FP Route of Administration of Injection Route of ‘Size of Sheot ‘Administration Needle Syringe T Tatra domed 26 or 27 gauge diameter and_| Til calibrated in O01 mal uals 3/810 578 of inch length | (Tuberoulin syringe) = “eee args 2 Subeutneous 25 gauge and 410 578 inch | Tralealibrated 40 or 80 unity we - ee Statens (212 gage Te Tah Tal alba CTT inength S S- seq. 7 niavenous TETODT gauge ‘Size depends onthe amount oF 02 ech {uid tobe injected ze ieee ‘The syringe chosen must be marked and calibrated propely. Thi ‘In selecting the needle ~ criteria tobe observed areas Peles, +The bevel shoutd be sharp and without hooks, * Appropriate size ofthe needle # Needle should ft tightly tothe syringe + Needle length appropriate to the site 'smay help the nurse to measure dosage accurately,Chater Uni 2: Adnan of Medicine 98 Sites for giving injections © Intra-muscutar injection, Deltotd muscle: The nurse {1702 inches) below he ass Nove de he scronion pos sf njrston site fs Shout 2.5 to S om ‘cromion process. ion process, The lc the site by placing three fingers across the (Photographs) and Figure 8.2.6(¢) Figure 8.2.6(c): Sito of deltoid muscle injection below acromian process Ventrogluteal muscle: The Ventroglteal muscle involves the gluteus medius and minimus. The nurse locates the aad he nating her had over the greater wochanter ofthe pals Hes Testo "ght hand is used for the left hip and the left hand is used forthe right hip. Place the index finger oves evant superior iliae spine and extend the ‘iddle finger slong the iliac crust towards the buttock. Index finger sade finger and iliac crest form a ‘V"- Shaped triangle andthe injection site is its centre, Figures 82.7(a) 82.76)) (Photographs) and Figure 8.2.7(c) Figure 8.2.7(c); Anatomical view of ventrogluteal muscle injection site. 368ss, Chapter 8: Pharmacology and Drag Therm ‘+ Dorso gluteal: It isa traditional site for UM injection, The dorso gluteal site is loa he upper cuter quadrant of the butock, Approximately §— 8 cm (2-3 inches) below the tae sew ta patient Sidhe re pai inside ying position with the upper eg flexed at the hip an the knee To eat sido. the nurse palpats the posterior superior iliac spine and the greater trochanter of the fem, Aen ‘imaginary ine ‘am between the two landmarks. The sciatic nerve runs parallel and below the line (Figure 828 ree ution ste is above and lateral othe line. This site of giving injection is used for adulls and stren (above three years) with well developed gluteal muscles, ted in the inner, outer angle of ‘An accidental introduction of the needle into the sciatic nerve leg. ‘The main blood vessels and bone are also near tissue, the site is ean cause permanent paralys the site, If the patient is abby and ha ier er our cane Siegen alan ‘ctor Figure 8.2.8(a) : Anatomical view ofthe site of injection into the left dorsogluteal muscle, ‘+ Vastus lateralis; This muscle is thick and well deve children. The muscle is located on the ant the greater trochanter of the femur to 4-5 the injection, The nurse ask: Figure 82.9) oped and is preferred for giving injection to adults, infants and ‘ior, Jteral aspect of thigh and extends in adults from 4-5 fingers below’ ingers above the knee, The middle part ofthe musel i the beat oe Py the patent to lie at with knee slightly fixed or ina siting positon terelox an, ‘muscle ‘ Latera femora conde Figure : 8.2.9: Anatomical view ofthe site for IM injection Into the vastus lateralis muscle. 369(Subcutaneous Injection Ss ihe cone U8 nttion inde vasa rea rund the ost ses ofthe upper athe Sail he site atin Of iliac crest andthe anterior aspect of the thigh. These areas a7 csi seca Fig. 82.10) ‘The site most frequently preferred for Heparin inject "i the oe ‘Outer sites include te rrp sees of in upper or dorsal gluteal areas, The injection sit chosen shouldbe fre of Should be instructed trees cy SONY Prominence and large underlying mascls rad nents, The patent of diabetes Site should be used fon ce (he injection ste regularly to prevent infecion ‘or hypertrophy (thickening). No injection site should be used for more than six to seven weeks ‘The nurse should choose the needle length and the 25-gauge 5-8") nese is inserted at aScdege ae needle long enough to insert through the a site for subcutaneous injection igel of insertion based on the patient's weight. More commonly the patient is obese the nurse pinches the tissue and uses a ity tissu¢ jase of skin fold. For a very weaker and thin patient, the best (supper abdomen, Figure 8.2.10: Common sites for SQ injections. Note how sites might be rotated. eri Fig, 82.11) d : (Gi) Intra-Dermal injection (ie Bey for skin testing (tuberculin screeing and allege tes), ‘The medicines ae Jnte-dermal injection oe Sfood supply is reduced and drug absorption occurs slow nra-dermal sits shuld be inetd no ee of lesions and relive bles. The ner Fr arm and upper back ae the eal loans lightly , a0(Chapter 8: Pharmacology and Drag Therapy ‘The nurse uses a hypodermic syringe or a tuberculin syringe for skin testing, The angle of insertion is 515 depress. As the nurse injects ma drug a small bleb like a mosquito bite should appear on the skin site, If the small ble SHOT visible after withdrawing the needle it indicates the medication has entered the subcutaneous tissue, ‘gure 8.2.11 : Body sites commonly used for intradermal injections, 2.9.9 General Instructions to be kept in mind * Injection should be given after doctor's prescription, Sit aseptic technique to be followed inthe sterilization of equipment, inthe preparation of medication, in the administration of injections, Syringes and needles used for injections shouldbe kept separately from those which are used for other purposes. Syringes should be airtight. ‘A nneedle should be sharp and patent Chung the needle ater withdrawing the medicine from the rubber stopper container, before siving injection to the patient. Observe five rights of administration of medicines, 4 Never use a drug whose expiry dat is over ‘Aivays make the patient relaxed and give him a comfortable poston while giving injection, AlNGYs give atest dose before administration of ll ypes of serum, and certain antibiotics suchas penicillin et. to rule out an allergic reaction Never inject any air while giving injection, ‘Select the appropriate site, “ Rotate the site of injection to prevent tissue fibrosis Use the correct technique forgiving injection, ‘Aer injecting always withdraw the needle to make sure tat tis notin a blood vessel in ease of intra-muscular Fre ar aangous injections. If there isthe presence of blood in the syringe withdraw he ene and select another site forthe inj Massage the ara atthe ste of injection except in case ofan inte-dermal injection ly after it ig administrated by the nurse. fe am2.9.13, Procedure for parenteral injection / infusion “0 Preparation ofa ticles Name of article Rationale Aitray containing: |, Sterile syringes and needles of various sizes. Tolar cra vole of das depending ne oto administration, 2, Transferring fore eps 0 an antseplic lotion. “To handle sterile bwabs, container. 7. Sietle cotton swabs /giuze pieces ina sere "To clean the ste before giving injection “A bowl with water and an antiseptic solution. Tring the glass syringes, needles and vo put the dspostble syringes. 36(Chapter: Pharmecloy ond ug Therapy 5 See water for jen To dave powder orm of ru © Brig ordre To air drag oe pl 7 Amputee “To et ope ie ample and open he vi © nied tere, mall covered ayy To any te propared medias wo the 7 9-A puncture proof container To diopose of te ponte necls. 10. A Rdney ay anda paper bag “To opss of wed swabs, ampules ad val ThA macht anda rowed “To poet he bed incase OFT pe heen oe “To prepare ke vein n ease OFT enon, 13. Adhesive plaster and scisiom To secure the needle in ease TV injection fst be repeated. Gi). Steps of procedure: ‘Steps of Procedure Rationale ‘Seientif Naring Principles Principles T. Wash hands “To reduce wansmisson oF Microbiology | Safeiy infection. 2 Check each medication card wih he | To ensure thata ight drug dosage Safely dag, is prepared, ‘3 Preparation of medicine from ampoule (Figure 8.2.16) Photograph 1-6 ‘+ Taptop of the ampule lightly and | Dislodgethe uid that collects | Physics Beonomy of ‘quickly with fingers uni fi leaves | above the neck so that all material the neck. ‘medicines move into the lower chamber. * Place small gauze piece orswab | Protects the fingers ofthe nurse | Anatomy Saley against the neck ofthe ampoule. from trauma *+ File the neck of he ampule and snap _ | Prevents shalting of glass toward | Anatomy Safety the neck quickly and firmly away ffom | the nutse or into the ampoule hands + _ Ise he syringe node ito thecenre | Oi ofthe rin ofthe ampule | Micebiolony | satay, ‘ofthe ampoule. (Do not et the needle | is usterile Eee a Sp oration of ample) : etetveness ‘+ Aspirate the medicines from the Withdrawal of piston ereatesa | Physics Beonomy of ampoule by pulling back the piston | negative pressure and bel inthe material senly. sspiration of medicine int the singe. ‘+ Mair bubbles ae aspirated, donot | Aiepessré wl force the uid expel iin ke apo: cut of he amp and te oe oe sedi wll be lost, + Tocspaltheexcesofaizbubbes, | Holding the ying verically wit | Phys remove the needle fom he ampoule | makethemedcoecome arr | PSS Thee and hold i pointing upward, and si upward and expel the air elfetreness | by pushing back the piston upwardChapter Unt 2: Admintaration of Mecine * Change the needi i . ‘Safety Cran + To gvean ijeciontothe | Misabalogy | Sateiy | sings inne baton witha serie wedi, + Toconol the nsnson oF infection 4. Preparation of medicine Fam Va (eure8.2.19 Photogspnev any *Repore heme ap covrng ts | To expt te bbe se Micrbit satay vial with fle. Wipe of the surtnc of ‘Remove dust and prevent cf ‘he vial witha spitawas ston * TRG bags and withdraw he amount | Toditlve the medicine Chemie Therapeutic Stuer edna ae . efetveness tine (e§ mediin isin poder fem) opal sel adptack | To ete wiht | pen Safety thepisonto daw an amountofsir | medicine fore, Ezonomy of into the syringe equivalent to the ‘helps to prevent building up of material Tete ofmedieaion be asped | neyasveeeaue from the va ** Insert the tip of the needle into the ‘Centre of the seal is thinner and Physic Safety rubber cap ofthe via. (Apply pressure | cule ope workmnship hile doing ned varia} + Inject rit the vie Tosca easy withdrawal ot | Phys Fine workmanship the medicine. Esenomy of materal * lnvenviland withdrew he ronied | © Invering vit atlows uid | Phys Fine warkmanthip Amount of medicine by holding the wal | "tigate beween the thumb and midlenger” | «Poston ethene sig, ifthe non-dominant hand and rsp |” Cay maniputon onde the syringe wi the dominant fang + Push he into the via To faciiate cnyfow of Py Fine workmanship medicine. * Pullbckthe pion ote atthe | Towa te eued amount | Phys Fine workmanship required medicine and remove the | ofmodiine Economy of ae natral * Chass tte need mdteep tte | Toca te pepo | Miaciolny | satay syringe inthe knife dish the pant ina ste conan, * epg te viline ny mya] Fornedipot ofan | wicnbigy | pie wosmip the used needle in the puncture-proof Safety container. © Administration af ajtion + Check the medicine ordered pene Basureacuracy Satey 4 Beplaatin tthe patent Toate anciey a a esol tnd weer glo To proven cross infection Microbid Safety + Wesh hands and wear gloves Fo prove note Efectveness a7Chapter &: Pharmacology and Drag Therapy 5 Payeholoay Satey Sify the cont again by asking the | To ensure accuracy; + Keni te auocorde | = Doublechecksnecesary before drug administration. atthe coreetsite | Anatomy and | Safety 4 Sclct an appropiate sie depending on | To give the drug att - a ‘the route of administration prescribed | with minimum discomfort. Physiology Therapeutic wo: effectiveness sic im (As explained cartier Ijeton ste should be fae of any abnormalities. ‘+ Give proper position; locate the site | To reduce strain on muscles and Anatomy and ‘Safety and comfort ‘and drape the patient tninimum discomfort. ‘Therapeutic + tneedormal “To make the patient comfortable effectiveness * Extend elbow and suppor he forearm ona fat surface, Relax an, le end Sdomen depending on these chosen. lnwsnuseular ‘Tomake te patent comfortable. | Anatomy and | Safety and comfort 1+ Lie lat, onside, prone ost Physiology Therapeutic position depending on the choscn site, ceffectivencss Clean the ste with an eniseptic swab | Mechanical action of swab Physics Safety athe eente ofthe stand rotate | removes ir and micro Microbiology fouwards ina creular motion. organisms, Chemistry + Holdthe swab between the third and | Swab canbe used afer injection | Phyice Economy of foun fingers ofthe ven-dominant | formassaping. ratral and. + Remove needle cover straight Topreventconuminaton ofthe | Microbiology | Safety rect, bevel or shall + Hold he syringe conecty between the | Quickerand smooth insenion of | Anstomy and | Safety and thumb and fingers ofthe dominant | th needle equres proper Paychology comfort ofthe hand, rmanpulaion of thesyringe, pater. Intr-dermal: Hold bevel ofneecle | Docs not give tothe tissue below ‘Therapeutic pointing up at 15 degre angle. theactul ieee * Subcutaneous: Hold at 45 degree angle. “Inia-muscular: At 90 dogres angle. ‘© Technique of giving jection + laden a the non-domiant hand stretch skin | Needle pierces ight kin cas vee the st wih tum and Ginger. are | cae Satay and Wilhneed slog ite cles skinat 1s | Ennttharthe needle tip isin be legree angle, insert the needle through the | epidermis nat , s epidermis (Sm below surfs) so thatthe | fatony and] Therapie needle tip canbe seen trough skin, ology effectiveness Pash he medicine. 