Different routes of injections and their procedure techniques

1. Injections
Mr. Mahesh Chand
Nursing Tutor
MTIN

2. What is an injection?
Injections are sterile solutions,
emulsions or suspensions.
They are prepared by dissolving,
emulsifying or suspending an active
ingredient and any other substances in
water for injection.
Injecting is the act of giving medication
by use of syringe and needle to obtain
the desired therapeutic effect taking into
account the patients safety and comfort

3. Types of Injections
Parenteral medication: administration of amedication
by injection into bodytissues
Subcutaneous (SC) – into tissue below dermis ofskin
Intramuscular (IM) – into the bodymuscle
Intravenous (IV) – into avein
Intradermal (ID)– into thedermis just underthe
epidermis

4. Purposes of Injection
To get rapid and systematic effect of the drug.
To provide the needed effect even when the
client is unconscious.
Assure that the total dosage will be
administered and the same will be absorbed
for the systemic actions of the drug.
To obtain a local effect at the sight of
injection e.g. xylocaine, tuberculin test.
To restore blood volume by replacing the
fluids.
To give nourishment when it can’t be taken by
mouth.

5. Syringes
 Three main parts:
– Barrel – chamber that holds
themedication
– Plunger – part within the
barrel thatmoves back and
forth to withdraw and instill
medication
– Tip – part that the needle is
attached to

7. Which is which needle?
The correct needle is the key to delivering the drug to
the correct area for the maximum effect with the least
amount of discomfort
The colour at the top of the needle reflects its size
the higher the number the smaller the lumen(bore).

10. Equipment for the administration of injections
 Clean tray in which to place drug and equipment
 Needle to ease reconstitution and drawing up
 Syringe of appropriate size
 Swabs saturated with isopropyl alcohol 70%
 Sterile topical swab if drug is presented in ampoule form
Drug to be administered
 Patients prescription to check dose, route and timing
 Notes available to record administration in accordance with law
 Gloves, Apron

11. Clinical room preparation for the administration
of injections
Protocols/procedure/standards information is
available.
Hand basin for washing hands and/or alcohol
hand rub.
Area for the client to lie down.
Panic button/phone to call for assistance
Gloves
Resuscitation /anaphylaxis equipment/drugs
Oxygen and appropriate mask if available
adequate time for procedure

12. Asepsis and reducing the risk of infection
Good hand washing
Good hand drying
Aseptic technique
Good observation and questioning
of the client
Skin preparation if required

13. The 7 Rights of Drug Administration
 Rightclient
 Right medication
 Rightdose
 Right route
 Right time
 Right reason
 Rightdocumentation

14. IV Medication
Ampul
es
Vials

15. Drawing Up Medication
From an Ampules
 Wash hands and
gather
equipment.
 Grasp the stem
with an alcohol
swab

16. Continue Drawing Up
Medication
From an Ampules
 Snap off the
ampoule’s neck
away from the
hands and face

17. Continue Drawing Up
Medication
From an Ampules
 Uncap the needle
and insert the
needle into the
ampule. Avoid
touching the rim
with the needle.

18. Continue Drawing Up
Medication
From an Ampules
 Invert the ampule,
insert the needle
into the solution
and aspirate.

19. Continue Drawing Up
Medication
From an Ampules
 Remove the needle
cap and draw an
amount of air into
the syringe that is
equal to the amount
of medication that
will be withdrawn
from the vial

20. Drawing Up Medication From a Vial
 Insert the needle
keeping it above the
solution

21. Continue Drawing Up
Medication
From a Vial
 Invert the vial at eye
level

22. Continue Drawing Up
Medication
From a Vial
 Hold the needle
upright and re-
check the
syringe’s contents
for presence of air

24. INTRADERMAL INJECTIONS

25. INTRADERMAL INJECTION
It is the introduction via needle of tiny amounts of
fluid into layers of skin.
It provides a local, rather than systemic effect.
Syringe used is 1ml tuberculin syringe because ofa
very small amount of drug needed.
Needle used is a short (1/4 to 5/8 inch), fine gauge
(g25-27).
Indications:
For diagnostic purposes (allergies and sensitivities
to drugs)
For administering tuberculin testing

26. INTRADERMAL INJECTION
Intradermal literally means “between
the skin layers” and injection is
administered just under the
epidermis .
Syringe is positioned at15˚ angle.
Small volumes, usually 0.01 to
0.05ml, are injected because of the
small tissue space.

