1.InjectionsDone by : Mohammed A Qazzaz

2. Routes of Medication AdministrationParenteral medication: administration of a medication by injection into body tissues Subcutaneous (SC) into tissue below dermis of skin Intramuscular (IM) into the body muscle Intravenous (IV) into a vein Intradermal (ID) into the dermis just under theepidermis 3. What is an injection?Injections are sterile solutions,emulsions or suspensions.They are prepared by dissolving,emulsifying or suspending an activeingredient and any other substances inwater for injection.Injecting is the act of giving medicationby use of syringe and needle to obtainthe desired therapeutic effect taking intoaccount the patients safety and comfort 4. How are drugs for injections presented?Single dose preparationsa pre - prepared volume of measured drug, in asyringe for single dose usei.e. Flu vaccines, Pneumovax and B12.Multidose preparationsmulti-dose preparations contain aantimicrobiacteral preservative, are used onmore than the one occasion and great care isrequired for its administration but especially itsstorage between successive withdrawalsi.e Insulin 5. Why give drugs in injection formInjections usually allow rapid absorptionCan produce blood levels comparable to thoseof intravenous bolus injectionsInjections can be given from 1ml and up to 2mils in the Deltoid and up to 3 mls in thegluteal muscle in adultsDrugs that are altered or not absorbed byother methods of administration 6. Needle length and sizeFor intramuscular injections e.g flu, pneumoniaand B12, the needle should be long enough topenetrate the muscle and still allow a quarter ofthe needle to remain external to the skinWhen choosing the needle it is important toassess the amount of muscle, subcutaneous fatand weight of the patient - which in the majorityof cases will be a blue needle 7. Syringes Three main parts: Barrel chamber that holds the medication Plunger part within the barrel that moves backand forth to withdraw and instill medication Tip part that the needle is attached to Calibration: Syringe sizes from 1 ml to 50 ml Measure to a 1/10th or 1/100th depending oncalibration 8. Needles Shaft of the needle Length chosen depends on the depth towhich medication will be instilled Tip of shaft is beveled or slanted to piercethe skin more easily Gauge: width ofthe needle (18 27 gauge) a smaller number indicates a larger diameter and larger lumen inside the needle 9. Considerations when choosing a syringe andneedle Type of medication Depth of tissue penetration required Volume of medication Viscosity of medication Size of the client 10. Which is which needle?The correct needle is the key to delivering the drug tothe correct area for the maximum effect with the leastamount of discomfortThe colour at the top of the needle reflects its sizethe higher the number the smaller the lumen (bore)Orange needles = 25 gauge = 10mm long (3/8 inch)or 16mm long(5/8 inch) or 25mm long (1 inch)Blue needles = 23 gauge = 25mm long 9 (1 inch)Green needles = 21 gauge = 38mm long (1.5 inches) 11. Equipment for the administration of injectionsClean tray or receiver in which to place drug and equipment21g needle to ease reconstitution and drawing up (23g if from a glassampouleSyringe of appropriate sizeSwabs saturated with isopropyl alcohol 70%Sterile topical swab if drug is presented in ampoule formDrug to be administeredPatients prescription to check dose, route and timingNotes available to record administration in accordance with lawGloves, Apron 12. Clinical room preparation for the administrationof injectionsProtocols/procedure/standards information isavailableHand basin for washing hands and/or alcoholhand rub.Area for the client to lie down if unwellPanic button/phone to call for assistancesharps containerGlovesResuscitation /anaphylaxis equipment/drugsOxygen and appropriate mask if availableadequate time for procedure 13. Asepsis and reducing the risk of infectionGood hand washingGood hand dryingAseptic techniqueGood observation and questioningof the clientSkin preparation if required 14. The 7 Rights of Drug Administration Right client Right medication Right dose Right route Right time Right reason Right documentation 