Injections ppt

study of injection

1. Injections By: Drx. Pankaj Dwivedi Faculty OPP College www.oppcollege.com 1

2. What is an injection? Injections are sterile solutions, emulsions or suspensions. They are prepared by dissolving, emulsifying or suspending an active ingredient and any other substances in water for injection. Injecting is the act of giving medication by use of syringe and needle to obtain the desired therapeutic effect taking into account the patients safety and comfort www.oppcollege.com 2

3. Types of Injections Parenteral medication: administration of a medication by injection into bodytissues Subcutaneous (SC) – into tissue below dermis ofskin Intramuscular (IM) – into the bodymuscle Intravenous (IV) – into avein Intradermal (ID) – into the dermis just under the epidermis www.oppcollege.com 3

4. Purposes of Injection To get rapid and systematic effect of the drug. To provide the needed effect even when the client is unconscious. Assure that the total dosage will be administered and the same will be absorbed for the systemic actions of the drug. To obtain a local effect at the sight of injection e.g. xylocaine, tuberculin test. To restore blood volume by replacing the fluids. To give nourishment when it can’t be taken by mouth. www.oppcollege.com 4

5. Syringes Three main parts: Barrel – chamber that holds themedication Plunger – part within the barrel thatmoves back and forth to withdraw and instill medication Tip – part that the needle is attached to www.oppcollege.com 5

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7. Which is which needle? The correct needle is the key to delivering the drug to the correct area for the maximum effect with the least amount of discomfort The colour at the top of the needle reflects its size the higher the number the smaller the lumen(bore). www.oppcollege.com 7

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10. Equipment for the administration of injections Clean tray in which to place drug and equipment Needle to ease reconstitution and drawing up Syringe of appropriate size Swabs saturated with isopropyl alcohol 70% Sterile topical swab if drug is presented in ampoule form Drug to be administered Patients prescription to check dose, route and timing Notes available to record administration in accordance with law Gloves, Apron www.oppcollege.com 10

11. Clinical room preparation for the administration of injections Protocols/procedure/standards information is available. Hand basin for washing hands and/or alcohol hand rub. Area for the client to lie down. Panic button/phone to call for assistance Gloves Resuscitation /anaphylaxis equipment/drugs Oxygen and appropriate mask if available adequate time for procedure www.oppcollege.com 11

12. Asepsis and reducing the risk of infection Good hand washing Good hand drying Aseptic technique Good observation and questioning of the client Skin preparation if required www.oppcollege.com 12

13. The 7 Rights of Drug Administration Right client Right medication Right dose Right route Right time Right reason Right documentation www.oppcollege.com 13

14. IV Medication Am pul es V ia l s www.oppcollege.com 14

15. D r a w i n g U p M e d i ca t i o n From an Ampules Wash hands and gather equipment. Grasp the stem with an alcohol swab www.oppcollege.com 15

16. C o n ti n u e D r aw i n g U p Medication F r o m a n A m pule s Snap off the amp o ul e ’ s n e ck away from the hands and face www.oppcollege.com 16

17. C o n ti n u e D r a w i n g U p Medication F r o m a n A m pu l e s Uncap the needle and insert the needle into the ampule. Avoid touching the rim with the needle. www.oppcollege.com 17

18. C o n ti n u e D r a w i n g U p Medication F r o m a n A m pu l e s Invert the ampule, insert the needle into the solution and aspirate. www.oppcollege.com 18

19. C o n ti n u e D r a w i n g U p Medication F r o m a n A m pu l e s Remove the needle cap and draw an amount of air into the syringe that is equal to the amount of medication that will be withdrawn from the vial www.oppcollege.com 19

20. Drawing Up Medication From a Vial  Insert the needle keeping it above the solution www.oppcollege.com 20

21. C on t i n u e D r aw i n g U p Medication From a Vial Invert the vial at eye level www.oppcollege.com 21

22. C on t i n u e D r aw i n g U p Medication From a Vial Hold the needle upright and re- check the syringe’s contents for presence of air www.oppcollege.com 22

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24. INTRADERMAL INJECTIONS www.oppcollege.com 24

25. INTRADERMAL INJECTION It is the introduction via needle of tiny amounts of fluid into layers of skin. It provides a local, rather than systemic effect. Syringe used is 1ml tuberculin syringe because ofa very small amount of drug needed. Needle used is a short (1/4 to 5/8 inch), fine gauge (g25-27). Indications: For diagnostic purposes (allergies and sensitivities to drugs) For administering tuberculin testing www.oppcollege.com 25

