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  1. 1. InjectionsDone by : Mohammed A Qazzaz
  2. 2. Routes of Medication AdministrationParenteral medication: administration of a medication by injection into body tissues Subcutaneous (SC) – into tissue below dermis of skin Intramuscular (IM) – into the body muscle Intravenous (IV) – into a vein Intradermal (ID)– into the dermis just under the epidermis
  3. 3. What is an injection?Injections are sterile solutions,emulsions or suspensions.They are prepared by dissolving,emulsifying or suspending an activeingredient and any other substances inwater for injection.Injecting is the act of giving medicationby use of syringe and needle to obtainthe desired therapeutic effect taking intoaccount the patients safety and comfort
  4. 4. How are drugs for injections presented?Single dose preparationsa pre - prepared volume of measured drug, in asyringe for single dose usei.e. Flu vaccines, Pneumovax and B12.Multidose preparationsmulti-dose preparations contain aantimicrobiacteral preservative, are used onmore than the one occasion and great care isrequired for its administration but especially it’sstorage between successive withdrawalsi.e Insulin
  5. 5. Why give drugs in injection formInjections usually allow rapid absorptionCan produce blood levels comparable to thoseof intravenous bolus injectionsInjections can be given from 1ml and up to 2mils in the Deltoid and up to 3 mls in thegluteal muscle in adultsDrugs that are altered or not absorbed byother methods of administration
  6. 6. Needle length and sizeFor intramuscular injections e.g flu, pneumoniaand B12, the needle should be long enough topenetrate the muscle and still allow a quarter ofthe needle to remain external to the skinWhen choosing the needle it is important toassess the amount of muscle, subcutaneous fatand weight of the patient - which in the majorityof cases will be a blue needle
  7. 7. Syringes Three main parts: – Barrel – chamber that holds the medication – Plunger – part within the barrel that moves back and forth to withdraw and instill medication – Tip – part that the needle is attached to Calibration: – Syringe sizes from 1 ml to 50 ml – Measure to a 1/10th or 1/100th depending on calibration
  8. 8. Needles Shaft of the needle – Length chosen depends on the depth to which medication will be instilled – Tip of shaft is beveled or slanted to pierce the skin more easily Gauge: width ofthe needle (18 – 27 gauge) – a smaller number indicates a larger diameter and larger lumen inside the needle
  9. 9. Considerations when choosing a syringe andneedle  Type of medication  Depth of tissue penetration required  Volume of medication  Viscosity of medication  Size of the client
  10. 10. Which is which needle?The correct needle is the key to delivering the drug tothe correct area for the maximum effect with the leastamount of discomfortThe colour at the top of the needle reflects its sizethe higher the number the smaller the lumen (bore)Orange needles = 25 gauge = 10mm long (3/8 inch)or 16mm long(5/8 inch) or 25mm long (1 inch)Blue needles = 23 gauge = 25mm long 9 (1 inch)Green needles = 21 gauge = 38mm long (1.5 inches)
  11. 11. Equipment for the administration of injectionsClean tray or receiver in which to place drug and equipment21g needle to ease reconstitution and drawing up (23g if from a glassampouleSyringe of appropriate sizeSwabs saturated with isopropyl alcohol 70%Sterile topical swab if drug is presented in ampoule formDrug to be administeredPatients prescription to check dose, route and timingNotes available to record administration in accordance with lawGloves, Apron
  12. 12. Clinical room preparation for the administrationof injectionsProtocols/procedure/standards information isavailableHand basin for washing hands and/or alcoholhand rub.Area for the client to lie down if unwellPanic button/phone to call for assistancesharps containerGlovesResuscitation /anaphylaxis equipment/drugsOxygen and appropriate mask if availableadequate time for procedure
  13. 13. Asepsis and reducing the risk of infectionGood hand washingGood hand dryingAseptic techniqueGood observation and questioningof the clientSkin preparation if required
