Intramuscular & Intravenous Injection.pptx

Parenteral route of Medication Administration. In this Intramuscular & Intravenous Injection is a part, here Explained about the sites, needed articles, Indication, Contra Indication, Complications & step wise Procedure was explained.

1. INTRAMUSCULAR & INTRAVENOUS INJECTION Prof.Saranya.R,M.sc (N ),[ Ph.D ], Associate Dean Dhanalakshmik Srinivasan University

2. OBJECTIVES At the end of the session the learners will be able to define Intramuscular injection enlist the sites of intramuscular injection describe the purpose of intramuscular injection explain about the procedure of intramuscular injection enumerate the advantages and disadvantages of IM injection

3. define intravenous injection enlist the purpose of I.V injection explain the purpose of I.V injection describe the procedure of I.V injection enlist the advantages and disadvantages of I.V injection define intravenous infusion enlist the purpose of intravenous infusion list down the articles of intravenous infusion explain the procedure of intravenous infusion

4. define venesection procedure explain the site of venesection procedure enlist the indication of venesection procedure describe the venesection procedure enumerate the after care list down the complication of venesection procedure describe the nurses responsibility

5. Intramuscular Injection( IM) Definition : Insertion of a needle into the muscle tissue to administer medication. 1 . Ventrogluteal muscle . It lies over the gluteus minimums. Involves the gluteus Medias and minimums it is situated deep and away from major nerves and blood vessels and is a safe site for all clients. It's the preferred injection site for adults and for children younger than 7 months. it preferred site for (IM) injection.

6. 2 . Dorsogluteal muscle It is composed of the thick gluteal muscle of the buttocks. The muscle is in the posterior superior iliac spine, the injection site then lateral and superior site by positioning the patient on prone position or side – lying position. The Dorsogluteal site can be used for adult and children with well develop gluteal muscle witch develop by walking

7. 3 . Deltoid muscle The deltoid muscle is in the edge of the acromion process, which forms the base of a triangle in line with the midpoint of the lateral aspect of the upper arm. The injection site is in the center of the triangle, about 2.5 to 5 cm (1to 2 inches) below the acromion process Should be use this site only for small medication volumes (0.5 to 1.0ml) and when other sites are inaccessible because of dressings or casts.

8. 4. Vastus lateralis muscle It is located on the anterior lateral aspect of the thigh; in an adult it extends from a Handbreadth above the knee to a handbreadth below the greater trochanter of the femur. The middle third of the muscle is the suggested site for injection. This injection site used in the adult client and is the preferred site for infants under 7 months; the muscle is thick and well developed.

9. 5. Rectus femur's muscle. The muscle belong to quadriceps muscle group it is used only occasionally for (IM) injection. It is situated on the anterior aspect of the thigh; its advantage the patient can reach this site easily. Disadvantage is considerable discomfort for some people.

10. Purpose Provide the means of administration for medication that cannot be given orally. To provide the needed effect when the patient is unconscious , unable to swallow due to neurological or surgical alteration effecting the throat and mouth or when the patient is un co-operative.

11. Advantage of Intramuscular Injection (IM) 1. The muscle is less sensitive to irritating and viscous drugs. 2. Adult client can safely tolerate as much as 4 ml of medication in larger muscles such as the gluteus medius without discomfort than subcutaneous tissue. 3. Safe method than other parenteral administration route. 4. Slow action of medication can be achieved by this route of administration. 5. Some medication need to absorbed slowly and harm if given intravenous such as oily hormone, long acting penicillin.

12. Disadvantage of Intramuscular Injection (IM) 1. Tissue injury (burn, wound). 2. Presence of nodules. 3. Lumps. 4. Abscesses. 5. Tenderness. 6. Other pathology such as (viral hepatitis B), (cross infection) . 7. Sciatic nerve injury (nerve damage). 8. Sterile abscess. 9. Gangrene.

13. Articles Tray containing sterile tray with 2ml/5ml syringe and 19-23 gauge needle, 1 to 1 ½ inch in length Children : 25-27 gauge with ½ - 1 length needle Transfer forceps in a container of antiseptic solution, medicine ampule or vial Fie to open ampules Syringe stand Bowl containing water K.basin Paper bag Medication card

14. Procedure Assess indication for type of injection to be administered • Assess medical history of allergies • Observe verbal and non verbal response towards receiving injection • Wash hands • Prepare needed equipment and supplies

15. • Check medication order • Prepare correct medication dosage from ampule or vial , Check dosage carefully. Be sure air is expelled. • Prepare an air lock by drawing 0.2cc air in syringe • Keep the syringe over syringe stand after loading • Identify patient by checking identification arm band and asking patients name • Explain procedure to client and proceed in calm confident manner • Close room door or curtain