26. INTRADERMAL INJECTION Intradermal literally means “between the skin layers” and injection is administered just under the epidermis . Syringe is positioned at15 ˚ angle . Small volumes, usually 0.01 to 0.05ml, are injected because of the small tissue space. www.oppcollege.com 26

27. INTRADERMAL INJECTION Most commonly used site: Inner surface of the forearm Subscapular region of the back can be used as wel as d . eltoid region www.oppcollege.com 27

28. INTRADERMAL INJECTION REMEMBER: Mixture of drug and water for skin testing: 0.9cc of distilled water/sterile water and 0.1cc of the drug. Inject the solution intradermally and just enough to form a wheal. Encircle the site correctly and write the time when to check the injection site to determine reaction to the drug. Check the site after 30 minutes for signs of reaction. If negative, document it as ANST(After Negative Skin test)(-); if positive, ANST (+) www.oppcollege.com 28

29. INTRADERMAL INJECTION REMEMBER : A pos i tive result may b e m an ifested b y an y o f the following: R e dd e n i n g o f the s it e acc o mpa n i e d w i th marked elevation Increase in circumference of the wheal Presence of itchiness on the site www.oppcollege.com 29

30. PRO C ED U RE Prepare all the equipment needed: 1cc syringe, disposable needle (aspirating needle), sterile water, drug to be tested, wet and dry cotton balls and ballpen. Wash hands and observe appropriate infection control measures. Introduce yourself and verify the client’s identity. Explain to the client what you are going to do, why it is necessary and how the client can cooperate. Prepare needed materials aseptically. Check the label of the drug three times. www.oppcollege.com 30

31. PRO C ED U RE Pre p a re th e medicat io n to b e used for skin tes t i n g (e.g ampule or vial) Aspirate 0.9cc of distilled water/sterile water and 0.1cc of the drug using the tuberculin syringe with the aspirating needle. Mix the drug and the distilled water in the syringe. Replace the aspirating needle with g25 needle. Expel excess air. P l ace the syringe o n the t r ay t o gether w i t h the w e t and dry cotton balls. www.oppcollege.com 31

32. PRO C ED U RE Confirm again patient’s identity. Locate the appropriate site for skin testing. C l eanse the med i a l surf ace o f th e for earm b y u s i ng firm, circular motion from inner to outer portion. Allow the skin to dry before injecting the drug. Place hand in non-dominant hand of the patient. Remove needle cap and holds syringe at 15 degree angle from skin with bevel up. Stret ch the skin an d t e l l the patient that he/she wil l feel a prick as needle is inserted. www.oppcollege.com 32

33. PRO C ED U RE Inject the solution intradermally and just enough to form a wheal. Remove the needle quickly but gently at the same angle used for injection. Wipe with dry cotton ball but do not press the injection site. Encircle the site correctly and write the time when to check the injection site to determine reaction to the drug. Check the site after 30 minutes. www.oppcollege.com 33

34. Su b cutane o us injection www.oppcollege.com 34

35. Insulin is the most important drug in the subcutaneous injections www.oppcollege.com 35

36. SUBCUTANEOUS INJECTION s Subcutaneous tissue lies between the epidermis and the muscle. S u b c u t an e o u s rout e i s us e d for s l o w , s u s t a i n e d absorption of medication. SC or SQ Indications: Used commonly for insulin injection Heparin www.oppcollege.com 36

37. SUBCUTANEOUS INJECTION Common sites used for SQ route: Outer aspect of the upper arm Abdomen(from below the costal margin to the iliac crests) Anterior aspects of the thigh Upper back Upper ventral or dorsogluteal area www.oppcollege.com 37

38. SUBCUTANEOUS INJECTION REMEMBER: domin a nt H o l d syringe i n the hand between the thumb and forefinger. I nj ect the needl e qu i ckly a t an a n g l e of de p en d i n g 45 to 90 degree, o n the amount and turgor of the tissue and the length of the needle. www.oppcollege.com 38

39. Indications Insulin Type I diabetes mellitus, type II diabetesmellitus , hyperkalemia, DKA/ Type I diabetes mellitus, type II diabetes mellitus, hyperkalemia, MO D A KA/ diabetic coma Stimulating peripheral glucose uptake and inhibiting hep M a O ti A c glucoseproduction Stimulating peripheral glucose uptake and inhibiting hepatic Pat g i l e uco nt s I e n p f r o oduction H Pa y t p ie o n g t l I y n c f e o mia ( BG < 70 mg/dL) esp with higherdoses  – H A y n p x o i g e l t y y c , em bl i u a r (B re G d < v 7 i si m on g/ , d p L a ) l e p s i p t w at it io h n h s ig , h s e h r a d k o i s n es ess, slurred s – pe A e n c x h ie , t s y, w b e lu a r t r i e n d g vision, palpitations , shakiness, slurred speech, sweating Weight gain www.oppcollege.com 39

