INJECTION SITES

1. Injection - Injection -
Sites Sites

2. IMIM

 Intra-Intra-
MuscularMuscular
 Dorsal Dorsal
glutealgluteal
 Ventro Ventro
glutealgluteal
SITESSITES

Deltoid Deltoid
 Vastus Vastus
lateralislateralis
 Rectus Rectus
femorisfemoris

3. IM SitesIM Sites
 Intradermal andIntradermal and
subcutaneous sitessubcutaneous sites
 Then procedure Then procedure
forfor injections: IM/SQinjections: IM/SQ

4. Nursing School Target Nursing School Target


PracticePractice

5. INTRAMUSCULAR SITESINTRAMUSCULAR SITES
 Give at 90 degree angle
 No more than 3cc/site
Find site by touch Find site by touch
(palpation) and site.(palpation) and site.

6. •
**ExceptionException*
 May give May give up to 5ccup to 5cc if if
absolutely necessaryabsolutely necessary
 Muscle absorbs more Muscle absorbs more
medication than other medication than other
tissuestissues
 1-1/2”, 21g1-1/2”, 21g needle most needle most
commoncommon

7. DORSAL GLUTEALDORSAL GLUTEAL

Buttocks

8. V
VENTROGLUTEAL SITEVENTROGLUTEAL SITE

9. DELTOID----ARMDELTOID----ARM
 No more No more
thanthan
1cc1cc

10. DELTOIDDELTOID

11. VASTIS LATERALISVASTIS LATERALIS
 Side of Side of
infants thigh infants thigh
has many has many
nerve nerve
endingsendings
 *May be*May be
painful*painful*

12. RECTUS FEMORISRECTUS FEMORIS
 Top of thigh

13. Why IM?Why IM?
 Rapid absorption Rapid absorption
of medication in of medication in
musclemuscle

14. INTRADERMALINTRADERMAL
 Given on inner Given on inner
forearmforearm
..1-.3cc injection
 TB syringe @ 15
degree angle/or 25
gauge 1-3/8” needle

15. INTRADERMALINTRADERMAL
 Bevel up
 Should form a
bleb or bubble if
properly
administered..

16. SUBCUTANOUS- SITESSUBCUTANOUS- SITES
 Outer, upper arm, thigh or
abdomen.
 Medication absorbs slowly
because SQ tissue is much
less vascular.

17. SUBCUTANEOUS SUBCUTANEOUS
SITESSITES
 No more than No more than 2cc 2cc ofof
medication given SQ.medication given SQ.
 0.5-1.0 cc0.5-1.0 cc preferred- preferred-
most common needle most common needle
size is size is 25 gauge, 5/8”25 gauge, 5/8”

18. 45 DEGREE ANGLE INTO 45 DEGREE ANGLE INTO
SQ TISSUESQ TISSUE
 May be 90 degree if May be 90 degree if
person is obeseperson is obese
 Bevel upBevel up

19. PROCEDURE PROCEDURE
FOR FOR
INJECTION:INJECTION:
IM/SQIM/SQ

20. LOCATE/ INSPECT SITELOCATE/ INSPECT SITE
PalpatePalpate
RASH?RASH?
REDNESS?REDNESS?
SWELLING?SWELLING?
PAINPAIN?

21. DISINFECT SKIN USING DISINFECT SKIN USING
ALCOHOL/ BETADINEALCOHOL/ BETADINE
 Using Using
circular- circular-
motionmotion
 From From
center-center-
outwardsoutwards

22. -OR--OR-
 One One
swipe swipe
downwarddownward

23.  Let alcohol dry
Avoids stinging!Avoids stinging!
 use alcohol wipe for use alcohol wipe for
after injectionafter injection

24. -OR--OR-
IMPORTANT IMPORTANT
POINT!POINT!
STRETCHSTRETCH The skin for The skin for
an IM to get closean IM to get close to the to the
musclemuscle

25.  PinchPinch the skin for a the skin for a
SQ.SQ. so you bring the so you bring the
SQ. layer off the muscleSQ. layer off the muscle

