Parenteral

Medication:
Intramuscular
&
Subcutaneous
Injection
Dorothy Joy D. Tan, RN,MAN
Zcharina J. Tinaytina,
RN,MN Lila Mae A.
Miranda,RN,MN
 Objectives
• At the end of the learning experience, the students will be able to:
• Establish an overview on parenteral medications, its different routes and purposes;
• Differentiate the needles and syringes used for parenteral medication;
• Identify the purpose of intramusculat medication administration and when is it
indicated;
• Select the appropriate sites for intramuscular medication administration
• Demonstrate the steps of medicine administration through intramuscular route; and,
• Discuss the rationale of the steps used in medicine administration through the
intramuscular route.

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 PARENTERAL
ADMINISTRATION

The parenteral route is defined as other than through the

alimentary or respiratory tract; that is, by needle.

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 PARENTERA
L ROUTES
Common routes for parenteral administration:
▪ Subcutaneous (hypodermic)—into the
subcutaneous tissue
▪ Intramuscular (IM)—into a muscle
▪ Intradermal (ID)— into the dermis
▪ Intravenous (IV)—into a vein
▪ Others: Epidural, Intrathecal
(Intraspinal), Intraosseous,
Intraperitoneal, Intra-arterial

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EQUIPMEN
T
1. Syringe
2. Needle
3. Ampules and Vials
4. Others
▪ Puncture-proof
waste receptacle
▪ Ampule Opener

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 SYRING
•
E
A medical equipment consisting of a cylindrical
barrel with a tip designed to fit the hub of a
hypodermic needle and
closed-fitting plunger.
• Classified as:
• Luer-Lok
• Non-Luer-Lok
• Parts:
• Tip
• Bar
rel
• Plu
nge
r
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 HYPODERMI
C SYRINGE
• Syringes used with needle to inject
medications into the skin
• Includes 1cc to 5cc syringes

TUBERCULIN SYRINGE
• 1cc syringe
• Calibrated in hundredths of a milliliter
• Used when preparing small amounts of
medications (ID, SQ) or when preparing small,
precise dose for infants or young children

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 INSULIN
SYRINGE
• Similar to a hypodermic syringe, but the
scale is specially designed for insulin
• A 100-unit calibrated scale intended for
use with U-100 insulin although low dose
syringes calibrated at 30 and 50 units are
also available
• This is the only syringe that should be
used to administer insulin.
• Calibrated in units.

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 NEEDL
E
• Needles are made of stainless steel, and most
are disposable.
• Reusable needles (e.g., for special procedures)
need to be sharpened periodically before
resterilization because the points become dull
with use and are occasionally damaged or acquire
burrs on the tips.
• A dull or damaged needle should never
be used.
• Parts:
• Hub
• Cannula or Shaft
• bevel

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BEVE
L
• The slanted part at
the tip of the needle
• Three
characteristics:
• Slant or length of
the Bevel
• Length of the
shaft
• Gauge (diameter of
the shaft)
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The smaller the number
the bigger the gauge and
vice versa.

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BUTTERFLY NEEDLE

• A device used to access a vein for drawing blood

or giving medications.
• Some medical professionals call a butterfly
needle a “winged infusion set” or a “scalp vein
set.”
• The set gets its name because there are plastic
“wings” on either side of a hollow needle used to
access the vein.

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AMPULES AND
VIALS
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General Instructions in giving Parenteral
Medications
• Use only sterile needles and syringes.
• Select the appropriate length of needle to administer the
medication in the proper tissue layer.
• Select the injection site carefully to avoid major nerves,
blood vessels and underlying organs.
• Select an injection site that is relatively free of hair,
lesion, inflammation, rashes, moles, freckles and the like.
• Rotate injection sites for patient receiving repeated
injections by establishing a predetermined plan.