15. INTRADERMAL INJECTIONS 16. INTRADERMAL INJECTIONS Most often used for PPD Site: the inner aspect of the forearm Needle size is 25 - 27 gauge, 1/2 to 5/8 inch Insert needle at 15o angle Injection made just below the outer layer of skin If injection does not form a wheal or if bleeding isnoted, the injection was probably too deep andshould be repeated 17. INTRADERMAL INJECTIONS Review the providers order for accuracy Ask the patient/parent if the patient is allergic to themedication Wash your hands and gather supplies, equipment Select proper needle size, length and gauge 18. INTRADERMAL INJECTIONS 6 Rights of medication administration Check the expiration date of the medication Check for discoloration etc., discard if questionable 19. INTRADERMAL INJECTIONS Explain procedure to patient/parent Ask for assistance with children Position patient appropriately Prepare injection site with alcohol - air dry Support skin with thumb With bevel up, completely insert bevel at a 15 o angle 20. INTRADERMAL INJECTIONS Inject medication gently, place a cotton ball over thesite after needle removal A visual wheal will be produced at the site Dispose of needle as per policy Wash hands Document procedure and patients response 21. INTRADERMAL INJECTIONSCorrect TechniqueIncorrect TechniqueTip of needle can be seenLittle resistance and a directly beneath theshallow bulge surface of the skin Needle inserted tooResistance should be felt deep when medication is - will cause an injectedindurationTense white wheal 5-10that is difficult to measure mm in diameter appears at the point of the needle and interpret 22. Subcutaneousinjection 23. Insulin is the most importantdrug in the subcutaneousinjections 24. InsulinInsulinIndicationsType I diabetes mellitus, type II diabetes mellitus, Indicationshyperkalemia, DKA/diabetic coma Type I diabetes mellitus, type II diabetes mellitus, hyperkalemia, DKA/diabetic comaMOAStimulating peripheral glucose uptake and inhibitingMOAhepatic glucose production uptake and inhibiting hepaticStimulating peripheral glucoseglucose productionPatient InfoPatient Info Hypoglycemia (BG < 70 mg/dL) esp with higher doses Hypoglycemia (BG < 70 mg/dL) esp with higher doses Anxiety, blurred vision, palpitations, shakiness, slurred Anxiety, blurred vision, palpitations, shakiness, slurred speech, sweating speech, sweating Weight gain Weight gain 25. Where does it work? 26. Insulin (cont)Administration: Subcutaneous injection Rotate site Check blood sugars regularlyStorage: Refrigerate until use Once vial is punctured, it is good for 28 daysand can be left at room temperature (exceptfor glargine which is 90 days) 27. Insulin (cont)Dosing: Starting daily dose: 0.5-1 unit/kg/day in divided doses Adjust according to fasting (premeal) blood glucose of 80-130 mg/dL and peak postprandial blood glucose < 180 mg/dL Provide 50% as long acting insulin and 50% as prandial insulin 1 unit of can account for 30 grams of carbohydrate (14-50) 1 unit can lower 50 mg/dL blood glucose (10-100)Special Population Consderations: Renal dysfunction CrCl 10-50 mL/min: 75% of normal dose CrCl < 10 ml/min: 25-50% of normal dose; monitor closely Exercise??? ---- Acute Stress??? 28. Insulin Action Rapid/immediate Intermediate Blood concentration Fast Slow 0 2 4 68 10 12 14 16 18 20 22 24 Time (hr) 29. Insulin DosingLong-actingLong-acting &Short-acting Normal insulin secretion 70/30 pre-mixed 30. Insulin Administration 31. Insulin (cont)Cautions/Severe Adverse Reactions Severe hypoglycemia (seizure/coma) (BG < 40mg/dL) Edema Lipoatrophy or lipohypertropy at injection siteCONTRAINDICATIONS Severe hypoglycemia Allergy or sensitivity to any ingredient ofthe product 32. SUBCUTANEOUS INJECTION 33. INTRAMUSCULAR INJECTION 34. INTRAMUSCULAR INJECTION 35. IM INJECTION SITESDeltoid DorsoglutealVentrogluteal Vastus lateralis 36. DELTOID MUSCLE 37. GLUTEUS MAXIMUS 38. GLUTEUS MEDIUS 39. VASTUS LATERALIS Institute of Nursing Theory and Practice, Prague 2007 40. Intramuscular Injections and PainThe needleThe techniqueThe speed of the injectionThe solution and composition of the drugThe volume of the drugThe approach and attitude of personadministering the injection