INJECTIONS

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• INJECTIONS
• Dr. Jay Shahed

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Equipment needed

• needles
• alcohol swap
• gauze 2x2
• band-aid

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VIALS

• Single dose
• multi dose - swap the tip before every use.
• Never return excess medication into vial .

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NEEDLE SIZE
WIDTH Gauge(14 - 28 ) 14 VENIPUNCTURE 21 IM
25 SC 28 ID LENGTH (3/8 - 4 inches) 3/8
ID 5/8 SC 1 1/2 IM 4 IV
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• Note
• The larger the number the smaller the lumen of
  the Gauge.
• E.g. 27g is smaller than a 20g

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TYPES OF INJECTABLE

• Cartilage Tubex
• Prefilled Syringes
• Disposable Syringes.
• Biojector (high speed injection) no needle

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• Medication Administration

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The Six Right

• Right Patient
• Right Drug
• Right Dose
• Right Route
• Right Time
• Right Documentation

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The Three Befores (Checking Dose)

• Before removing from shelf.
• Before pouring.
• Before returning meds. to shelf.

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Assessing The Patient Before Administrating
Medications

• Check pt. History
• Check current status of patient
• Check if patient is taking any over counter meds
• Check if patient has any allergies
• Check the patient height, weight and age
• Check the injection site
• Observe patient for any reaction after
  administration of drug

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TIPS ABOUT INJECTION ADMINISTRATION

• Three befores/ six rights
• Glove , swap, stretch skin.
• Insert needle swiftly.
• Push medication slowly.
• Stay away from bone, vessels, nerves, scars,
  pigmentation, moles, warts, no lymphatics areas.

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• Prepare medications without patients noticing.
• Recap if need to transfer syringes.
• Transfer syringes on tray.
• Explain procedure if pt. Never had injections
  before
• Never tell pt. It hurts, say it will possibly
  pich a little.

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• INJECTION PROCEDURES

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Intramuscular (IM) (Deltoid)

• Given when medication is irritant aqueous.
• More rapid absorption than SQ or ID.
• If volume is large (2-3 ml.)
• At a 90 degree angle (straight down).
• Always grasp a bulk of muscle before injection to
  keep bone away.
• Most frequently used in antibiotic administration.

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PROCEDURE

• GOAL
• To inject 2cc of medication into the muscle.
• Select the current medication from the shelf or
  the refrigerator.
• Warm refrigerated medications by gently rolling
  between palms.
• Prepare the syringe, calculating the right dose.
• Do the 6 rights

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• Position the patient comfortably
• Expose the site
• Cleanse the patients skin with the antiseptic
  sponge.
• Pinch a large portion of the muscle at the site
  to be injected.
• With one swift movement, insert the entire needle
  up to the hub, at a 90-degree angle into the
  muscle.

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Intramuscular Vastas Laterals (thigh)

• Quadriceps group.
• The most frequent safest site used in
  infants.(developed completely at birth)
• One hand below the greater trochanter must
  massage after.
• INFANTS AND CHILDREN

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PROCEDURE

• Wash hands.
• Select the correct pose.
• Position child or infant.
• Cleanse site.
• Hold infants anterior thigh.
• Swift needle fast at 90 degrees manually.
• Aspirate manually.

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• Inject slowly.
• Cover site C gauze.
• Place a bandage

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Dorsogluteal (gluteus Medius).

• Given 90 degree angle.
• All deep IM
• Most frequent site for z-tract.
• Not used in infant.
• Given in the OUQ area (away from sciatic nerve).
• Used for large volumes (greater than 3 ml).
• Must massage after.

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PROCEDRUE

• Lay patient in prone position
• Locate site 3 fingers away from the iliac crest
  in the outer upper quadrant of the buttock
• Grasp a muscle
• Inject swiftly 90 degrees
• Aspirate inject needle slowly.
• Remove needle.
• Cover injection site.

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Ventrogluteal (Gluteus Medius) Site (IM)

• PROCEDURE
• Locate the greater trochanter of femur.
• Place hand on side of thigh.
• Spread middle fingers.
• Inject in between middle fingers.
• Aspirate one hand.
• Inject medication slowly.
• Remove syringe and lower injection site.