7 Note he formation of small ble onthe | Tndicstes medicine is deposited in skin surface and encrl itt see reaction | theinte-demnal tases = Subcutancous: [ese peneates light kin (For an average bultpaen) spread akin | easy Pn OM Atatomy and | Safey and tightly or pinch skin with the non-dominant | Pinching skin elevates *eslhoy contin hand (for obese patients). Inject needle | subcutancous tissues auicky and fly st 45-degre angle and_| Obese penta ity lyer Therapeutic release the skin af sues above subcutaneous effectiveness tissues, 39Chapter 8: Unt 2 Aditsration of Mesiine and safety In Musca: Figure B27 ARB) | Eny aaron of needle Aratomyend | | Toto: (Figue 82.6 A&B) Photo Physiology Position the non-dominant hand a proper anatomical landmarks, Spread skin tighly {every hina rep te me tween thumb and index fags) Insen the nedle quickly at 90-degree angle. | Ensures the needle reaches ‘Anatomy and | Comfort and I'he medicine isiritating, use Z rack | muscle, Physiology Sey technique. ‘Aer nedle insertion incase of inra- sae ‘muscular and subcutaneous injections, grab | Proper manipulation of the Physics ‘the lower end of the syringe barrel with the | syringe and needle prevents Fine workmanship ‘ondominant hand (inthe hub ofthe | injury. needle) Move the dominant hand tothe piston, | Itshows thatthe needle as Anatomy and | Comfort and safety Pull book the syringe to see if there i any | punctureda veins subcutaneous | Physiology Therapeutic bod. blood appears, remove the bd intr-muscular medicines effectiveness needle, discard medicine and prepare again. | cannot be given by UV route. {no biood appears push the medicine slowly = Remove the needle quickly and smoothly | To prevent injury Avatomy * comfort * Intra-dermal and subcutaneous ‘Subcutaneous and intra-dermal * Physiology *Safety Does not require massage. injeetions are not to be massaged | * Physics * Therapeutic + Inua-museula injection: eefeciveness Massage the site (unless contraindicated in cae of intant drugs). ‘Assis the client to assume a comforable | To giveasense of well-being. | Psychology Comfort position. Discard he needle and syringe in an Topreventreuse ofthe needle | Microbiology | Safety appropriate conser and syringe. Needle ina puneture-proof container. | Tosinfsct the syringe before Syringe ine bow of disinfectant. xpos. ~ Remove gloves and wash hands To reduce transmission ofmiero- | Microbiology | Safety organisms, = Record inthe medicine chartand the | To prevent enor of edministaton | Microbiology | Safety hurse's record by writing tename ofthe | and ensue accuracy. | Fine Workmanship ‘medicine, dose, rout, sits and time when administered and signature, For intradermal injection, observe the site for reaction. Ifthe elient snot sensitive, administer the medicine, trough the appropriate route as mentioned ealr. THT, Assiting ta 1V Tnjoctions (Figure 82.18) Spread the mackintosh and the towel _ | To prevent soiling ofthe bed ‘Microbiology Safely under the site tobe punctured for VV Fine workmanship injection. Prepare the vein by appl istnded vein creates easy | Anatomy and —_| Safety and comfort tourniquet above the vein and ask the | insertion of needle Psychology therapeutic patent close the fis. effectiveness ‘* Assist the doctor by handing over the | Cleaning of skin Microbiology Safety sonb, chances of infection‘Ghapter 8: Pharmacology and Drug Therapy waiony aad Cont When eisai ven ak ie] For Sinan mooi Tow at [Baio " Simonetta, | sacri Pocilgy | Thapae atomique end pu he msde io Rematerptipietmenes|opoetsnoeste: | aaenyant | ay ‘the puncture site with a sterile swab. Psychology ins wean + Mate th pant confonate and | To proven enor Fine workmanship ‘corde prozac meniont | To elt eunenation ‘carlier. Pull this end oo Figure 8.2.19: Applying a tourniquet IV, Termination of the procedure Dismantle all the articles in an appropriate manner: 4) Syringes in an antiseptic bowl, ~ .sless syringes tobe sent fr autoclaving isposable syringes to be sent for crushing in a shredder, ~ disposable needles are sent for crushing in a shredder, ~ ‘Steel needles are washed and sent for autoclaving, * Wash the kidney tray and ptece it inthe cupboard, + Knife dish is washed and sen for autoclaving. 381