5 rights). Promotes patient’s safety by preventing medication error.

5. Pick up syringe and attach aspirating needle. This prevents contamination of the needle and syringe.

6. Proceed as in the procedure of preparing/withdrawing a Pharmaceutical products for parenteral administration are
drug from an ampule or vial. supplied in various containers.
NOTE: To prepare for skin testing, withdraw 0.9 cc of the
diluent and 0.1 cc of the prescribed medicine.

7. Change aspirating needle with G – 25 or 26 needle.

Maintain sterility by retaining the cap of the needle. Place
on top of hypotowel.

8. Present preparation to C.I. or head nurse for checking This guards against error in medication.
together with the empty ampule or vial of the drug
prepared and medication booklet for signing.

9. Carry tray to patient’s room. Identify the patient and This prevents errors in medication. An explanation
explain the procedure. encourages patient cooperation and reduces apprehension.

10. Select an area on the inner aspect of the forearm (or The forearm is a convenient and easy location for
other appropriate sites). introducing an agent intradermally.

11. Cleanse the area with CB soaked in 70% alcohol Pathogens on the skin can be forced into the tissues by the
wiping with a firm, circular motion and moving outward needle. Drying the skin will prevent introducing alcohol
from the injection site. Discard used CB. Allow the skin into the tissues during injection as alcohol is irritating to
to dry. the tissues and this makes patient uncomfortable.
12. Pick up syringe and remove the cap. Use your non-
dominant hand to grasp the dorsal forearm and gently pull
the skin taut.
13. Place the needle 5-15 degree angle against
the patient’s skin. With bevel side up, insert the needle
beneath the skin so that the point of the needle can be seen
through the skin. Insert the needle only about 1/8 inch or
almost flat against the patient skin.
14. Slowly inject the agent while watching for a small
wheal or bleb to appear. If none appears, withdraw the
needle slightly.
15. Withdraw the needle quickly at the same angle that it
was inserted.
16. Do not massage the area after removing the needle.
Pat dry. Encircle the wheal with a blue or black pen.
17. Use the fish-hook technique to recap the used needle
and place it on top of the hypodermic towel.
18. Write the time injected, due time and site at the back
of the medicine ticket.
19. Instruct the patient and/or watcher not to disturb the
wheal nor erase the mark. Inform the patient / watcher that
you will be back with the physician after 30 minutes.
20. Inform the CI or NOD of the procedure done, patient’s
name, due time and site. Endorse the medicine ticket to
the NOD.
21. Leave the medicine ticket and the used hypodermic
syringe on the sterile. towel for possible re-skin testing.
Wash your hands.
22. Observe the area for signs of a reaction within 30
minutes. Accompany the attending physician or ROD who
will interpret the result.
23. Write the positive (+) or negative (-) sign on the
appropriate space of the medicine ticket, medication sheet
and on your medication booklet, as the case may be.
24. Document in the chart the administration of the
medication.
a. time
b. name of drug
c. dosage
d. site of injection
e. result
f. name of physician who interpreted the result.
Taut skin provides an easy entrance into intradermal
tissue.
Intradermal tissue will be entered when the needle is held
as near parallel to the skin as possible and is inserted
about 1/8 inch.
If a small wheal or bleb appears, the agent is in
intradermal tissue.
Withdrawing the needle quickly and at the angle at which
it entered the skin minimizes tissue damage and
discomfort for the patient.
Massaging the area may interfere with test results by
spreading medication to underlying subcutaneous tissue.
A red pen may influence the reading.
Most accidental puncture wounds occur when recapping
the needles. Using this method protects the nurse from
accidental injury with the needle.
The nurse considers the well–being of the patient.
The physician will interpret the result of the procedure.
Awareness of the procedure done and to give time to
contact the physician for interpretation.
If the result is doubtful, there may be a need to re-skin test
as ordered. Handwashing removes transient
microorganisms and deters cross-contamination to clients
and self.
A circle easily identifies the site of intradermal injection
and allows for careful observation of the exact area.
Accurate documentation is necessary to prevent a
medication error.
 SAN PEDRO COLLEGE
Davao City
PERFORMANCE CHECKLIST
ADMINISTRATION of INTRADERMAL or INTRACUTANEOUS INJECTION
Name:_________________________________ Grade: ___________________
Year and Sec.: _________________ Date : ___________________
Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 – Poor
Rating

5 4 3 2 1
1. Verifies facts in the medication ticket by checking it
against the doctor’s order.
2. Obtains equipment and assembles syringe and needle to
be used on the injection tray.
3. Gets the drug from the patient’s medication box and
checks it with the medication ticket.
4. Washes hands.