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General Instructions in giving Parenteral
Medications
• Obtain assistance as needed in giving an injection when the
patient is a frightened child or uncooperative adult.
• Aspirate by pulling back the plunger to avoid injecting
subcutaneous and intramuscular medication into a blood vessel.
• Check for drug allergies before injecting any medication
• Know the medication you will administer and observe for side
effects and therapeutic action.
• Maintain to observe the 10 Patients’ Rights in medication
administration.

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INTRAMUSCULAR

ADMINISTRATION
The introduction of a solution
by means of a syringe deep into
the muscles. This allows the
medication to be absorbed into
the bloodstream quickly.
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• Found on the lateral aspect of the
upper arm.
• It is not used often for intramuscular
injections because it is a relatively
small muscle and is very close to the
radial nerve and radial artery.
• It is sometimes considered for use in
adults because of rapid absorption
from the deltoid area, but no more
than 1 mL of solution can be
administered.
• This site is recommended for the
administration of hepatitis B vaccine
in adults.

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• The ventrogluteal site is in the gluteus medius
muscle, which lies over the gluteus.
• The ventrogluteal site is the safest site of
choice for an IM injection of more than 1 mL
in clients older than 7 months.
• The ventrogluteal site is the preferred site
for intramuscular injections because the
area:
• Contains no large nerves or blood
vessels.
• Provides the greatest thickness of gluteal
muscle consisting of both the gluteus
medius and gluteus minimus
• Is sealed off by bone.
• Contains consistently less fat than the
buttock area, thus eliminating the need
to determine the depth of subcutaneous
fat.
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• The vastus lateralis muscle is usually
thick and well developed in both adults
and children.
• It is recommended as the site of
choice for intramuscular
• injections for infants and young
children because it is the
• largest muscle mass and because there
are no major blood vessels or nerves in
the area, it is desirable for infants
whose gluteal muscles are poorly
developed.

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• Historically, the dorsogluteal site was primarily
used for intramuscular injections. However, this
site is close to the sciatic nerve and the superior
gluteal nerve and artery.
• As a result, complications (e.g., numbness, pain,
paralysis) occurred if the nurse injected a
medication near or into the sciatic nerve.
• In addition, there tends to be more
subcutaneous tissue at the dorsogluteal site. As
a result, the medication may be injected into
the subcutaneous tissue instead of the muscle,
which can then affect the intended therapeutic
effect.

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RECTUS FEMORIS
• The rectus femoris muscle, which belongs to the
quadriceps muscle group, is used only
occasionally for intramuscular injections.
• It is situated on the anterior aspect of the thigh.
• Its chief advantage is that clients who administer
their own injections can reach this site easily.
• Its main disadvantage is that an injection here
may cause considerable discomfort for some
people.

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 Z-TRACK
TECHNIQU
E
The Z-track method is a type
of IM injection technique
used to prevent tracking
(leakage) of the medication
into the subcutaneous tissue
(underneath the skin).

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SUBCUTANEOUS
ADMINISTRATION
Aka: Hypodermic administration
The introduction of a solution by
means of a syringe into the
subcutaneous layer. This allows the
medication to be absorbed into the
bloodstream gradually.

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Demonstration on Intramuscular
Medication Administration

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Click to editMedication
Intradermal Master title style
Administration
•Equipment:
• Working Gloves
• Medication in ampule
• Blue Medication Ticket or Scanner
• Medicine Tray
• 3cc syringe
• Dry Cotton ball
• Cotton ball with alcohol or alcohol
swab
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IM/SQ MEDICATION
ADMINISTRATION: GENERAL
PREPARATION
Procedure Rationale
1. Check accuracy and • To verify doctor’s order and
completeness of eMAR (or
medication ticket for ensure the right drug,
noncomputerized systems). dosage and route will be
Compare it with the doctor's prepared
order. Clarify incomplete or
unclear orders.
2. Review pertinent information • Allows you to anticipate
related to medication such as
purpose, action, normal effects of the drug and
dosage and route, side observe client’s response.
effects, time of onset and
peak and nursing
implications.
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 RM 301 Patient A (32 years old)
□ Ampicillin 1g IVTT q8 ANST

