Safe injection practice for nurses

A quick and easy reference guide to nurses. Here describing different injection sites and techniques

1. WELCOME

2. CONTINUING NURSING
EDUCATION,
Nursing Service Division,
GOVT. MEDICAL COLLEGE
HOSPITAL,
THIRUVANANTHAPURAM

3. SAFE INJECTION
PRACTICE
BIJUKUMAR.V, STAFF NURSE Gr.1 ,
MCH

4. AIM:
Although a safe injection does not
harm to patient, unsafe injection
practices may leads some health
problems.
The most affected category of health
care providers are the nursing
personnel.

5. SAFE AND UNSAFE
INJECTION PRACTICE
An injection is said to be safe:
if it does not harm the recipient,
it does not expose the provider to avoidable
risk, and
it does not result in wastes that is dangerous
for the community.

6. Injection safety is achieved by :
* administering the injection using a sterile device (syringe,
needle etc.),
* adopting sterile technique by a qualified and well trained
person and
* discarding the used devices in a puncture-proof container
specially designed for appropriate disposal.
Any breach in the process makes the injection unsafe.

7. Unsafe injection practices in developing
countries are due to the reuse of
contaminated syringes and unsafe
disposals
Unsafe disposal of used injection
equipment can facilitate scavenging,
repackaging and reselling

8. Safety of recipient (patient)
The risk of harming recipient can be avoided by
administering right medication with a new sterile single
use device, and observing proper technique by qualified
and well trained health workers.

9. To ensure safety to the recipient
there should be sufficient supply
of quality single use devices
throughout the year.

10. The injection provider can reduce
avoidable risks by disposing used syringe in
a puncture proof closed container
immediately after use without recapping.
Needle stick injury (NSI) is commonly
encountered by the provider especially
during recapping.
Safety of the provider (Nurse)

11. About thirty infectious diseases may be
transmitted by NSI but chances
of acquiring hepatitis B infection are much
higher than other infections.
Risk of infection after Needle Stick Injury (NSI)
HBV : 30% (30 in 100)
HCV : 3% (3 in 100)
HIV : 0.3% (3 in 1000)

12. Hence, full immunization
against Hepatitis B is
important to ensure safety
of the provider.

13. These interventions (proper disposing
technique without recapping and
vaccination) can provide protection to the
healthcare worker from occupational
infections.

14. Safety of the community
The used syringes should be
immediately disposed in a specially
designed puncture proof box or
segregated for disposal after burning &
cutting the needle.

15. Creating a climate of safety includes-
-strengthening of an infection control committee
-ensuring an adequate supply of quality disposable injecting
devices and sharps containers
-promoting injection safety awareness
-vaccination of workers against Hepatitis B & other BBVDs(Blood Born
Viral Diseases)
-supervising workers with low performance & push them to CNE
That is why CNE MCH is conducting Training in ‘safe injection
practice’ for the injection NURSES.
How to make our Nurses ‘SAFE’?

16. How to reduce the risk of infection?
---Good hand washing
---good hand drying
----strict aseptic technique
----good skin preparation
----good questioning of the client

17. INJECTION
Injections are sterile solutions, either ready
to use or prepared by dissolving an active
ingredient in water for injection.
‘Injecting’ is the act of giving medication in to
the blood vessels or body tissue through a hollow
tube or needle.
Good injection technique means less pain
and less injury.

19. Types of injections commonly practiced by
Nurses .
1.Intra dermal (ID) –in to the dermis just under the
epidermis
2.Subcutaneous (SC) –in to the tissue below dermis
(subcutaneous fat)
3.Intra muscular (IM) -in to the body muscle
4.Intravenous (IV) -in to a vein

20. Why give drugs in injection form ? (Purpose)
-to get a rapid effect, drugs given by mouth take time for
absorption
-some medicines are ineffective in GI tract by the action of
digestive juices. Eg. Insulin
-To obtain a local effect. Eg; Xylocaine
-For diagnostic test. Eg. Tuberculin test
-Test for sensitivity
-To restore blood volume in emergency conditions.

21. Needle length and size
when choosing the needle it is
important to assess the amount of
muscle, subcutaneous fat and
weight of the patient.

23. Needle size and colour
Orange-25G
Blue-23G
Black-22G
Green-21G
Yellow-20G
Rose-18G
Ash-16G

25. Equipments for the administration of injections
-clean tray
-Spirit or betadine
-Syringes of appropriate size
-cotton swab
-Medicine vial or ampoule
-Needles / cannula’s of appropriate size
-gloves, apron, mask
-patient prescription to check dose, route and timing
-nurses record

26. Clinical room preparation for the administration of
injections
-protocol/ procedure or standards of injections
-Wash basin for hand washing & Soap
-alcohol hand rub
-area for the patient to lie down
-panic button for emergency help
-sharp containers
-resuscitation equipments such as defibrillator, laryngoscope, ambu
bag etc.
-emergency drugs to treat anaphylaxis
-oxygen and mask

29. are administered into the dermis,
just below the epidermis.