5. Withdraws the drug with the prescribed amount/ dosage

from the ampule/ vial.
6. Changes aspirating needle with G.25 or 26 needle and
places it on the injection tray.
7. Presents preparation to CI/ Headnurse for checking.

8. Carries tray to patient’s bedside.

9. Confirms patient’s identity by asking for name or by

checking the wristband.
10. Explains the procedure to the patient.

11. Selects an appropriate injection site.

12. Exposes and cleanses area with cotton balls with

alcohol, from center moving outward in circular motion.
13. Picks up syringe between the thumb and 3 fingers with
the bevel of the needle pointing up.
14. Stretches skin by pulling skin to the back of the arm
with the non-dominant hand.
15. Places plunger almost parallel (at 5 to 15 degrees) to the
patient’s hand with the bevel up.
16. Injects solution slowly about 0.1 cc forming a
bleb/wheal.
17. Withdraws needle slowly and pats the area with dry
cotton ball.
18. Encircles the wheal with black or blue pen and instructs
patient and /or watcher accordingly.
19. Notes time of administration, due time and site at the
back of the medicine ticket.
20. Assists patient to a comfortable position.

21. Turns ticket upside down. Inform staff nurse or CI, skin
testing is over with complete data given.
22. Requests and accompanies the physician to read result
after 30 minutes.
23. Disposes materials used properly.

24. Washes hands.

25. Records/ documents medication on patient’s chart.

Notes time of administration, site, time due, physician
who read the result and puts the mark (-) negative or
positive (+) on the medicine ticket and medication
sheet, as the care may be.
26. Informs NOD/ HN of the result.

27. Maintains body mechanics throughout the performance

of the procedures.
28. Manifests neatness in the performed procedure.

29. Receptive to criticisms.

30. Observes courtesy.

31. Shows calmness while performing the procedure.

32. Uses correct English.

33. Shows mastery of the procedure

Remarks:

Criteria: I Knowledge (quiz) 30%

II Performance 70%
100%

________________________________ __________________________
Student’s Signature Over Printed Name Date

________________________________ __________________________
Instructor’s Signature Over Printed Name Date
 SUBCUTANEOUS or HYPODERMIC INJECTION
Definition:
It is the introduction of a small amount of solution by means of a syringe and needle into the
adipose tissue beneath the skin.

Purposes:
1. To deliver medication more rapidly to the bloodstream than oral administration.
2. To allow slower and sustained drug administration than intramuscular injection.
3. To prevent destruction of the drug by the action of digestive secretions.
4. To minimize tissue trauma and avoid the risk of hitting large blood vessels and nerves.

Special Considerations:
1. If 2’’ (5 cm) of tissue can be grasped, insert the needle at a 90-degree angle; if only 1” of tissue
can be grasped, use a 45-degree angle for the injection.
2. Injection sites should be rotated from one side of the body to the other.
3. Heparin or insulin injections are given in the abdomen on both sides of and below the umbilicus
outside of a 2” radius around the umbilicus from the costal margins to the iliac crests. May refer
to hospital protocol for other sites. Do not aspirate before injecting the heparin or insulin.
4. The needle angle used depends on the length of the needle and the amount of subcutaneous tissue
at the site.
5. A record should be kept of where each insulin injection is given. Insulin is absorbed more quickly
and uniformly when injected into the abdominal sites.

Precaution:
1. Subcutaneous injection sites should be rotated.
2. When giving medication other than insulin and heparin, aspirate after inserting the needle into the
site and before injecting the medication.
3. For heparin, injection sites should be rotated within the abdominal area only alternating from one
side to another.
4. For insulin, sites should be rotated in any available appropriate site.

Sites:
1. Lateral and anterior aspects of upper arm
2. thigh
3. lower abdomen
4. upper back
5. upper ventrogluteal and dorsogluteal areas.