3/12/19 301 3/12/19

1pm Tetanus Toxoid 0.5cc
IM Jose P. Rizal
Tetanus Toxoid
0.5mL IM

NOW

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IM/SQ MEDICATION
ADMINISTRATION: GENERAL
PREPARATION
Procedure
3. Assess for any
contraindications (i.e drug
to drug and food to drug
interactions, allergies) to
client receiving oral
medication including the
ability to swallow. Notify
the health care provider if
contraindications are
present.
Rationale
• To avoid any untoward
effect and ensure that client
is able to take the
medication. HCP must be
informed of the
contraindication to modify
the order.
• Organization and
completeness of equipment
increases efficiency.
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IM/SQ MEDICATION
ADMINISTRATION : GENERAL
PREPARATION Rationale
Procedure

4. Collect appropriate equipment and • Organization and completeness of

eMAR (or medication ticket). equipment increases efficiency.
5. Log on to Automated Dispensing Interruption contributes to medication
System (ADS) or unlocked
medicine drawer or cart. Plan errors thus it must be minimized.
organization of preparation and
administration of medication to
avoid interruptions and
distractions.

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IM/SQ MEDICATION
ADMINISTRATION : GENERAL
PREPARATION Rationale
Procedure
6. Perform hand hygiene. • To deter the spread of
7. Arrange and organize microorganism
medication tray and cups in • Organization and completeness of
preparation area including equipment increases efficiency.
medication tickets, if not
using eMAR. • Reading labels and comparing them
with transcribed order reduces error.
8. Prepare medication for one This is the first accuracy check.
patient at a time. Obtain the Logging out of the ADS ensures no
one else can use you identity to get
correct drug, compare name medications from the ADC.
of medication on label with
eMAR (or medication ticket)
and exit ADS after removing
drug(s).

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IM/SQ MEDICATION
ADMINISTRATION: GENERAL
PREPARATION
Procedure Rationale
9. Check or calculate drug dose • Double checking reduces
as necessary, double-check error. Medication count are
calculation, check expiration
date on
carefully tallied and
all medications and return controlled.
outdated medication to
pharmacy, if there are any.
Check record for medication
count and compare current
count with supply available
especially if preparing a
controlled substance.

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 PREPARING MEDICATION FROM AN
AMPULE
Procedure
10. At the preparation area,
read the medication label,
compare it with the eMAR
(or medication ticket) then
scan the barcode of the
drug.
Rationale
• Rechecking drug labels
reduces error. This is the
second accuracy check.
Scanning the medicines
ensures that it is accounted
in the system.
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 PREPARING MEDICATION FROM AN
AMPULE
Procedure Rationale
10. At the preparation area, read the • Rechecking drug labels
medication label, compare it with reduces error. This is the
the eMAR (or medication ticket)
then scan the barcode of the
second accuracy check.
drug. Scanning the medicines
11. Check the ampule. Make certain ensures that it is accounted
that all of the drug is in the body of
the ampule and not in the stem or
in the system.
neck. Check the neck if it is scored
or not. Use a file to grate the
ampule's neck for easier opening.

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 PREPARING MEDICATION FROM AN
AMPULE Rationale
Procedure

12. Wipe the neck of the ampule with • To cleanse the neck of the ampule
cotton soaked in 70% alcohol.
13. Use a small gauze pad or dry cotton • To protect your fingers from being
ball to hold the ampule when injured
breaking it open or use an ampule
opener if available.
14. Snap neck of the ampule quickly
and firmly away from hands. • Snap away to avoid injury
Discard the sharps in the sharps'
container.

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 PREPARING MEDICATION FROM AN
AMPULE Rationale
Procedure

12. Wipe the neck of the ampule with • To cleanse the neck of the ampule
cotton soaked in 70% alcohol.
13. Use a small gauze pad or dry cotton • To protect your fingers from being
ball to hold the ampule when injured
breaking it open or use an ampule
opener if available.
14. Snap neck of the ampule quickly
and firmly away from hands.
• Snap away to avoid injury
Discard the sharps in the sharps'
container.