30. Intradermal injections are used for:
--Sensitivity tests
--allergy tests
--local anesthesia.

31. What gauge needle do you use for ID injections?
26-or 27-gauge needle

32. The angle of administration for an
intradermal injection is?
5 to 15 degrees.

33. Small volume of 0.01 to 0.05 ml are
injected because of the small tissue
space.

35. Cont…..
--Check the expiry date of medicines,
syringes, needles and other materials
--follow the 7 rights of medicine
administrations
--check for discolouration

38. The appearance of a wheal indicates
that the medication has entered the
area between the intradermal tissues.
If a wheal does not appear, withdraw
the needle and repeat the procedure in
another site.

40. Dispose of Equipment.
Dispose of equipment
according to the standard
protocol

41. Record Administration of
Intradermal Injection.
Record the injection information
on the patient’s chart or nurses
record.

42. Remember:
--drug preparation for test dose is 0.9 ml of sterile water
& 0.1 ml of the drug
--inject the solution intradermally just enough to form a
wheal
--encircle the site correctly and write the time
--check the site after 20 to 30 minutes for the signs of
reaction
--if negative document it as (-) and if positive (+)

44. What is a subcutaneous injection?
A subcutaneous injection is aninjectiongiven into the
fat layer between the skin and muscle..

46. Upper Arm
The area between the elbow
and the shoulder at the
outer aspect.
One hand with above from
the elbow and one hand
width below from the
shoulder

47. THIGH
Area between the knee and
hip slightly to the side.
One hand width above the
knee and one hand width
below the hip.

48. Abdomen
Two inches around
the umbilical button

49. Why are subcutaneous injections given?
Because there is little blood flow to
fatty tissue and the injected medicine is
absorbed slowly.

50. General instructions
-Pinch up fatty tissue always before giving subcutaneous injections.

51. --Place the needle at 90 degree. But
for children and thin adults try it at
45 degree.

54. Medicines injecting in to the
body muscles are called
Intramuscular injections

55. IM injection sites
1.Upper arm (Deltoid)
2. Thigh ( Vastus Lateralis)
3. Hip ( ventrogluteal or gluteal medius)
4. Buttocks ( dorsogluteal or gluteal
maximus)

56. 1.DELTOID MUSCLE
Location-upper and outer aspect of
the upper arm.

57. How to locate deltoid area?
-The safe area for injection is generally defined as about three
fingers ( 1-2 Inches) below the shoulder joint at the outer side.
--‘V’ shape method-injection should go in the ½ outer side of the
‘V’ shape

58. Age limit
3 years and above
Maximum amount to be injected –
0.5 to 2 ml.

59. 2. THIGH MUSCLE ( VASTUS LATERALIS)
-It is located on the outer lateral aspect of the
thigh.
--one hand’s width above the knee to one hand’s
width below the groin or hip joint.
-

61. --When injecting in to the thigh, lift up
the Vastus Lateralis muscle away from
the bone.
--Maximum amount to be injected is 4
to 5 ml.
--This site is safe for infants and
children

62. 3 . Hip Muscle ( Ventro-Gluteal or Gluteal
Medius muscle)

63. How to locate Ventro Gluteal or hip injection site?
Place the heel of your hand
over the patients greater
trochanter and feel the
anterior superior iliac spine
with index finger( or point
the thumb towards the
patients abdomen).
The middle finger then
slides across up to the iliac
crest to make ‘ V’ shape.
The injection site is at the
middle of the ‘V’

64. Age Limit-7 months to adult.
Maximum amount of fluid –2.5 to 5 ml.
Ventro gluteal site is the safest site for
IM injections because it avoids all major
nerves and blood vessels

65. Buttocks (Dorso Gluteal or Gluteus maximus muscle)
Location-Divide one buttock in to 4 quarters (from top to bottom
and side to side)
The injection should be given in the upper and outer quarter.

66. Maximum amount of fluid –4ml.
This site is high risk of hitting
sciatic nerve and superior gluteal
artery.
To avoid this injury, divide the
upper outer quadrant again in to
4 equal part and give injection to
the upper outer quadrant of this
division.

67. Remember:
The thickness of fat in buttock’s area is greater
than the length of standard needles in obese
patients.
This may cause decreased absorption and
deposition of medicines under the
subcutaneous layer .
Later this may be an injection abscess.

68. ONCE MORE FOR YOU……

72. Z-track:
stretching the skin downwards or sideways at the site
before injection the track is closed when the skin is released,
preventing leakage.

73. NURSING IMPLICATIONS
-IM injections can be an unpleasant experience for patients
-Extra caution is required when administering IM injections to children.
-Look at the skin to ensure there are no signs of infection, damage or poor blood
supply.
-Where frequent IM injections the use of a rotation chart may be considered.
-Oedematouslimbs will not absorb medication as effectively as well-perfused
limbs.
-The nurse must have a good knowledge of the appropriate technique and
anatomy to avoid any damage to surrounding structures.
-IM injections should be avoided in patients with thrombocytopenia (a decreased
number of platelets), in whom clotting problems may occur.
-Caution must be exercised to ensure that the medication is suitable for IM
injection.

75. SEEK MEDICAL CARE IF:
The patient feels like he or she is having side
effects or an allergic reaction from the
medicine.
The medicine was injected incorrectly.
You or someone else is unable to give the
injection.
The patient has a rash, swelling, or
continued bleeding or pain at an injection
site.