Anintroductiontothe

principlesandpracticeof
safeandeffective
administrationofinjections
Givinganinjectionsafelyisconsideredtobearoutine
nursingactivity.Howeveritrequiresknowledgeof
anatomyandphysiology,pharmacology,psychology,
communicationskillsandpracticalexpertise.
Todaywewillemphasisetheresearchbasedpractices
thatareknowntoencouragenursestoincorporate
bestpracticeintoaneverydayprocedure.
Introduction
Recognisethefivereasonswhymedicationmaybegivenby
injection(parenteralroute)
IntendedLearningOutcomes
Differentiatebetweenthestructuresinvolvedandusesofthe
intramuscular(IM)andsubcuctaneous(SC)
Outlinefactorsinfluencingchoiceofsyringesandneedles
Outlinesites,basicpreparationandadministrationtechniquesfor
theIMandSCroutes
Recognisetheimportanceofuniversalprecautionswhengiving
injections
Equipment
Route
Site
Technique
Safety
Considerations
Forsecureconnections
EccentricLuerslip
ConcentricLuerslip
LuerLok

Allowsonetogetcloser
totheskin
Forallotherapplications
Equipment
WhatneedleshouldIuseforIMinjections?
21Gor23G
Greenorbluehub
Lengthdependson
patientandsite
Equipment
25gor26g
Orangeorbrown
hub
Lengthdependson
patientandsite
WhatneedleshouldIuseforSCinjections?
Equipment
BluntFilter/FillNeedles
Filteroutsubvisibleparticlesofglass,rubber,
fibreandotherresidues.Theinfusionofthese
particleshasbeenlinkedwith
phlebitis,vascularocclusionandsubsequent
embolism,formationofgranulomasand
septicaemia.
Theyareforusewhenwithdrawingdrugs
fromvialsandglassampoules.
ParticleContamination
Equipment
BluntFill
BluntFilter
Equipment
Rapidactionrequired
Drugalteredbyintestinalsecretions
Drugnotabsorbedbyalimentarytract
Patientcannottakeoraldrug
Drugunavailableinoralform
ReasonsforGivingMedicationbyInjection
Injections
PreparationofPatient
Promotecomfortandrelaxation
Explainreasonforinjection
Describetheprocedure/obtaininformedconsent
Checkforanyallergies/historyofanaphylaxis
Checkprescription/drug/patientidentify
Checkexpirydatesandrecordlotnumbers
Avoidoverexposureofpatient
Positioningofpatient
Selectsite
Selectcorrectneedlelengthandsyringe
Washhandsandapplygloves
Prepareinjectionsusingaseptictechnique
ProcedureforInjections
Injections
Checkpatientidentity
Skinpreparation(localpolicy)
Injectslowlyandremoveneedle
Documentprocedure
Reviewtheindividualasappropriate
ProcedureforInjections
Injections
PreparationofskinpriortoInjections
Littleevidencetosupporttheneedfordisinfection
oftheskinpriortosubcutaneousorintramuscular
injection
Ifsoiled,however,skinshouldbecleanedbysoap
andwaterorcanbedisinfectedbyanalcoholswab
(ifalcoholswabhasbeenusedallowthealcoholto
evaporatebeforeinjecting)
Refertolocalpolicy
Injections
Howmanysitescanbeusedtogivean
I.M.injection?
1)TheDeltoid.
2)TheVentroglutealsite.
3)TheDorsogluteal
4)TheVastusLateralis.
IntramuscularRoute
Injections
VastusLateralis
Deltoid
Dorsogluteal
Ventrogluteal
SitesforIMInjections
Injections
Traditionallynurses
weretoldtodivide
thebuttocksinto
fourquadrants
INJECTINTO
THEUPPER
OUTER
QUADRANT
Injections
Clinicalstudy Cockshott,etal.NewEngl.JMed,307(1982)
dorsoglutealinjectionsin213adults
1inch(or38mm)21ggreenneedle
localisationusingCTscans
Conclusions
Only5%ofwomen
Only15%ofmen
actuallyreceivedIMinjections,allotherinjectionswentinto
subcutaneoustissue
IntramuscularInjection
Variabilityinsubcutaneoustissuethickness
Injections
MRIcloseupscanofthebuttocks
Thedistancefrom
skintomusclein
thispatient(line
marked1)is42mm
Aninjectiongiven
witha38mm
(11/2)needle
stayedinthefatty
SCtissue
IntramuscularInjections
Injections
TheDoubleCross
Dividethebuttockwithanimaginarycross
THENdividetheupperouterquadrantby
anotherimaginarycross
Injectintotheupperouterquadrantofthe
upperouterquadrant
ARecentAdaptationofthisApproach
Injections
Injections
TheDoubleCross
TheDoubleCross
Injections
TheDoubleCross
Injections
VastusLateralis
Bunchupinelderly,
emaciatedorinfants
Dividethighinto
thirds,injectinto
bottomoftop1/3
IntramuscularInjections
