Types of injection

About injections

1. Types of inJectionS

2. Sonali Harsh Raj

3. INJECTION TECHNIQUE Giving an injection safely is considered to be a routine activity. However, it requires knowledge of anatomy and physiology, pharmacology, psychology, communication skills and practical expertise. A safe injection is one that does not harm the recipient, does not expose the provider to any avoidable risks and does not result in waste that is dangerous for the community.

4. INJECTION It is an infusion method of putting fluid into the body, usually with a syringe and a hollow needle which is pierced through the skin to a sufficient depth for the material to be administered into the body. Syringe – a device made of a hollow tube and a needle that is used to force fluids into or take fluids out of the body

5. INTRADERMAL INJECTION SUBCUTANEOUS INJECTION INTRAMUSCULAR INJECTION INTRAVENOUS INJECTION INJECTION TECHNIQUE

6. 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.

7. INTRADERMAL INJECTION Most commonly used site: Inner surface of the forearm. Subscapular region of the back can be used as well as the deltoid region.

8. 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 (-); if positive, ANST (+)

9. SUBCUTANEOUS INJECTION Subcutaneous tissue lies between the epidermis and the muscle. Subcutaneous route is used for slow, sustained absorption of medication . Used commonly for insulin injections Heparin

10. 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

11. REMEMBER: Hold syringe in the dominant hand between the thumb and forefinger. Inject the needle quickly at an angle of 45 to 90 degree, depending on the amount and turgor of the tissue and the length of the needle.

12. INTRAMUSCULAR INJECTION The intramuscular (IM) route injection delivers medication into well perfused muscle, providing rapid systemic action and absorbing relatively large doses. Gastric disturbances do not affect the medication. Clients does not need to be conscious to receive the medication. Absorption occurs even more rapidly than with SQ route because of greater vascularity of muscle tissue. Irritating drugs are commonly given IM because very few nerve endings are in deep muscle tissues.

13. 5 SITES ACCEPTABLE FOR IM INJECTION Deltoid muscle of the upper arm – Preferred site for vaccinations in adults. Dorsogluteal – Performed by entering through the gluteus maximus muscle. Care should be given to avoid damage to the sciatic nerve and vessels surrounding this area. Ventrogluteal – Safer option which accesses the gluteus medius muscle. (Primary location for IM use as it avoids all major nerves and blood vessels)

14. 5 SITES ACCEPTABLE FOR IM INJECTION Vastus Lateralis – A quadriceps muscle situated on the outer side of the femur and is used as a primary site for children. It does have risks associated to it due to overuse but has been suggested safe for children up to seven months old. Rectus Femoris – Anterior quadriceps muscle which is rarely used by physicians/nurses but is easily accessed for self- administration, or for infants.

15. REMEMBER: 3cc syringe can be used for IM 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)

16. peripheral venous catheter  A device used to draw blood and give treatments, including intravenous fluids, drugs, or blood transfusions. A thin, flexible tube is inserted into a vein, usually in the back of the hand, the lower part of the arm, or the foot. A needle is inserted into a port to draw blood or give fluids .

17. Use The catheter is introduced into the vein by a needle (similar to blood drawing), which is subsequently removed while the small plastic  cannula remains in place. The catheter is then fixed by taping it to the patient's skin or using an adhesive dressing. A peripheral venous catheter is the most commonly used vascular access in medicine. It is given to most  emergency department  and  surgical  patients, and before some  radiological  imaging techniques using  radiocontrast , for example. In the United States, in the 1990s, more than 25 million patients had a peripheral venous line each year. [1] A peripheral venous catheter is usually placed in a vein on the hand or arm. It should be distinguished from a  central venous catheter  which is inserted in a central vein (usually in the  internal jugular vein  of the neck or the  subclavian vein  of the chest), or an  arterial catheter  which can be placed in a peripheral or central artery. In children, a topical  anaesthetic  gel (such as  lidocaine ) may be applied to the insertion site to facilitate placement

18. Complications Infection ,  phlebitis ,  extravasation ,  infiltration ,  air embolism ,  hemorrhage  (bleeding) and formation of a  hematoma  (bruise) may occur. Because of the risk of insertion-site infection the  CDC  advises in their guideline that the catheter needs to be replaced every 96 hours. [2] However, the need to replace these catheters routinely is debated. [3]  Expert management has been shown to reduce the complications of peripheral lines. [1] [4] Sizes Sizes of peripheral venous catheters can be given by  Birmingham gauge  or  French gauge . Gauge and diameter are inversely proportional

19. infusion system An infusion system is a device, and any associated disposables, used to deliver fluids or drugs in solution to the patient. The common routes are: intravenous, subcutaneous, epidural or enteral. The simplest devices, gravity controllers, employ a clamping action to vary the flow of liquid under the force of gravity. More complex systems use a positive pumping action for infusion. The simplest of these is an elastomeric pump which has a balloon reservoir which contracts delivering the infusion at a constant rate