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Z - Tract (IM)

• Given 90 degree angle.
• Used frequently glutealy.
• Used for irritable medications.
• Prevent leakage.
• Must massage after.

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PROCEDURE Z-TRACT INTRAMUSCULAR INJECTION

• Cleanse the patients skin.
• Pull the skin to one side and hold it firmly in
  place. If the skin is slippery, use a dry gauze
  sponge to hold the skin in place.
• Grasp the syringe as you would a dart, with one
  swift movement, insert the entire needle up to
  the hub, at a 90-degree angle into the muscle.
• Aspirate Withdraw the plunger slightly.

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• If no blood appears in the syringe, push in the
  plunger slowly and steadily until all medication
  has been administered.
• Wait a few seconds, cover the area with the
  sponge, and withdraw the needle at the same angle
  of insertion.
• Gently massage the site with the antiseptic
  sponge.
• Observe the patient for 20 to 30 minutes.

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Sub Cutaneous (SC, SQ)

• Given at 45 degree angle.
• In the Deltoid muscle.
• Must massage after.

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PROCEDURE

• Wash your hands.
• Select the correct medication from the shelf or
  the refrigerator.
• Do 3 Ds
• Warm refrigerated medications by gently rolling
  the container between your palms.
• Position the patient comfortably.
• Expose the site.

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• Cleanse the patients skin with the antiseptic
  sponge.
• Compare the order with the prepared medication.
• Form a skin fold by picking up the tissue or by
  pulling the skin taut.
• With one swift movement, insert the entire needle
  up to the hub at a 45-degree angle.

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• Aspirate
• If blood appears, immediately withdraw the
  syringe, and compress the injection site with the
  sponge.
• If no blood appears, push in the plunger slowly
  and steadily until all medication has been
  administered.
• Cover the area with the sponge, withdraw the
  needle at the same angle of insertion.

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• Gently massage.
• Observe the patient for 20 to 30 minutes.
• Record the drug administration on the patients
  medical record.

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INTRADERMAL INJECTION

• 15 degree angle.
• Allergy shots.
• Forms a wheal
• No massage.

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PROCEDURE

• GOAL
• To inject 0.1 cc of medication into the skin
• Wash your hands.
• Select the correct medication from the shelf or
  the refrigerator.
• Read the label.
• Warm refrigerated medications by gently rolling
  the container between your palms.

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• Prepare the syringe, withdrawing the right dose.
• Greet and identify the patient by name.
• Position the patient comfortably. 8. Locate, then
  find a site down the forearm
• Cleanse the patients skin

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• Allow the antiseptic to dry
• Do the 6 rights
• Do 3 Ds
• Stretch the skin.
• Grasp the syringe between the thumb and first two
  fingers
• At a 15-degree angle, carefully insert the needle
  through the skin about 1/8 inch,keeping the
  needle visible through the skin.

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• Turn the syringe 180 degrees to turn the bevel
  downward, to prevent medication from breaking
  through the skin.
• Slowly and steadily inject the medication.
• When a wheal appears, stop.
• Do not massage.
• Observe the patient for 20 to 30 minutes.

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• MED ROUTE SITESa. PCN IM
  Deltoid, Glut, VL. b. Epinephrine IM
  Same c. Demerol IM Same d.
  Vitamin B12 IM / Z Gluteale. Insulin
  SQ vas.lat.f. Vaccines
  SQ deltoid, g.
  allergy ID forearm h.
  T.B. ID forearm

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LEGAL AND ETHICAL RESPONSIBILITIES

• The medical assistant is ethically and legally
  responsible for her or his actions, the law will
  not permit the careless actions of health care
  workers to go unpunished, specially if harming a
  patient is involved , therefore the MA must obey
  by all the correct steps of administering
  injection under the authorization of their
  physician.

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• The patient always comes first, you cant afford
  giving the wrong medication to the patient, there
  is no chance for the a slight mistake

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BE CAREFUL