Injection

Injection and Types of injection

1. Injection
Often referred to as a "shot" in US English, or a "jab" in UK English) is the act of putting a liquid,
especially a drug, into a person's body using a needle (usually a hypodermic needle) and a
syringe.[1] Injection is a technique for delivering drugs by parenteral administration, that is,
administration via a route other than through the digestive tract. Parenteral injection includes
subcutaneous, intramuscular, intravenous, intraperitoneal, intraosseous, intracardiac,
intraarticular, and intracavernous injection.Injection is generally administered as a bolus, but can
possibly be used for continuous drug administration as well.[2] The medication may be long-acting
even when administered as a bolus and is then called depot injection. Administration by an
indwelling catheter is generally preferred instead of injection in case of more long-term or
recurrent drug administration.Injections are among the most common health care procedures, with
at least 16 billion administered in developing and transitional countries each year.[3] 95% of
injections are administered in curative care, 3% are for immunization, and the rest for other
purposes, such as blood transfusions.[3] In some instances the term injection is used synonymously
with inoculation even by different workers in the same hospital. This should not cause confusion;
the focus is on what is being injected/inoculated, not the terminology of the procedure.Since the
process imparts a small puncture wound to the body (with varying degrees of pain depending on
injection type and location, medication type, needle gauge, the skill of the individual administering
the injection and the sensitivity of the individual being injected), fear of needles is a common
phobia and proper antiseptic measures should be used.

2. Types of Injections
Intravenous injection
Intravenous therapy Intravenous injections (IV injections) involve needle insertion directly into
the vein and the substance is directly delivered into the bloodstream.[4] In medicine and drug use,
this route of administration is the fastest way to get the desired effects since the medication moves
immediately into blood circulation and to the rest of the body.[5] This type of injection is the most
common and often associated with illicit drug use because of the rapid effects.[6][7]


Intramuscular injection
Intramuscular injections (IM injections) deliver a substance deep into a muscle, where they are
quickly absorbed by blood vessels. Common injections sites include the deltoid, vastus lateralis,
and ventrogluteal muscles.[8] Most inactivated vaccines, like influenza, are given by IM
injection.[9] Some medications are formulated for IM injection, like epinephrine autoinjectors.
Medical professionals are trained to give IM injections, but patients can also be trained to self-
administer medications like epinephrine.

3. Subcutaneous injection
In a subcutaneous injection (SubQ injections), the medication is delivered to the tissues between
the skin and the muscle.[10] Absorption of the medicine is slower than that of intramuscular
injection. Since the needle does not need to reach the muscles, often a bigger gauge and shorter
needle is used. Usual site of administration is fat tissues behind the arm. Certain intramuscular
injection medicines such as EpiPen® can also be used subcutaneously.[11] Insulin injection is a
common type of subcutaneous injection medicine. Certain vaccines including the MMR vaccine
(measles, mumps, rubella), varicella vaccine (chickenpox), and zoster vaccine (shingles) are given
subcutaneously.[12]


Intradermal injection
A tuberculin sensitivity test being administered intradermally.In an intradermal injection,
medication is delivered directly into the dermis, the layer just below the epidermis of the skin. The
injection is often given at a 5 to 15 degree angle with the needle placed almost flat against the
patient's skin. Absorption takes the longest from this route compared to intravenous, intramuscular,
and subcutaneous injections. Because of this, intradermal injection are often used for sensitivity
tests, like tuberculin and allergy tests, and local anesthesia tests. The reactions caused by these

4. tests are easily seen due to the location of the injections on the skin.[13]Common sites of
intradermal injections are the forearm and lower back.

Depot injection
A depot injection is an injection, usually subcutaneous, intradermal, or intramuscular, that deposits
a drug in a localized mass, called a depot, from which it is gradually absorbed by surrounding
tissue. Such injection allows the active compound to be released in a consistent way over a long
period. Depot injections are usually either solid or oil-based. Depot injections may be available as
certain forms of a drug, such as decanoate salts or esters. Examples of depot injections include
Depo Provera and haloperidol decanoate. Prostate cancer patients receiving hormone therapy
usually get depot injections as a treatment or therapy. Zoladex is an example of a medication
delivered by depot for prostate cancer treatment or therapy. Naltrexone may be administered in a
monthly depot injection to control opioid abuse; in this case, the depot injection improves
compliance by replacing daily pill administration.The advantages of using a long-acting depot
injection include increased medication compliance due to reduction in the frequency of dosing, as
well as more consistent serum concentrations. A significant disadvantage is that the drug is not
immediately reversible since it is slowly released.In psychiatric nursing, a short acting depot,
zuclopenthixol acetate, which lasts in the system from 24–72 hours, is more regularly used for
rapid tranquillisation.[14]
Infiltration injection
The pharmaceutical injection type of infiltration involves loading a volume of tissue with the drug,
filling the interstitial space. Local anesthetics are often infiltrated into the dermis and hypodermis.
Injection pain