16. • Keep sheet or gown draped over body parts not requiring exposure • Select appropriate injection site • Inspect skin surface over sites for bruises , inflammation or edema. Note integrity and size of muscleand palpate for tenderness • Assist patient to comfortable position. Depending on the site chosen, the patient lies flat, on his side or pone or sits • Relocate site using anatomical land marks in the deltoid, ventro gluteal, dorsogluteal , vastus lateralis or rectus femoris regions

17. • Cleanse site with antiseptic swab. Apply the swab at the centre of the site and rotate outward in a circular direction for about 5 cm • Hold swab between 3rd and 4th fingers of non-dominant hand • Remove needle cap from needle by pulling it straight off • Hold syringe correctly between thumb and fore finger of dominant hand hold as dart with palm down • Administration of injection : • Position non-dominant hand at proper anatomical landmarks and spread skin tightly. Inject needle quickly at 90 degree angle into muscle

18. If patient muscle mass is small grasp body of muscle between thumb and other fingers • If medication is irritating use ‘z’ tract method . Here the nurse pulls the overlying skin and subcutaneous tissues approx.. 2.5 to 3.5cm laterally to the side. Holding the skin taut with the non-dominant hand the nurse injects the needle deep into the muscle and after injecting the nurse release the skin.

19. • After the needle enters site of injection grasp lower end of syringe barrel with non-dominant hand. More dominant hand to end of plunger • Avoid moving syringe while slowly pulling back on plunger to aspirate drugs. If blood appears in the syringe remove needle discard medication and syringe and repeat procedure. • Inject medication slowly • Withdraw needle while applying alcohol swab gently above injection site • Massage skin lightly • Assist patient to comfortable position

20. • Flush out the syringe and needle and keep it in the bowl with water • Wash and replace all articles • Wash hands • Chart medication , dose route and site , time and date given in medication sheet • Ask patient for acute pain, burning, numbness or tingling at injection site • Evaluate responses to medication in 10-30 mins

21. Intravenous Injection ( IV) Intravenous injection is the introduction of a small quantity of drug into the vein by veni - puncture. Purpose : To obtain rapid action. To administer drug that is irritating to the subcutaneous or muscle tissue.

22. Advantage 1. When rapid effect is required. 2. Rout is appropriate when medications are too irritating to the tissue when given by other routes. 3. When there are contraindications to give medication by other rout such as abscesses on gluteal muscles occur. 4. When large volume infusion or medication are indicated. 5. When there are multi dose of drug administration for long period. 6. Easy to perform venipuncture's by needle to administer medication.

23. Disadvantage of Intravenous Injection (IV) 1. Rapid severe reactions to the medication (anaphylactic shock). 2. Infection transmission. 3. Fluid volume overload. 4. Transmission of infection by contaminated syringe such as (HIV, viral hepatitis B). 5. Thrombophlebitis repeated injection on the same vein.

24. Procedure : Check physicians order for type of medication to be administered, dosage and route Wash hands Prepare needed equipment and supplies: Tray containing Sterile tray containing syringe & needle 18-21 gauge 1”-2” needle length Bowl containing cotton swab Antiseptic solution Paper bag Medication card & k.basin

25. Check the medication record prepare ordered medication as per direction for dilution. Load medication in syringe and keep it over the syringe stand Identify patient by checking arm band or asking name Explain procedure to the patient Assess intravenous insertion site Assess patient to comfortable position. Ask patient to extend his elbow and support it on a flat surface Talk with the patient about subject of interest.

26. Apply tourniquet about 6-8 cm proximal to injection site Massage or stroke the vein distal to the knot and in the direction of the venous flow Encourage the patient to clench and unclench the first rapidly Lightly tap the vein with antiseptic swab Hold swab between third and fourth finger of non dominant hand Remove cap from needle by pulling it straight off For insertion of needle into the vein grasp the arm distally to the point of entry of the needle. Place left thumb one inch below the expected point of entry. Pull the site taut.

27. Holding the needle at a 30 deg. Angle with the bevel up, pierce the skin lateral to the vein, lower the angle of the needle so it becomes parallel with the skin Follow the course of vein and pierce the side of vein When the back flow of blood occurs, insert the needle further into the vein about ¾”-1” Release the tourniquet Inject the medication slowly Watch for swelling at and around the site of injection Withdraw the needle quickly after injection of medication Apply pressure over the injection site, do not massage

28. Wash the syringe and needle. Keep it in the bowl with water Assist the patient to a comfortable position Wash and replace all the articles Wash hands Record medication dose, route, site and time when administered and sign the record Ask the patient for any pain or burning sensation at injection site Evaluate responses to medication in 10-30 minutes

29. Intravenous Infusion (closed method) Definition : It is giving colloids or crystalloids aseptically through a needle into a vein to supply the body with fluids electrolyte, nutrients and medication Purpose : For fluid and electrolyte replacement To maintain homeostatic balance When a change in the patient condition is anticipated the I.V line is maintained at a keep open state to instill fluids/medication at the time of emergency.