  14. 14. The 7 Rights of Drug Administration Right client Right medication Right dose Right route Right time Right reason Right documentation
  16. 16. INTRADERMAL INJECTIONS Most often used for PPD Site: the inner aspect of the forearm Needle size is 25 - 27 gauge, 1/2 to 5/8 inch Insert needle at 15o angle Injection made just below the outer layer of skin If injection does not form a wheal or if bleeding is noted, the injection was probably too deep and should be repeated
  17. 17. INTRADERMAL INJECTIONS Review the provider’s order for accuracy Ask the patient/parent if the patient is allergic to the medication Wash your hands and gather supplies, equipment Select proper needle size, length and gauge
  18. 18. INTRADERMAL INJECTIONS 6 Rights of medication administration  Check the expiration date of the medication  Check for discoloration etc., discard if questionable
  19. 19. INTRADERMAL INJECTIONS Explain procedure to patient/parent Ask for assistance with children Position patient appropriately Prepare injection site with alcohol - air dry Support skin with thumb With bevel up, completely insert bevel at a 15 o angle
  20. 20. INTRADERMAL INJECTIONS Inject medication gently, place a cotton ball over the site after needle removal A visual wheal will be produced at the site Dispose of needle as per policy Wash hands Document procedure and patient’s response
  21. 21. INTRADERMAL INJECTIONSCorrect Technique Incorrect TechniqueTip of needle can be seen Little resistance and a directly beneath the shallow bulge surface of the skin  Needle inserted tooResistance should be felt deep when medication is - will cause an injected indurationTense white wheal 5-10 that is difficult to measure mm in diameter appears at the point of the needle and interpret
  22. 22. Subcutaneous injection
  23. 23. Insulin is the most importantdrug in the subcutaneousinjections
  24. 24. Insulin InsulinIndicationsType I diabetes mellitus, type II diabetes mellitus, Indicationshyperkalemia, DKA/diabetic coma Type I diabetes mellitus, type II diabetes mellitus, hyperkalemia, DKA/diabetic comaMOAStimulating peripheral glucose uptake and inhibiting MOAhepatic glucose production uptake and inhibiting hepatic Stimulating peripheral glucose glucose productionPatient Info Patient Info Hypoglycemia (BG < 70 mg/dL) esp with higher doses  Hypoglycemia (BG < 70 mg/dL) esp with higher doses – Anxiety, blurred vision, palpitations, shakiness, slurred – Anxiety, blurred vision, palpitations, shakiness, slurred speech, sweating speech, sweating Weight gain Weight gain
  25. 25. Where does it work?
  26. 26. Insulin (cont)Administration: Subcutaneous injection Rotate site Check blood sugars regularlyStorage: 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 90 days)
  27. 27. Insulin (cont)Dosing: Starting daily dose: 0.5-1 unit/kg/day in divided doses Adjust according to fasting (premeal) blood glucose of 80-130 mg/dL and peak postprandial blood glucose < 180 mg/dL Provide 50% as long acting insulin and 50% as prandial insulin 1 unit of can account for 30 grams of carbohydrate (14-50) 1 unit can lower 50 mg/dL blood glucose (10-100)Special Population Consderations: Renal dysfunction – CrCl 10-50 mL/min: 75% of normal dose – CrCl < 10 ml/min: 25-50% of normal dose; monitor closely Exercise??? ---- Acute Stress???
  28. 28. Insulin Action Rapid/immediate Intermediate Blood concentration Fast Slow 0 2 4 6 8 10 12 14 16 18 20 22 24 Time (hr)
  29. 29. Insulin Dosing Long-acting Long-acting & Short-acting Normal insulin secretion 70/30 pre-mixed
  30. 30. Insulin Administration
  31. 31. Insulin (cont)Cautions/Severe Adverse Reactions Severe hypoglycemia (seizure/coma) (BG < 40 mg/dL) Edema Lipoatrophy or lipohypertropy at injection siteCONTRAINDICATIONS Severe hypoglycemia Allergy or sensitivity to any ingredient of the product
  35. 35. IM INJECTION SITES Deltoid Dorsogluteal Ventrogluteal Vastus lateralis
  39. 39. VASTUS LATERALIS Institute of Nursing Theory and Practice, Prague 2007
  40. 40. Intramuscular Injections and PainThe needleThe techniqueThe speed of the injectionThe solution and composition of the drugThe volume of the drugThe approach and attitude of personadministering the injection
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