27. INTRADERMAL INJECTION
Most commonly used site: Inner surface of
the forearm
Subscapular region of the back can be used as
well as deltoid region.

28. INTRADERMAL INJECTION
REMEMBER:
Mixture of drug and water for skin testing: 0.9cc of
distilled water/sterile water and 0.1cc of the drug.
Inject the solution intradermally and just enough to
form a wheal.
Encircle the site correctly and write the time when to
check the injection site to determine reaction to the
drug.
Check the site after 30 minutes for signs of reaction.
If negative, document it as ANST(After Negative
Skin test)(-); if positive, ANST (+)

29. INTRADERMAL INJECTION
REMEMBER:
A positive result may be manifested by any of the
following:
Reddening of the site accompanied with marked
elevation
Increase in circumference of the wheal
Presence of itchiness on the site

30. PROCEDURE
Prepare all the equipment needed: 1cc syringe,
disposable needle (aspirating needle), sterile water,
drug to be tested, wet and dry cotton balls and
ballpen.
Wash hands and observe appropriate infection
control measures.
Introduce yourself and verify the client’s identity.
Explain to the client what you are going to do, why it
is necessary and how the client can cooperate.
Prepare needed materials aseptically.
Check the label of the drug three times.

31. PROCEDURE
Prepare the medication to be used for skin testing
(e.g ampule or vial)
Aspirate 0.9cc of distilled water/sterile water and
0.1cc of the drug using the tuberculin syringe with the
aspirating needle.
Mix the drug and the distilled water in the syringe.
Replace the aspirating needle with g25 needle.
Expel excess air.
Place the syringe on the tray together with the wet
and dry cotton balls.

32. PROCEDURE
Confirm again patient’s identity.
Locate the appropriate site for skin testing.
Cleanse the medial surface of the forearm by using
firm, circular motion from inner to outer portion.
Allow the skin to dry before injecting the drug.
Place hand in non-dominant hand of the patient.
Remove needle cap and holds syringe at 15 degree
angle from skin with bevel up.
Stretch the skin and tell the patient that he/she will
feel a prick as needle is inserted.

33. PROCEDURE
Inject the solution intradermally and
just enough to form a wheal.
Remove the needle quickly but
gently at the same angle used for
injection.
Wipe with dry cotton ball but do not
press the injection site.
Encircle the site correctly and write
the time when to check the injection
site to determine reaction to the
drug. Check the site after 30
minutes.

34. Subcutaneous
injection

35. Insulin is the mostimportant
drug in the subcutaneous
injections

36. SUBCUTANEOUS INJECTION
s
Subcutaneous tissue lies between the epidermis and
the muscle.
Subcutaneous route is used for slow, sustained
absorption of medication.
SC or SQ
Indications:
Used commonly for insulin injection
Heparin

37. SUBCUTANEOUS INJECTION
Common sites used for SQ
route:
• Outer aspect of the upper
arm
• Abdomen(from below
the costal margin to the
iliac crests)
• Anterior aspects of the thigh
• Upper back
• Upper ventral or
dorsogluteal area

38. SUBCUTANEOUS INJECTION
REMEMBER:
syringe in the dominantHold
hand between the thumb and
forefinger.
Inject the needle quickly at an
angle of
depending
45 to 90 degree,
on the amount and
turgor of the tissue and the length
of the needle.

39. Insulin
Indications
Type I diabetes mellitus, type II diabetes mellitus, hyperkalemia,
DKA/diabeticcoma
MOA
Stimulating peripheral glucose uptake and inhibitinghepatic
glucoseproduction
PatientInfo
 Hypoglycemia (BG < 70 mg/dL) esp with higherdoses
– Anxiety, blurred vision, palpitations, shakiness,slurred
speech, sweating
 Weightgain
Insulin
Indications
Type I diabetes mellitus, type II diabetesmellitus,
hyperkalemia, DKA/
MOA
Stimulating peripheral glucose uptake and inhibiting
hepatic glucoseproduction
Patient Info
 Hypoglycemia (BG < 70 mg/dL) esp with higherdoses
– Anxiety, blurred vision, palpitations, shakiness,slurred
speech, sweating