26. INSERT NEEDLE INSERT NEEDLE
QUICKLY QUICKLY AT THE PROPER AT THE PROPER
ANGLE- ANGLE- 15, 45, 90 DEGREE15, 45, 90 DEGREE
Bevel up!Bevel up!
Insert all the way to hubInsert all the way to hub

27. HOW DO YOU KNOW IF HOW DO YOU KNOW IF
YOU HIT A BLOOD YOU HIT A BLOOD
VESSEL?VESSEL?
 You will see blood in You will see blood in
the barrel of syringethe barrel of syringe

28. RELEASE RELEASE SKIN AND SKIN AND
SUPPORTSUPPORT SYRINGE SYRINGE
 Aspirate by pulling Aspirate by pulling
back on plunger to see if back on plunger to see if
needle has entered blood needle has entered blood
vessel

29. Then What?Then What?
 Remove needle Remove needle
and syringe, and and syringe, and
begin again (New begin again (New
equipment andequipment and
medication)medication)

30. THERE ARE THERE ARE 22 TIMES TIMES
YOU DON’T YOU DON’T
ASPIRATEASPIRATE
Another Another
exception!exception!

31. INTRADERMAL INTRADERMAL
INJECTIONSINJECTIONS
 WHY ??WHY ??
 Needle doesn’t go deep Needle doesn’t go deep
enough to reach blood enough to reach blood
vesselsvessels

32. ANTICOAGULANTS ANTICOAGULANTS
(i.e. heparin)(i.e. heparin)
 WHY ??WHY ??
 Doing so may cause Doing so may cause
uncontrolled bleedinguncontrolled bleeding

33. INJECT MEDICATION INJECT MEDICATION
SLOWLYSLOWLY

34. HOLD ALCOHOL PADHOLD ALCOHOL PAD
NEAR NEEDLE ANDNEAR NEEDLE AND
WITHDRAW NEEDLE, WITHDRAW NEEDLE,
BEING CAREFUL NOT TOBEING CAREFUL NOT TO
STICK YOURSELF WITHSTICK YOURSELF WITH
NEEDLE!NEEDLE!

35. MASSAGE SITE TO MASSAGE SITE TO
PROMOTE PROMOTE
ABSORPTIONABSORPTION
 Now, for more Now, for more
exceptions!exceptions!

36. MASSAGE IS MASSAGE IS
CONTRAINDICATED CONTRAINDICATED
IN THE FOLLOWING:IN THE FOLLOWING:

MASSAGE IS MASSAGE IS
CONTRAINDICATED CONTRAINDICATED
IN THE FOLLOWING:IN THE FOLLOWING:

37.  When medicationWhen medication
could could stainstain oror irritateirritate
tissue tissue ( i.e. iron ) ( i.e. iron )
 Slow absorption is Slow absorption is
desireddesired

38.  Heparin Heparin may may
cause bleeding cause bleeding
and insulin may and insulin may
absorb absorb too too
rapidlyrapidly

39. SITE ROTATION:SITE ROTATION:
Must Must
rotate rotate
sitessites to to
avoid avoid
tissue tissue
damage damage
and and
scarringscarring

40. TRACKING:TRACKING:
 The leaking of a The leaking of a
medication back up medication back up
the channel after the channel after
needle is withdrawnneedle is withdrawn

41. HOW DO YOU PREVENT HOW DO YOU PREVENT
TRACKING TRACKING
ChangeChange needle p drawing needle p drawing
up solution if giving ironup solution if giving iron
 Inject medicine slowlyInject medicine slowly
and leave needle in forand leave needle in for 10 10
secondsseconds p injectionp injection

42.  USE 2CC AIR BUBBLESUSE 2CC AIR BUBBLES
 It seals off needle It seals off needle
tracktrack
 Iron- uses .5cc airIron- uses .5cc air,,
leave needle in for 30leave needle in for 30
seconds p giving

43. Avoid Avoid massaging massaging
injection siteinjection site
Instruct patient-Instruct patient- wear wear
loose clothing,avoid loose clothing,avoid
use of muscle that use of muscle that
received injectionreceived injection

44. Z-Track methodZ-Track method
 Vistaril Vistaril
 ImferonImferon
 change change
needleneedle after
drawing up,
especially
iron!

