SAFE INJECTION

PRACTICES
Intended learning outcomes
• Identify the safe anatomical sites for ID, SC and IM injections.
• Locate the specific muscles for IM injections and explain the rationale
for their use.
• Give sound reasons for method of skin preparation.
• Discuss ways to reduce patient discomfort during an injection.
• Describe the nursing care a patient requires to avoid complications
associated with injections.
• Drugs are given via the parenteral routes because they are usually
absorbed faster than by the oral route.
• There are four main considerations regarding injections:
the route, site, technique and equipment.
The intradermal route
• The intradermal route provides a local, rather than systemic, effect.
• It is used primarily for diagnostic purposes such as allergy or
tuberculin testing, or for local anaesthetics.
The intradermal route contd….
• Needle size: 26- 28 gauge
• Angle: 10-15° bevel up, just under the epidermis
• Max dose:0.5 ml
The intradermal route contd….
If it is being used for allergen testing, the area should be
labelled indicating the antigen so that an allergic response can
be monitored after a specified time lapse.
The intradermal route contd….
Location of Injection
• Anterior aspect of forearm
• Upper chest
• Upper back
• Back of upper arm
The subcutaneous route
• The subcutaneous route is used for a slow, sustained
absorption of medication,
• Up to 1-2ml being injected into the subcutaneous tissue.
• It is ideal for drugs such as insulin, which require a slow and
steady release,
• And as it is relatively pain free, it is suitable for frequent
Injections.
The subcutaneous route contd…
• Traditionally, SC injections have been given at a 45°angle into a raised
skin fold.
• However, with the introduction of shorter insulin needles(5, 6 or
8mm), the recommendation for insulin injections is now an angle of
90°.
• The skin should be pinched up to lift the adipose tissue (3 finger
pinch)away from the underlying muscle, especially in thin patients.
The subcutaneous route contd…
• Insulin that is injected in to muscle is absorbed more rapidly and can
lead to glucose instability and potential hypoglycaemia
• It is no longer necessary to aspirate after needle insertion before
injecting subcutaneously.
Injection site
• Outer area of the upper arm
• The front of the thigh, midway to the outer side
• 4 inches below the top of the thigh to 4 inches above the knee
• Upper back
• The upper area of the buttock
The intramuscular route
What site should I use?
Consider
• age of the client
• medication to be injected
• client’s general condition e should I use?
The intramuscular route
Sites that are available for IM injections
• The deltoid muscle of the upper arm.
• The dorsogluteal site using the gluteus maximus muscle
• The ventrogluteal site.
• The vastus lateralis
The intramuscular route
Vastus lateralis site
• Safe, rapid absorption
• Location: – one handbreadth above the knee – one handbreadth
below the greater trochanter – medial lateral portion of the thigh
• Can be used for infants, children & adults
• Needle length usually 1 inch or less
The intramuscular route contd…
The deltoid injection
• Place fingers on the patient’s shoulder
• Locate the acromion process landmark
• Place index & middle finger on landmark, creating an inverted
triangle and Inject 1 - 2 inches below the acromion process in center
of triangle
The intramuscular route contd…
Dorsogluteal site
•Position patient prone or lateral (sidelying)
• Locate the superior iliac spine & the greater trochanter of the femur
• Draw an imaginary diagonal line between the two landmarks
• Site is superior & lateral to this line, several inches below the iliac
crest.
The intramuscular route contd…
The ventrogluteal site.
• Free of major blood vessels & nerves
• Less fatty tissue distribution
• Position patient sitting or lateral (sidelying)
• Considered safest & least painful site
The intramuscular route contd…
Ventrogluteal site
• Free of major blood vessels & nerves
• Less fatty tissue distribution
• Position patient sitting or lateral (sidelying)
• Considered safest & least painful site
The intramuscular route contd…
• Locating the ventrogluteal site
• Palpate greater trochanter, place palm of hand here
• Palpate anterior superior iliac spine with index finger
• Spread middle finger to palpate the bony ridge of the iliac crest
• The center of the formed triangle is the ventrogluteal site
The intramuscular route contd…
• Spread the skin to ensure firmness
• 90° angle
• Insert needle quickly, dart-like fashion
• ALWAYS aspirate prior to injection
• Remove needle quickly in the same direction as insertion .
• ACTIVATE NEEDLE SAFETY
VENIPUNCTURE
• The process of puncturing a vein , with a needle, using aseptic
technique.
Contraindications
• An arteriovenous fistula in the extremity.
• Mastectomy on the same side of the arm/ surgically compromised
extremity.
• Presence of phlebitis, infiltration or sclerosis
Procedure
• Select venepuncture site
• Unless contraindicated select the non- dominant arm of the hand of
the client.
• Look for veins that are relatively straight. Consider catheter length so
that the wrist/ elbow will be away from the catheter tip
Procedure
• Dilate the vein
• Place extremity in a dependant position (lower than heart)
• Apply tourniquet firmly about 15-20cm above the vein puncture
site (the tourniquet must be tight enough to obstruct venous flow
but not tight enough to obstruct arterial supply.)
• If the vein is not sufficiently dilated, massage/ stroke the vein distal
to the site in the direction of venous flow towards the heart.
Procedure
• Encourage the client clench and unclench the fist.
• Lightly tap the vein
• If all the above steps fail, remove the tourniquet and apply heat to the
entire extremity for 10- 15mts.
• Don clean gloves
Procedure contd…..
• Clean venepuncture site
• Clean with antiseptic swab from centre out-ward in circular motion
for several inches.
• Permit solution to dry on the skin
• Insert the needle/ catheter
• Use non dominant hand to pull the skin taut below the entry site
• Hold the catheter/ needle at a 15 to 30 degree angle with bevel
up, insert the catheter through the skin and in to vein in one
thrust.
Procedure contd…..
• Once blood is seen in the lumen or when a lack of resistance is felt,
reduce the angle of the catheter till it is almost parallel to the skin and
advance the needle and catheter approximately 0.5- 2cm.
• Remove the needle from inside the angiocath completely and attach
syringe with medication/syringe for blood draws/ IV infusion tube is
required.
• Tape the catheter
• Label the site with date and time