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PREPARING MEDICATION FROM AN
AMPULE
Procedure
15. Use syringe with an
aspirating (Filter) needle
to draw the drug from the
ampule either by holding
the ampule upside down,
then withdraw the drug or
setting the ampule on a
flat surface, then
withdraw the drug. Do not
allow needle tip or shaft
to touch the rim of the
ampule. Do not inject air
into the ampule.
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 PREPARING MEDICATION FROM AN
AMPULE
Procedure
15. Use syringe with an aspirating
(Filter) needle to draw the
drug from the ampule either
by holding the ampule upside
down, then withdraw the drug
or setting the ampule on a
flat surface, then withdraw
the drug. Do not allow needle
tip or shaft to touch the rim of
the ampule. Do not inject air
into the ampule.

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 PREPARING MEDICATION FROM AN
AMPULE
Procedure Rationale

16. Recap the syringe using • Recap properly to avoid

fish-hook method. Change needle-prick injury.
the aspirating (Filter)
needle with an injecting
needle. Set aside and
secure the empty ampule
and aspirating needle at
one side of the medication
tray. Do not dispose
empty ampule for the
meantime.
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 PREPARING MEDICATION FROM AN
AMPULE
Procedure Rationale
17. With bevel facing up in line with
syringe calibration, push the
• The ensures no air will be
plunger to fill the needle with the injected.
medication until there is a drop of
medication formed at the tip of the
needle. Recap the needle using the
fish-hook method.
18. Arrange equipment on the • Rechecking drug labels
medication tray. Recheck
medication label and compare it reduces error. This is the
once again with eMAR or
medication ticket. second accuracy check.

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Syringe size

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 IM/SQ MEDICATION ADMINISTRATION
Procedure
19. Prior to performing the procedure,
introduce self and verify the
client’s identity using agency
protocol. Inform the client and the
family of the procedure.
20. Compare names of medication on
lables with medication tickets at
client's bedside. If using the eMA
scan the client's barcode to verify
the administration of medication.
Pick up the due medication and
compare the labels with barcode
on the drug and eMAR.
Rationale
• To establish rapport and
ensure your interacting with
the right client. Inform the cliet of
the procedure to reduce anxiety.
n
• To verify client and medication
being given is correct in order
to reduce error. This is third
R,
accuracy check.
• Scanning the barcode of the client
accounts that the medication is
given to the client.
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 IM/SQ MEDICATION
ADMINISTRATION
Procedure Rationale

23. Educate the client and client's family of
the medication to be given, its purpose,
route of administration, intended effect
and possible side effects.
24. Provide for client privacy. Position
the client appropriately. Obtain
assistance for an uncooperative
client if necessary.
• Information can facilitate
acceptance of and compliance
with the therapy.
• To protect client’s dignity. Proper
positioning will facilitate easier
access.

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 IM/SQ MEDICATION
ADMINISTRATION
Rationale

Procedure • Don gloves to reduce transfer of

microorganism.
• 25. Apply clean gloves as per agency • Injection sites need of be free of
policy or if necessary. Select for an abnormalities that would interfere
with medication absorption.
appropriate skin site and cleanse the skin
at the site using a firm circular motion
starting at the center and widening the
circle outward. Allow the area to dry
thoroughly.

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 IM/SQ MEDICATION
ADMINISTRATION
Procedre Rationale

26. Hold a dry cotton ball or an alcohol

swab between the third and fourth
fingers of your nondominant hand in
readiness for needle withdrawal, or
position the swab on the client’s skin
above the intended site.
27. Grasp the area of the injection site
and hold in cushion fashion or z-track
if necessary.