5. The pain of an injection may be lessened by prior application of ice or topical anesthetic, or
simultaneous pinching of the skin. Recent studies suggest that forced coughing during an injection
stimulates a transient rise in blood pressure which inhibits the perception of pain.[25] Sometimes,
as with an amniocentesis, a local anesthetic is given.[26] The most common technique to reduce
the pain of an injection is simply to distract the patient.Babies can be distracted by giving them a
small amount of sweet liquid, such as sugar solution,[27] or comforted by breastfeeding [28]
during the injection, which reduces crying.
Injection hygiene
Proper needle technique and hygiene is important to perform injections safely for patients and
healthcare personnel.[29] A new, sterile needle should be used each time, as needles get duller and
more damaged with each use and reusing needles increases risk of infection. Needles should not
be shared between people, as this increases risk of transmitting blood-borne pathogens. This can
lead to infections and even lifelong disease.In addition, multi-use medication bags, bottles,
syringes, and ampules should not be entered with used needles. This practice also increases the
risk of disease transmission between people sharing the same medication.[29]Aseptic technique
should always be practiced when administering injections. Aseptic practices and procedures
include barriers such as gloves, gowns and masks for health care providers, sterile instruments
(needles, syringes, etc.) and equipment, contact guidelines to avoid touching non-sterile surfaces
with sterile items, and environmental controls.[30]Needles should be disposed of in sharps
containers. This reduces the risk of accidental needle sticks and exposure to other people.[31]
Sharps containers should be closed once they are 3/4 full and sealed with duct tape.[32] In the
United States, there are 39 states that participate in programs to provide needle or syringe exchange
programs.[33] If living in a state with a sharps take back program, the sharps container may be
taken to the take back center for disposal. Otherwise, it should be placed in the center of a full
trash bag. In the state of Ohio, sharps are allowed to be put in the regular trash. Some medicine
companies provide mail-back sharps programs.[32]
Injection safety
Unsafe injection practices can be attributed to at least 49 disease outbreaks since 2001.
Contamination of needles at the point of administration can lead to transmission of Hepatitis B and
C, HIV, and bloodstream infections.[34] Drug users have high rates of unsafe needle use including

6. sharing needles between people.[35] The reuse of needles puts people at risk for disease.[36][37]
The spread of HIV, Hepatitis B, and Hepatitis C from injection drug use is a worldwide issue.[38]
In North America in 1994, over half of HIV cases were the result of drug use and unsafe injection
practices.[6]Another risk is poor collection and disposal of dirty injection equipment, which
exposes healthcare workers and the community to the risk of needle stick injuries. In some
countries, unsafe disposal can lead to re-sale of used equipment on the black market. Many
countries have legislation or policies that mandate that healthcare professionals use a safety syringe
(safety engineered needle) or alternative methods of administering medicines whenever possible.
Open burning of syringes, which is considered unsafe by the World Health Organization, is
reported by half of the non-industrialized countries.[3]According to one study, unsafe injections
cause an estimated 1.3 million early deaths each year.[39]To improve injection safety, the WHO
recommends:[40]Changing the behavior of health care workers and patientsEnsuring the
availability of equipment and supplies Managing waste safely and appropriately A needle tract
infection is an infection that occurs when pathogens are seeded into the tissues of the body during
an injection.[41] Such infections are also referred to as needlestick infections.
Improvements to injection safety
An important movement in injection safety is the rising prevalence of supervised injection sites.
These sites not only provide clean needles to mitigate infection risk, they also provide a safe space
with clinicians and life saving support if needed. In an event of an overdose a clinician would be
able to administer life saving support including medications such as naloxone, an opioid
antagonist, used as an antidote in opioid overdose situations. Safe injection site are associated with
lower overdose mortality, ambulance calls, and HIV infections.[42]Ten countries around the world
currently use safe injection sites, also called supervised consumption services. These include
Australia, Canada, Denmark, France, Germany, Luxembourg, The Netherlands, Norway, Spain
and Switzerland. In total, there are about 120 sites operating.[43] Although the United States does
not currently have any safe injection sites, some cities such San Francisco, Philadelphia, and
Denver are considering opening them.[33] In 2018, the California State Assembly attempted to
pass Assembly Bill 186 to launch a three-year pilot program in San Francisco for California's first
safe injection sites.[44] Colorado and Pennsylvania are not too far behind, expressing their

7. interests in launching safe injection sites. Recent rulings in Pennsylvania have determined that safe
injection sites are not unlawful under the federal law.[45]
In nature
Many species of animals, and some stinging plants, have developed poison-injecting devices for
self-defence or catching prey, for example:Venomous snakes,Stinging insects,Weevers (a fish)
Sting rays,Bloodsucking insects: some of them first inject an anticoagulant to make feeding easier
Cnidocyte cells in the animals called cnidarian,Stinging nettles,Dart injection,Jet injector
Injection port,Lethal injection,Needlestick injury,Needle remover,Safety syringe.
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