Equipment:
1. Medicine
2. Medication tray
3. Injection tray – Hypo tray
4. Syringe
5. Disposable sterile aspirating needle
6. Disposable sterile injection needle g.25 5/8" or g.26 1"
7. Jar of CB with 70% ROH
8. Waste receptacle
9. Sharps container
10. Jar of dry CB

Procedure:
Action Rationale
1. Get the medicine ticket and compare it with the doctor’s The source of the order is more reliable than the medication
order. ticket which is only a device for convenience

2. Wash hands and assemble syringe and needle to be used Deter the spread of microorganisms
in the injection tray.

3. Withdraw the drug from ampule/vial into the syringe and Prolonged exposure to the air and or contact with moist
replace the aspirating needle with the injecting needle. surface will contaminate the needle.

4. Present the medication to your C.I. or Headnurse for The C.I’s signature signifies that the checking process
checking and signing of the medication booklet. actually took place.

5. Carry tray to the patient’s bedside. Identify the patient Cooperation is easily gained when the patient knows what
carefully and explain what you are going to do. is to be performed.
6. Select the site for injection (review sites). Rotate sites Selecting a site where skin appears to be healthy and free
according to schedule. of irritation and inflammation reduces the discomfort of the
injection.

7. Cleanse with an alcohol swab (or CB saturated with 70% Friction aids in cleaning the skin. A clean area is
ROH) the area to be injected. Apply a firm, circular motion, contaminated when a soiled object is rubbed over its
starting at the center and going to the outer portion of the surface. ROH 70% is an antiseptic solution for the skin.
area.

8. Grasp the area surrounding the site of injection and hold Cushioning the subcutaneous tissue helps to ensure having
in a cushion fashion. the needle enter into the subcutaneous connective tissue.

9. Inject the needle quickly at an angle of 30 degrees to 60 Pain is minimized by inserting the needle without
degrees, depending on the amount of the tissue. hesitation. Subcutaneous tissue is abundant in well–
nourished, hydrated persons and scarce in emaciated
dehydrated ones.

10. Once the needle is in position, release the grasp on the Injecting the solution into compressed tissue results in
tissue, and hold the hub of the needle. pressure against nerve fibers and creates discomfort.

11. Pull back gently the plunger of syringe to determine Substance injected directly into the blood stream are
whether needle is in the blood vessel or not.( Not done absorbed immediately.
when injecting HEPARIN or INSULIN)

12. If no blood appears, inject the solution slowly. If blood Rapid injection may cause discomfort.
appears, remove the needle and replace it with a sterile one
before continuing with the procedure.

6. Rub the area gently with CB with ROH. Make patient Rubbing aids in the distribution and absorption of the
comfortable. (Do not rub if contraindicated, like HEPARIN solution and relieves discomfort.
and INSULIN).

7. Turn the medicine ticket upside down on the hypo tray. Indicates the medicine has been administered.

8. Do after care. Discard the used syringe and needle into Proper disposal of sharps prevents accidental pricks.
the container for sharps.

9. Wash your hands and return medicine ticket to its box Prevents transmission of microorganisms. Careful
promptly. management of tickets reduces error and losses.

10. Record the drug given, amount given, site and Prompt recording prevents chances of errors in medication.
reactions, if any.
 SAN PEDRO COLLEGE
Davao City
PERFORMANCE CHECKLIST
ADMINISTRATION of SUBCUTANEOUS INJECTION
Name:_________________________________ Grade: ___________________
Year and Sec.: _________________ Date : ___________________
Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 – Poor
Rating

5 4 3 2 1
1. Verifies the order on the patient’s medication ticket/s by
checking it against the doctor’s order.
2. Obtains equipment and assembles syringe and needle to
be used in the injection tray.
3. Gets the drug from the patient’s medicine box and checks
it with medication ticket.
4. Washes hands.

5. Withdraws the drug with the prescribed amount.

Changes the aspirating needle with the injection needle and
places it on the injection tray.
6. Presents the medication to the CI or Headnurse for
checking
7. Carries tray to the patient’s bedside

8. Checks patient’s identity by asking to state name and/or

by checking on his wristband.
9. Selects an appropriate injection site. Rotates sites
according to planned schedule.
10. Cleanses the area or injection site with CB with ROH
from center moving outward in circular motion.
11. Grasps the area around the injection site and holds in a
cushion fashion.
12. Injects the needle quickly at 300 – 600 angle depending
upon the amount of subcutaneous tissue present at the site
and the needle length.
13. Pulls back the plunger of the syringe gently to
determine whether the needle is in the blood vessel or not.
(NA for Heparin and Insulin)
14. Injects the drug slowly.

15. Removes the needle quickly and applies gentle pressure

at the site using CB with ROH.
16. Makes patient comfortable. Turns ticket upside down
in hypo tray.
17. Records the time and the date of injection, amount, site
and route and patient’s reaction to the medication.
18. Puts back the medication ticket to the box promptly.