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64
 IM/SQ MEDICATION
ADMINISTRATION
Procedure Rationale

28. Insert the tip of the needle far enough to • This insertion will facilitate the
place the bevel through the epidermis creation of the wheal or bleb.
into the dermis. The outline of the bevel
should be visible under the skin surface.
29. Stabilize the syringe and needle by
holding the hub of the syringe with the • To avoid injury.
thumb of your non-dominant hand.
30. Inject 0.1cc of the medication
carefully and slowly so that it
produces a small wheal on the skin. • The formation of wheal verifies that
the medication entered the dermis
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Tuberculin Syringe

65
Insulin Syringe

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 IM/SQ MEDICATION
ADMINISTRATION
Procedure •Rationale
31. Withdraw the needle quickly at
the same angle at which it was • Support of tissue around
inserted. Activate the needle injection site minimizes
safety device or recap the syringe
using the fish-hook method. discomfort during needle
withdrawal.
32. Pat dry the area using a dry cotton
ball. Using a black or blue ballpen,
trace the wheal. If using a • Dry cotton ball minimizes
medication ticket, record at the
back of the ticket the site where
discomfort associated with
the skin test was done, the alcohol on nonintact skin.
injection time and time due for
reading.
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 IM/SQ MEDICATION
ADMINISTRATION
Procedure Rationale

33. Instruct the client not to touch or • Massage can disperse the medication
massage the area. The wheal will be into the tissue or out through the
check 30 minutes after to assess needle insertion site.
client's sensitivity to the medication.

34. Assist client to a comfortable position.

35. Do aftercare. Dispose
single-use items properly and perform
hand hygiene.

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 IM/SQ MEDICATION
ADMINISTRATION
Procedure
36. Document the testing
medication given, the
injection time, due time for
assessment and the site at
which the medication was
injected.
Rationale
• Documentation ensures
completeness and accuracy
of rendered nursing care.
Signing for the medication
given denotes that due
meds were given on time to
the right client.
72
 JOSE RIZAL 000873-83636
301 A 12/31/45 75 DR. BONIFACIO

IBURPOFEN, SEAFOOD

3/12
3/12/19 Ampicillin 1g IVTT 6AM
q8 ANST ( )
2PM

10PM

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 3/5 3/6 3/7
3/5/19 Paracetamol 4AM 4AM
500mg/tab
9AM
i N 8AM
for Fever 12NN
12NN

tab PO q4 PR 4PM
7PM
8PM
12MN
12MN

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 - Iara Abad, RN
- Randy Bigcas, RN
- April Tabar, RN

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 IM/SQ MEDICATION
ADMINISTRATION
Procedure Rationale

37. Together with the resident physician, return to • Support of tissue around
the client when the medication is expected to injection site minimizes
take effect (usually 30 minutes) to read the discomfort during needle
skin test.
withdrawal.
If no allergic reaction is noted, inform the client that
the medication will be administered.
However, if any adverse effects or side effects is • Dry cotton ball minimizes
noted, report significant deviations from
normal to the primary care provider and discomfort associated with
document accordingly including the actions alcohol on nonintact skin.
taken.

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 301 3/12/19

Jose P. Rizal

Ampicillin ANST ( )

1 gram IVTT

Every 8 hours

6am – 2pm – 10pm

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 IM/SQ MEDICATION
ADMINISTRATION
Procedure
38. Document if the client had a
positive or negative skin test
result. Follow agency protocol
on labeling of allergies.
•Rationale
• Support of tissue around
injection site minimizes
discomfort during needle
withdrawal.
• Dry cotton ball minimizes
discomfort associated with
alcohol on nonintact skin.
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Before we’ll end; here is a quick view on the safety on needle
injection with the recent innovation of auto-retractable needle syringe, this was
design to cater the call of preventing health care workers from needle
prick injury in which according to World Health Organization, it accounts
to worldwide infection and contamination as a result of a needle
injury.
Click the play video on the next slide. The video that will be shown are 2 types, the
first video is the manual retractable syringe and the second is the auto retractable
syringe. Thank you

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