4. SELECTING DEVICES
Type of injection
Must be suitable for injection site
Viscosity and volume of injection
Age of patient
Condition of patient
5. 8
Allows user to attach the needle to a syringe
by either a luer lock or a luer slip connection
.
All safety-engineered needles are color coded to
denote the gauge of the needle
.
(See chart on
pages 14 and 15
.
)
Designed to protect the user from
accidental needlestick injuries
.
Safety technology for injection
needles include retracting syringes,
shielding needles and sliding
sleeve syringes
.
Most needles are made of stainless steel, which
is siliconized to allow easier penetration force
.
Available in different lengths and gauges to suit
individual clinical and patient needs
.
There are three types of needle walls 1
:
Regular wall: This is the most common wall thickness
.
The thickness of the steel wall minimizes flexing when the
needle is inserted into a vial stopper or patient
.
Thin wall: As shown in the diagram, the thin wall needle
has a narrower steel wall, allowing a greater volume of
fluid to pass through it
.
The flow rate is typically equivalent
to that of a regular wall needle one gauge larger
.
This is
especially important with very thin needles
.
Extra thin wall:
This has the
thinnest steel
wall, designed
to increase the
benefits of the
thin wall needle
.
Thin
wall
Extra thin wall
9
The sharpened angular tip at the end of the needle
.
There are typically four types of bevels used for skin injections
.
Regular bevel: The most common bevel, used for a vast
majority of applications
.
Typically used for intramuscular
and subcutaneous injections
.
Short bevel: Used for specialty applications such as arterial
blood gas sampling and nerve blocks
.
Intradermal bevel: This needle bevel is used primarily for skin
testing (e
.
g
.
, allergy tests)
.
5-bevel: The two additional bevels create a flatter, thinner
surface that is perceived to have less pain
.
*,2
Hub
Bevel Needle
Safety mechanism
Product photo enlarged, not actual size
*Study was not conducted on all needle sizes
.
Regular
wall
7. Needle length and gauge selection
INTRAMUSCULAR (IM) * Location of injection Needle length Needle gauge Needle angle
Pediatric
Infants < 12 months Vastus lateralis muscle (< 0
.
5 mL vol
.
) 22 mm – 25 mm 25 – 27 G 90 ˚
Toddlers and children
months to 18 years )
(12
Deltoid muscle
Ventrogluteal site
Dorsogluteal site (not recommended for < 3 years)
Vastus lateralis muscle
22 mm – 30 mm – 25 G
22 ˚
90
Adult
> 18 years
Deltoid muscle
Ventrogluteal site (may be best site for
cachectic adults)
Dorsogluteal site (avoid in obese adults)
Vastus lateralis muscle
25 mm – 40 mm (up to 76 mm
for large adults)
19 – 25 G 90 ˚
SUBCUTANEOUS (SubQ) Location of injection Needle length Needle gauge Needle angle
Pediatric to adult
Anterolateral thigh
Upper outer tricep area; upper buttocks
Abdomen (avoid 50 mm radius around umbilicus)
Insulin delivery: 4 mm – 13 mm
Other injections: 13 mm – 16 mm
Insulin delivery:
29 – 32 G
Other injections:
26 – 31 G
45 ° – °
90
INTRADERMAL (ID) Location of injection Needle length Needle gauge Needle angle
Pediatric to adult
Anterolateral aspect of forearm
Upper chest
Upper back
Back of upper arm
mm
10 – 19 mm 26 – 28 G 10 ˚ – 15 ˚
gauge selection 4
Needle length dependent on
age, physical condition and
medication requirements.