30. Equipment: Injection tray with spirit , betadine , cotton ball , Injection stand, solution with thumb forceps I.V set with needle or catheter IV solution/Drug Scalp vein needle/JELCO/ Insyte / Venflon Tourniquet IV stand, IV basket ( if necessary) Small mackintosh, adhesive , scissors

31. Procedure: Wash hands Assemble the equipment's at the bed side Open the administration set and tubing maintaining sterility of contents Keep the clamp closed Remove the protective covering of solution container and hang from IV pole Squeeze flexible drip chamber gently. Until solution enters the chamber

32. open the clamp until solution slowly fills the tubing. Inspect the tubing for air bubbles. If Present expel the bubbles Performing venipuncture : Explain to the patient Cut adhesive piece and keep ready Select the site Shave excessive body hair from selective site Secure the tourniquet approximately 5-6 inches above the site Instruct the patient to open and clench his fist several times Cleanse the site with spirit swab

33. 8. Insert needle at 30 Deg angle ½ distal to the vein puncture site Connect IV tubing to the S/V needle / Jelco 9. Watch tubing for blood return 10. Relax tourniquet with free hand 11. Open clamp on IV tubing and monitar drip chamber for dripping solution 12. Inspect the puncture site for swelling discoloration 13. Secure it with the adhesive 14. Adjust the flow rate 15. Wash hands

34. Evaluation : Record time and date of venipuncture, any infection, phlebitis, thrombophliebitis , air embolism, local infiltration, allergic reaction.

35. Venesection - Cut down procedure Definition : Whenever blood vessels become collapsed and invisible or becomes difficult to trace a vein and to start infusion, the vein will have to be exposed opened and blunt metal canula or fine piece of polythene tubing is inserted into the vein to start infusion it is called as ‘ venesection ’ or cut down Site : Usually saphenous vein over the ankle or cephalic vein over the arm is selected.

36. Indications: To replace fluid into the circulation when a patient is in shock and collapse To supply large amount of fluids rapidly i.e in cardiac arrest Before a major surgery where a fall in blood pressure is anticipated To monitor central venous pressure

37. Articles : Covered sterile tray : Sponge holding forceps-1 B.P handle with knife-1 Scissors, Small pointed-1 Sterile rounded scissors – 1 Mosquito forceps – 1 Tooth forceps – 1 Allis forceps -1

38. Needle holder – 1 Curved cutting needle – 2 Annuerysm needle – 1 to pass the thread under the vein Venous section canula with stiller or polythene tubing 5ml syringe with needle no.20 and 22 Cotton suture no.10 Hole towel, towel clips Dressing material i.e. cotton swabs, guaze pieces and cotton pads Gloves , gown and mask

39. Unsterile tray Cheatle forceps in a lotion jar kidney tray Mackintosh and draw sheet Tourniquet Adhesive tape with scissors spirit iodine Lignocaine 1 % IV infusion set , Screen Torch IV solution

40. Procedure : Explain the procedure to the patient and relatives to get the co-operation Obtain written consent from the patient or his relatives Prepare the site for venesection with Dettol, iodine spirit, the nurse assist the doctor in the cutdown Strict aseptic technique is maintained through out the procedure. Local anesthesia is given. The skin is incised and vein is exposed. An aneurysm needle is passed below the vein , threaded and drawn back.

41. The distal end of the vein is tired and the proximal end is caught between the thread, the vein is then cut partially between the two ligatures. The canula is passed and the proximal ligature is tied to keep the canula in place. IV drip is connected to the venesection needle. Skin is sutured and bandaged After care : Observe the site to detect infiltration of fluid and dislodgement of cannula Restrict the movement of the patient Make the patient comfortable and relaxed

42. 4. Clean and dress ignition site daily, to help in the healing of wound 5. Remove the sutures after one week 6. Clean articles with vim powder, rinse and dry , send articles for auto claving for reuse 7. Clean other articles with soap and water, rinse, dry and replace to their usual places 8. Record the procedure. Report any complication. Record removal of sutures, condition of the wound on nurses notes

43. Complications to observe for during IV therapy Infiltration : escape of fluid into subcutaneous tissue due to dislodgement of the needle causing swelling and pain . Circulation overload : The intravascular fluid compartment contain more fluid than normal. Embolism : Obstruction of the blood vessels by travelling air emboli or clot of the blood. It is fatal

44. Duties of the nurse during IV therapy Explain the need for the IV therapy what to expect, duration of the therapy , activities permitted during the procedure and observation to be made. Help patient to maintain activities of daily living, bathing and grooming, feeding etc. Observation should be made on the flow rate, patency of the tubing, infusion site, level of fluid in the infusion bag/ bottle, patients comfort and reaction to therapy.