Injections
Deltoid
IdentifytheGreater
Tuberosity
Move5cms(12inches)
belowthesite
Rotatearmtoconfirmsite
IntramuscularInjections
Injections
ZtrackingProcedure
Pullskin
tautthen
Insert
needle
Removeneedle
andrelease
skin
IntramuscularInjections
Injections
ZtrackingProcedure
Pullskintaut
Keepingskintautwithheelofhandinsertneedleata90%angle
Aspirateplungerover510secondsnotinganyblood
Ifclearinject1mlevery10seconds
Wait10secondsbeforeremovingneedle(Beyea&Nicoll1995)
Keepskintautuntilneedleremoved
Dontmassagethesite
Checkpatientandsite(30minutes)
IntramuscularInjections
Injections
ZtrackingProcedure
Pullskin
tautthen
Insert
needle
Removeneedle
andrelease
skin
IntramuscularInjections
Injections
Recommendedmedicationvolumesper
musclesite
Ventrogluteal Upto4mlinawelldevelopedmuscle
Upto2mlinlessdevelopedmuscle
Vastuslateralis Upto4mlinawelldevelopedmuscle
Upto2mlinlessdevelopedmuscle
Deltoid Upto1mlinawelldevelopedmuscle
Upto0.5mlinlessdevelopedmuscle
Injections
SubcutaneousRoute
Injections
SpeedofAbsorptioninInjectionSites
Injections
Liftskinfold
Punctureskinat90degrees
Donotaspirate
Injectslowlyandremoveneedle
Releaseliftedskinfold
ProcedureforSubcutaneousInjections
Injections
Abdomen
Thigh
Scan:ThinPatient
Injectionsperformed
withan8mmneedle,
Withoutaliftedskin
fold(left)
Withaliftedskinfold
(right)
Injections
Noliftedskinfold Liftedskinfold
Injections
Correctlyliftedskinfold IncorrectlyLiftedskinfold
Injections
PotentialComplications
Infection
Incorrectlocationofinjectate
Pain
Anaphylaxis
Injections
PotentialComplications
Longandshorttermnervedamage
Intramuscularhaemorrhage
Hittingabloodvessel
Sterileabscess
Lipodystrophy
Injections
Understandthelegal&professionalresponsibilities
whenadministeringaninjection.
LegalandProfessional
Traininganddirectsupervisionwithmentor
CarryoutprocedureinaccordancewithTrustpolicy
Developcompetence
Practiceyourskillregularly
Donotproceedunlessconfident
Documentation
LegalandProfessional
Whogetsinjured?
35%areNursingStaff
Wheredoestheinjuryoccur?
37%inthepatientsroom/ward
Wasthesharpcontaminated?
78%Yes
36%NSIoccurduringuse
19%NSIoccurduringaninjection
(intramuscular/subcutaneous)
EPINet
TM
dataforNeedlesandSyringes2003
SafetyIssues
IfIamstuckwithaninfectedneedle
whatistherisk?
HBV 1in3
HCV 1in30
HIV 1in300
Safety
Costtopractitioner
Immeasurablestress
Lifestylechanges
Possibleprematuredeath
Costtoemployer
Coveringsickness
Treatmentcosts
Litigation
Recruitmentandretentionofstaff
Safety
TheNationalAuditOffice(NAO2003)
Thereportstatedneedlestickandsharpsinjuriesaccounted
for17%ofaccidentstoNHSstaffandwerethesecondmost
commoncauseofinjury,behindmovingandhandlingat18%.
AtleastfourUKHCWsareknowntohavediedfollowing
occupationallyacquiredHIVinfection
Since1996,theHPAhasreceivedreportsofnineHCWswho
havebeeninfectedwithHCVbecauseofoccupational
exposure
With40,000reportedincidentsayearandatleastasmany
unreported,needlesticksandsharpsinjuriesareasignificant
issue.
Themanagementofhealth,safetyandwelfareissuesforNHSstaffNewedition2005
Safety
StandardPrecautions
Skin
Cutsorabrasionsinanyareaofexposedskinshouldbecovered.
Gloves
Wellfittingcleanglovesmustbewornduringprocedureswheretheremaybe
contaminationofhandsbyblood/bodyfluids.
HandWashing
Theuseofglovesdoesnotprecludetheneedforthoroughhandwashingbetween
procedures.
Aprons
Wherethereisapossibilityofbloodspillage.
EyeProtection
Wherethereisadangerofflyingbloodsplashes.
SharpsContainer
Needlesarenottoberesheathedpriortodisposalintoapprovedsharpscontainer.
Safety
SAFEDISPOSALOFSHARPS
Immediatelyafteruse
Neverresheathorbendneedles
Ifpossible,disposeofneedleandsyringeasa
singleunit
Dontoverfillsharpsboxes
Reportanyaccidents/incidentsinaccordance
withyourlocalhospitalpolicy
Safety
ManagementofNeedlestick
injury
Bleedwoundunderrunningwater
Washwithsoapandwater
AttendOccupationalHealthdeptassessriskand
takeappropriateaction
Identifysourceofcontaminationegpatientdetails
DocumentandReportincident