40. Insulin (cont) Administration : Subcutaneous injection Rotate site Check blood sugars regularly Storage: Refrigerate until use Once vial is punctured, it is good for 28 days and can be left at room temperature (except for glargine which is 90days) www.oppcollege.com 40

41. Insulin Dosing Normal insulin secretion Long - a ct i n g Long-acting & Short-acting 70/30 p r e - m i x ed www.oppcollege.com 41

42. Insulin (cont) Cautions/Severe Adverse Reactions Severe hypoglycemia (seizure/coma) (BG < 40 mg/dL) Edema CONTRAINDICATIONS Severe hypoglycemia Al l e r g y or s e n s i t i vi t y t o a n y i n g r e d i e n t of the product www.oppcollege.com 42

43. INTRAMUSCULAR INJECTION www.oppcollege.com 43

44. INTRAMUSCULAR INJECTION www.oppcollege.com 44

45. SITES ACCEPTABLE FOR IM INJECTION www.oppcollege.com 45

46. Deltoid     Palpate lower edge of acromion process. Place 4 fingers across the deltoid muscle with the top finger along the a c ro mi on pro c e s s . T h i s forms the base of a triangle. Draw an imaginary line at the axilla. This forms the apex of the triangle. Injection site is the center of the triangle, 3 finger widths (1-2 inches) below the acromion process. www.oppcollege.com 46

47. DELTOID MUSCLE www.oppcollege.com 47

48. GLUTEUS MAXIMUS    Locate the posterior iliac spine. Locate the greater trochanter. Draw an imaginary line between these two landmarks.  Injection site is above and lateral to the line.  Most dangerous site because of sciatic nerve location www.oppcollege.com 48

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50. GLUTEUS MEDIUS  Palm of hand on greater trochanter of femur.  Index finger on anterior superior iliac spine (hip bone).  Middle finger extended toward iliac tubercle.  Injection site lies within the triangle formed by the index and middle fingers www.oppcollege.com 50

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52. Vastus Lateralis  One hand above the knee.  One hand below the greater trochanter.  Locate midline of anterior thigh and midline of lateral thigh. Injection site is the lateral area of the thigh www.oppcollege.com 52

53. Institute of Nursing Theory and Practice, Prague 2007 VASTUS LATERALIS www.oppcollege.com 53

54. INTRAMUSCULAR INJECTION REMEMBER: 3cc syringe can be used for IIM injection with g22 or 23 needle; 1-2 inches long. Position the needle at 90˚ angle. Do not forget to aspirate the plunger once injected to check for blood. (To determine if a blood vessel was hit) Inject medication slowly (To minimize pain) www.oppcollege.com 54

55. INTRAMUSCULAR INJECTION REMEMBER : Apply pressure to site and massage after (To prevent hematoma and prevent oozing of blood and for proper absorption of the medicine. www.oppcollege.com 55

56. PRO C ED U RE Prepare needed materials aseptically. Check the label of the drug three times. Prepare the medication. Position the patient and locate the site correctly. C l ea nse the site us i n g circ u l a r mo t i o n fr o m i n ne r to outer portion and allow it to dry. Place a swab between fingers of non-dominant hand. Pinch or spread tissue and insert needle quickly at 90 degrees angle in a dartlike position. www.oppcollege.com 56

57. PRO C ED U RE Pull back the plunger to check for blood. Inject the medication slowly if no blood appears. Withdraw needle quickly. A p p l y press u re an d dry co t ton b a ll to the site a n d massage. Leave the client in a comfortable position. D i sp o s e the sy r ing e an d other ma t er i a ls used properly, wash hands and document the procedure. www.oppcollege.com 57

58. Z-track IM Administration Method used with ir r it a ting me d i c at i o ns . E.g. Iron Used to “trap” medication in muscle and prevent “tracking” of solution through tissues. www.oppcollege.com 58

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60. Z-track IM Administration Prepare medication Change needle after drawing up med Gather supplies Identify site Do gloves Cleanse site with alcohol Displace skin laterally 1-1 ½ inches from injection site While holding skin, insert needle with a darting motion, at a 90° angle. www.oppcollege.com 60

61. Z-track IM Administration Stabilize needle with thumb and forefinger. Aspirate. If no blood, then inject medication slowly and steady Wait 10 seconds Quickly withdrawal needle Then release skin Cover site with swab and DO NOT MASSAGE DO NOT RECAP. Activate safety feature. Place needle in sharps container uncapped Remove gloves www.oppcollege.com 61

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