45. PULL SKIN TO ONE SIDE-PULL SKIN TO ONE SIDE-
Hold it there for entire
injection
 Hold for at leastHold for at least 10 seconds10 seconds
before withdrawing needlebefore withdrawing needle

46.  REMOVE NEEDLE AND REMOVE NEEDLE AND
YOUR HANDYOUR HAND WHICH WAS WHICH WAS
DISPLACING SKIN AT THEDISPLACING SKIN AT THE
SAME TIME
 THE NEEDLE TRACK IS THE NEEDLE TRACK IS
SEALED OVERSEALED OVER AS THE AS THE
TISSUE RETURNS TO ITSTISSUE RETURNS TO ITS
NORMAL POSITIONNORMAL POSITION

47. WHAT HAPPENS IF WHAT HAPPENS IF
NEEDLE BREAKS?NEEDLE BREAKS? If visible in skin, don’tIf visible in skin, don’t
move point,move point, pullout with pullout with
sterile tweezerssterile tweezers -OR--OR-

 Mark (circle) site with Mark (circle) site with
pen,call physician pen,call physician Fill Fill
out incident reportout incident report

48. DORSOGLUTEALDORSOGLUTEAL

49. DORSOGLUTEALDORSOGLUTEAL
 2 Ways to locate 2 Ways to locate
sites:sites:
Divide Divide
buttocks into buttocks into
quarters, usequarters, use
upper outerupper outer
quadrant

50. DRAW AN IMAGINARY DRAW AN IMAGINARY
LINE BETWEENLINE BETWEEN the the
greater trochanter and greater trochanter and
the posterior superior the posterior superior
iliac spine, iliac spine, injection is injection is
given above and to given above and to
outside of lineoutside of line

51. Place patient in Place patient in
prone position prone position
with toes pointed with toes pointed
inward to inward to relax relax
musclemuscle

52. VENTROGLUTEALVENTROGLUTEAL

53. VENTROGLUTEALVENTROGLUTEAL
 Place heel of handPlace heel of hand
on greater trochanter on greater trochanter
with fingers pointing up with fingers pointing up
toward patients head toward patients head
and thumb pointing up and thumb pointing up
toward ceilingtoward ceiling

54.  With index finger With index finger
on patientson patients anterior anterior
superior iliac spinesuperior iliac spine
the 2the 2ndnd finger is finger is
stretched dorsally to stretched dorsally to
form aform a “V”“V”

55. DELTOIDDELTOID
 1-2” Below1-2” Below Acromion Acromion
process, maximum amountprocess, maximum amount
injected 1cc1cc with 1”1” needle

56. VASTUS LASTERALISVASTUS LASTERALIS

57. • OUTER/UPPER THIGHOUTER/UPPER THIGH
Middle third area between
knee and greater trochanter
 Preferred site for Preferred site for
infantsinfants
 No major blood vessels No major blood vessels
or nerves in this areaor nerves in this area

58. RECTUS FEMORISRECTUS FEMORIS

59. ANTERIOR ASPECT OF ANTERIOR ASPECT OF
THIGHTHIGH (Quadriceps muscle
group)
Middle third of anterior Middle third of anterior
thigh thigh
 DisadvantageDisadvantage is site is is site is
painfulpainful

60. A FEW LAST A FEW LAST
MINUTE MINUTE
ITEMSITEMS

61. IV THERAPY:IV THERAPY:
 Most rapid form Most rapid form
of drug therapyof drug therapy
 LPNsLPNs do not give do not give
IV drugsIV drugs

62. DISPLAY CONFIDENCE!DISPLAY CONFIDENCE!
EXPLAIN WHAT YOU EXPLAIN WHAT YOU
ARE DOING!!ARE DOING!!
Decrease your own fear Decrease your own fear
by-by-
PRACTICE!PRACTICE!
PRACTICE!PRACTICE!
PRACTICE!