19. Does after care. Disposes equipment properly.

20. Washes hands.

21. Maintains body mechanics throughout the

performance of the procedures.
22. Manifests neatness in the performed procedure.

23. Receptive to criticisms.

24. Observes courtesy.

25. Shows calmness while performing the procedure.

26. Uses correct English.

27. Shows mastery of the procedure.

Remarks:

Criteria: I Knowledge (quiz) 30%

II Performance 70%
100%

________________________________ __________________________
Student’s Signature Over Printed Name Date

________________________________ __________________________
Instructor’s Signature Over Printed Name Date
 INTRAMUSCULAR INJECTION
Definition:
It is the introduction of medication deep into the muscle tissue where a large network of blood
vessels can absorb it readily and quickly.

Purposes:
1. To allow less painful administration of irritating drugs.
2. To allow more rapid absorption of the drug compared to subcutaneous injection.
3. To administer large doses (up to 5 ml in appropriate sites) of the medication.
4. To give drugs to patients who can not take medications orally and for drugs that are degraded by
the digestive juices.

Sites:
1. deltoid
2. vastus lateralis
3. rectus femoris
4. dorsogluteal
5. ventrogluteal

Equipment:
1. Hypodermic tray lined with sterile towel.
2. Prescribed medication
3. Medication ticket
4. Sterile needles for aspirating and for injecting G.20 – 22 1 ½”
5. Sterile syringes
6. Jar CB soaked in 70% ROH
7. Waste receptacle
8. Sharps container
9. Jar of dry CB

Procedure:
Action Rationale
1. Follow steps # 1-7 of subcutaneous injection.

8. Select the sites for injection:

A. VENTROGLUTEAL
Place palm of left hand on ® greater trochanter so
that index finger points toward anterosuperior iliac
spine. Spread first and middle fingers to form a V.
The injection site is the middle of the V.

B. DORSOGLUTEAL Toes pointing inward will relax the muscles of the buttocks.
Place hand on iliac crest and locate the Injection into tense muscle causes pain. Good visualization
posterosuperior iliac spine. Draw an imaginary of the buttock aids in correct location of the site.
line between the trochanter and the iliac spine. The
injection site is the outer quadrant.

C. DELTOID This is the densest site containing no major blood vessels

Locate the lower end of the acromial process and and nerves.
measure 2 – 3 fingers breadths. Inject just below
that area.

D. VASTUS LATERALIS/RECTUS FEMORIS This area contains big muscles.

Locate middle outer third of the thigh by dividing
the thigh into 3 parts and drawing a longitudinal
line from the greater trochanter of the femur down
to the knee. Select the middle third lateral aspect
as injection site.

9. Gently tap the selected site of injection with fingers Stimulation of the peripheral nerve helps to minimize the
several times. initial reaction when the needle is inserted.

10. Clean the area thoroughly using CB with ROH from Pathogens present in the skin can be forced into the tissue
the proposed site of injection going outside in a by the needle.
circular motion. Have an extra alcohol swab ready for
use after injection.
11. Grasp the area surrounding the site of injection and Cushioning the subcutaneous tissue helps to ensure having
hold it in a cushion fashion. the needle enter into the areolar connective tissue.

12. Once the needle is in position, release the grasp on the Injecting the solution into compressed tissue results in
tissue, and hold the hub of the needle. pressure against nerve fibers and creates discomfort.

13. Inject the needle quickly at 900 angle. Pain is minimized by inserting the needle without hesitation
(see book for 900 L).

14. Pull back gently the plunger of syringe to determine Substance injected directly into the blood stream are
whether needle is in the blood vessel or not. absorbed immediately.

15. If no blood appears, inject the solution slowly. If blood Rapid injection may cause discomfort. Beginning again
appears, remove the needle, discard the set and begin prevents the medication from being injected intravenously
the procedure. Prepare another dose of medication. and the reinjection of aspirated blood.

16. Rub the area gently with CB with ROH. Make patient Rubbing aids in the distribution and absorption of the
comfortable. Do not rub if contraindicated. solution and relieves discomfort.

17. Turn the medicine ticket upside down on the injection Indicates the medicine has been administered.
tray.

18. Do after care. Discard the used syringe and needle into Proper disposal of sharps prevents accidental pricks.
the container for sharps. Prevents transmission of microorganisms.