40. Insulin (cont)
Administration:
Subcutaneous injection
Rotate site
Check blood sugarsregularly
Storage:
 Refrigerate until use
 Once vial is punctured, it is good for 28 days
and can be left at room temperature (except
for glargine which is 90days)

41. Insulin Dosing
Normal insulin secretion
Long-acting
Long-acting &
Short-acting
70/30
pre-mixed

42. Insulin (cont)
Cautions/Severe Adverse Reactions
 Severe hypoglycemia (seizure/coma) (BG < 40
mg/dL)
 Edema
CONTRAINDICATIONS
 Severe hypoglycemia
 Allergy orsensitivity toany ingredientof the
product

43. INTRAMUSCULAR
INJECTION

44. INTRAMUSCULAR INJECTION

45. SITES ACCEPTABLE FOR IM INJECTION

46. Deltoid



Palpate lower edge of
acromion process.
Place 4 fingers across
the deltoid muscle with
the top finger along the
acromion process. This
forms the base of a
triangle.
Draw an imaginary line at
the axilla. This forms the
apex of the triangle.

Injection site is the
center of the triangle,
3 finger widths (1-2
inches) below the
acromion process.

47. DELTOID MUSCLE

48. GLUTEUS MAXIMUS



Locate the posterior iliac
spine.
Locate the greater
trochanter.
Draw an imaginary line
between these two
landmarks.
 Injection site is above and
lateral to the line.
 Most dangerous site
because of sciatic nerve
location

50. GLUTEUS MEDIUS
 Palm of hand on greater
trochanter of femur.
 Index finger on anterior
superior iliac spine (hip
bone).
 Middle finger extended
toward iliac tubercle.
 Injection site lies within
the triangle formed by the
index and middle fingers

52. Vastus Lateralis
 One hand above the knee.
 One hand below the greater
trochanter.
 Locate midline of anterior
thigh and midline of lateral
thigh.
 Injection site is the lateral
area of the thigh

53. Institute of Nursing Theory and Practice, Prague
2007
VASTUS LATERALIS

54. INTRAMUSCULAR INJECTION
REMEMBER:
3cc syringe can be used for IIM
injection with g22 or 23 needle; 1-2
inches long.
Position the needle at 90˚ angle.
Do not forget to aspirate the plunger
once injected to check for blood. (To
determine if a blood vessel was hit)
Inject medication slowly (To minimize
pain)

55. INTRAMUSCULAR INJECTION
REMEMBER:
Apply pressure to site and
massage after (To prevent
hematoma and prevent
oozing of blood and for
proper absorption of the
medicine.

56. PROCEDURE
Prepare needed materials aseptically.
Check the label of the drug three times.
Prepare the medication.
Position the patient and locate the site correctly.
Cleanse the site using circular motion from inner to
outer portion and allow it to dry.
Place a swab between fingers of non-dominant hand.
Pinch or spread tissue and insert needle quickly at 90
degrees angle in a dartlike position.

57. PROCEDURE
Pull back the plunger to check for blood.
Inject the medication slowly if no blood appears.
Withdraw needle quickly.
Apply pressure and dry cotton ball to the site and
massage.
Leave the client in a comfortable position.
Dispose the syringe and other materials used
properly, wash hands and document the procedure.

58. Z-track IM Administration
 Method used with
irritating medications.
E.g. Iron
 Used to “trap”
medication in muscle
and prevent “tracking”
of solution through
tissues.

60. Z-track IM Administration
 Prepare medication
 Change needle after drawing up med
 Gather supplies
 Identify site
 Do gloves
 Cleanse site with alcohol
 Displace skin laterally 1-1 ½ inches from
injection site
 While holding skin, insert needle with a
darting motion, at a 90° angle.

61. Z-track IM Administration
 Stabilize needle with thumb and forefinger.
 Aspirate.
 If no blood, then inject medication slowly and steady
 Wait 10 seconds
 Quickly withdrawal needle Then
release skin
 Cover site with swab and DO NOT
MASSAGE
 DO NOT RECAP. Activate safety feature. Place needle
in sharps container uncapped
 Remove gloves