8. PREPARATION
Hand hygiene
Checking the medication single-dose
ampule, vial or multi dose vial
Verify that length and gauge of needle is
appropriate
Check time and date the medication
perform hand
9. How to prepare & give an injection
When you receive an injection :
. The expiry date
. Strength of the medication
. Route
. Inspect the vial
10. Setting up for an injection
Clean tray
Draw sheet / rubber sheet
Betadine / sterilium / methylated spirit
Cotton swab
Medicine vial or ampoule
Syringes/needle/ cannulas of appropriate size
Gloves ,apron, mask
11. Injection tray
Splint
Plasters/files
Kidney tray
0.9% Nacl / distilled water
Patient prescription to check dose, route and
timing
Nurses record
12. PREPARATION OF PATIENT
Identification
Explain the procedure to the client
Provide privacy
Take assistance in case of children
Comfortable position
Suitable site for injection
Skin preparation
13. CLINICAL ROOM PREPRATION
Protocol/procedure or standards of injections
Hand washing area
Alcohol hand rub
Clean surrounding
Area for the patient to lie down
Calling bell
Resuscitation equipment's
Emergency drugs /Oxygen
15. ADMINISTRATION
RIGHTS
RIGHT MEDICATION
RIGHT PATIENT
RIGHT ROUTE
RIGHT DOSE
RIGHT TIME
RIGHT PATIENT EDUCATION
RIGHT DOCUMENTATION
RIGHT TO REFUSE
RIGHT ASSESSMENT
RIGHT EVALUATION
17. Skin preparation
Before administering any
injection skin should be
cleaned with antiseptic swab
Apply swab at the point of
insertion
Clean in circular motion about
5 cm around the injection site
Allow to air dry
26. What is injection safety
Injection safety includes:
Practices intended to prevent transmission of infectious
Disease
An injection is said to be safe :
no harm the recipient
not expose the provider to avoidable risk
not result in wastes that is dangerous for the community
27. Why to follow safe injection
practices
A set of measures to perform injections in an
optimally safe manner for patients
According to a study in India an estimated
46% of hepatitis B cases and 38% of hepatitis
C & 12% of HIV cases in India spread through
the reuse of needles and syringes
28. SAFE INJECTION PRACTICES
Universal precautions
Use a sterile single use disposable syringes
Prevention of any form of contamination to the
medications or vaccines to be injected
Prevention of sharp injuries
Proper waste disposal
29. SAFE INJECTION PRACTICES
The CDC recommends to follow the basic
rules while administering the injections
Use aseptic techniques
Don’t administer medications from a syringe to
multiple patients even if the needle or cannula
on the syringe is changed
30.
31. Safe injection practices cont.…
Use separate fluid infusion and administration
sets for one patient
use single-dose vials for parental use
Don’t use single-dose vials to multiple patients
or combine leftover contents for later use
Don’t use bags or bottles of iv as a common
32. SAFE INJECTION PRACTICES
If MDV are used, both the needle and syringes
must be sterile
Don’t keep MDV in the immediate patient
treatment area, and it should be store as per
manufactures recommendations ;discard if
sterility is compromised
33.
34. UNSAFE INJECTION PRACTICES
Using the same syringe
Using a common bag of saline
leaving an IV set for dispending
fluids
Accessing the bag with a syringe
that has already been used to flush
a patients IV
35. UNSAFE INJECTION PRACTICES
UNHYGENIC PRACTICES
Poor hand hygiene
Improper cleaning of injection site
Touching the needle
Leaving the needles in a multi dose vials
37. UNSAFE INJECTION PRACTICES
WRONG TECHNIQUE
Wrong selection of injection site
Using medication without checking labels and
expiry date
Using SDV for more than one patient
Recapping the needle after the use
BIOMEDICAL WASTE
Improper segregation
38.
39. SINGLE DOSE VIALS (SDV)
A single dose vial (SDV) is approved for a
single procedure or injection
SDVs typically lack an antimicrobial
preservative
Don’t save it
Harmful bacteria can grow
Discard after every use
40. MULTIPLE DOSE-VIAL(MDV)
It is recognized by its FDA-approved label
MDVs can be used for multiple patient
When aseptic technique is followed
MDVs typically contain an antimicrobial
preservative
Discard MDVs when the beyond use date has
been reached
Any time the sterility of the vial is in question
41. PREVENTION
Follow standard precautions
NO CHANCE for transmission of blood borne
viruses
Follow aseptic technique
Use single-dose vials for parenteral medications
Proper hand hygiene
Clean the vial with spirit
42. PREVENTION
One syringe , one needle, one time
If you are using a SDV and it has already been
accessed (e.g., Needle puncture) throw it away
If it is MDV, double check the expiry date and
visually inspect to ensure there is no visual
contamination
When in doubt , throw it out
43. Role of health care profession
Education and training of staff
Patient/caregiver education and involvement in
decision making
Documentation
Reporting all patient safety incidents
Research, audit, assurance