19. Wash your hands and return medicine ticket to its box Careful management of tickets reduces error and losses.
promptly.

20. Record the drug given, amount given, site and Prompt recording prevents chances of errors in medication.
reactions, if any.
 Z – Technique of Intramuscular Injection
Z – technique intramuscular injection is the introduction of oily or viscous medication deep into
the muscle tissue. The technique seals the medication in the chosen muscle site.

Indication:
It is used for certain drugs that irritate and discolor the subcutaneous tissues (eg. Iron). It provides
less discomfort and decrease the occurrence of lesions at the injection site.

Procedure
Action Rationale
1. Follow steps # 1-7 of subcutaneous injection.

8. Using the thumb and forefinger make a movement Z–track method prevents leakage and tracking of
forming Z on the muscles. medication through subcutaneous tissue with needle
removal after injection.

9. Hold steadily the syringe and aspirate for blood.

9a. If with blood, withdraw the needle and dispose of the Presence of blood indicates the needle is placed in a blood
syringe and needle. Draw up the medication with a new vessel where it is contraindicated to inject the medication.
syringe.

9b. If without blood, slowly inject the medication. Wait
for 10 seconds before withdrawing the needle.
Inject the needle slowly into the muscles at 900 angle.
Injecting medication slowly allows the tissue to absorb the
medication and prevents untoward bruising. Waiting for
10 seconds allows time for the medication to disperse into
the tissue, helping prevent it from traveling back up the
needle track.

10. Withdraw the needle while releasing the tissue. Gently Letting go of the tissue while withdrawing the needle
wipe the injection site with ROH swab. DO NOT disrupts the path of the needle track, preventing the
MASSAGE the SITE. Use alternate sites for subsequent medication from traveling to the skin surface. Massage
injections. might force the medication out into the SQ tissue.

11. Make patient comfortable.

12. Turn back the medicine ticket on the injection tray. Indicates the medicine has been administered.

13. Do after care. Discard the used syringe and needle into Proper disposal of sharps prevents accidental pricks.
the container for sharps.

14. Wash your hands and return medicine ticket to its box Careful management of tickets reduces error and losses.
promptly.

15. Record the drug given, amount given, site and Prompt recording prevents chances of errors in
reactions, if any. medication.
 SAN PEDRO COLLEGE
Davao City
PERFORMANCE CHECKLIST
ADMINISTRATION of INTRAMUSCULAR INJECTION
Name:_________________________________ Grade: ___________________
Year and Sec.: _________________ Date : ___________________
Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 – Poor
Rating

5 4 3 2 1
1. Verifies the facts on the medication ticket by checking
it against the doctor’s order.
2. Obtains equipment and assembles syringe and needle to
be used in the injection tray.
3. Gets the drug from the patient’s medicine box and
checks it with medication ticket.
4. Washes hands.

5. Withdraws the prescribed amount of drug. Replaces the

aspirating needle with the injection needle and places it on
the injection tray.
6. Presents the medication to CI or headnurse for
checking.
7. Confirms patient’s identity by asking to state his/her
name or by checking on wristband.
8. Selects an appropriate injection site. Locates the site
correctly.
9. Cleanses the injection site with CB with ROH from the
center outward in circular motion.
10. Grasps the area around the injection site and holds in a
cushion fashion.
11. Injects the needle quickly at an angle of 900.

12. Pulls back gently the plunger of the syringe to

determine whether the needle is in the vein or not.
13. Injects the drug slowly.

14. Removes the needle quickly and applies gentle

pressure at the site with CB with ROH.
15. Makes patient comfortable. Tears / turns back
medication ticket.( for STAT order only)
16. Records time and date of injection, amount, site and
route of administrations as well as patient’s reaction to the
combined Doctors’ and Nurses’ notes.
17. Puts back the medication ticket to the patient’s
medicine box or Kardex promptly.
18. Does after care. Disposes equipment properly.

19. Maintains body mechanics throughout the

performance of the procedures.
20. Manifests neatness in the performed procedure.

21. Receptive to criticisms.

22. Observes courtesy.

23. Shows calmness while performing the procedure.

24. Uses correct English.

25. Shows mastery of the procedure

Remarks:

Criteria: I Knowledge (quiz) 30%

II Performance 70%
100%

________________________________ __________________________
Student’s Signature Over Printed Name Date

________________________________ __________________________
Instructor’s Signature Over Printed Name Date