8/14/2019 Safe Injection Techniques[1]

1/27

8/14/2019 Safe Injection Techniques[1]

2/27

The IntradermalRoute

8/14/2019 Safe Injection Techniques[1]

3/27

The intradermal route provides a local,rather than systemic, effect and is used

primarily for diagnostic purposes suchas allergy or tuberculin testing, or forlocal anesthetics. To give an ID injectiona 25-gauge needle is inserted at a 10-

15 angle, bevel up, just under theepidermis, and up to 0.5ml is injecteduntil a wheal appears on the skinsurface

If it is being used for allergen testing,the area should be labeled indicatingthe antigen so that an allergic response

can be monitored after a specified timela se.

8/14/2019 Safe Injection Techniques[1]

4/27

The sites suitable for intradermaltesting are similar to those for

subcutaneous injections but alsoinclude the inner forearm and shoulderblades When testing for allergies, it isessential to ensure that ananaphylactic shock kit is easilyaccessible in case the patient developsa hypersensitive reaction

8/14/2019 Safe Injection Techniques[1]

5/27

8/14/2019 Safe Injection Techniques[1]

6/27

8/14/2019 Safe Injection Techniques[1]

7/27

The subcutaneousRoute

8/14/2019 Safe Injection Techniques[1]

8/27

Medication, up to 1-2ml beinginjected into the subcutaneous tissue.

It is ideal for drugs such as insulin,which require a slow and steadyrelease, and as it is relatively painfree, it is suitable for frequent

injections

8/14/2019 Safe Injection Techniques[1]

9/27

8/14/2019 Safe Injection Techniques[1]

10/27

Insulin that is injected into muscle isabsorbed more rapidly and can lead to

glucose instability and potentialhypoglycemia. Hypoglycemic episodes mayalso occur if the anatomical location of theinjection is changed, as insulin is absorbedat varying rates from different anatomicalsites Therefore insulin injections should besystematically rotated within an anatomicalsite for example, using the upper arms orabdomen for several months, before there is

a planned move elsewhere in the body.When a diabetic patient is admitted tohospital, the current injection area shouldbe assessed for signs of inflammation,

edema, redness or lip hypertrophy, and

8/14/2019 Safe Injection Techniques[1]

11/27

It is no longer necessary to aspirateafter needle insertion before injecting

subcutaneously. reported studies thatfound blood was not aspirated prior toSC injection, indicating that piercing ablood vessel in a SC injection was veryrare. Additionally, patient educationliterature from the manufacturers ofinsulin devices does not advocate

aspiration before injection. It has alsobeen noted that aspiration beforeadministration of heparin increases therisk of hematoma formation .

8/14/2019 Safe Injection Techniques[1]

12/27

Pinch up a skin fold during subcutaneous injection

8/14/2019 Safe Injection Techniques[1]

13/27

Pinch up a skin fold during subcutaneous injection

8/14/2019 Safe Injection Techniques[1]

14/27

The intramuscularRoute

8/14/2019 Safe Injection Techniques[1]

15/27

Prepare patients with appropriateinformation before the procedure, so

that they understand what ishappening and can comply withinstructions

Change the needle after preparationof the drug and before administrationto ensure it is clean, sharp and dry,and the right length

8/14/2019 Safe Injection Techniques[1]

16/27

8/14/2019 Safe Injection Techniques[1]

17/27

8/14/2019 Safe Injection Techniques[1]

18/27

Rotate sites so that right and leftsites are used in turn, and document

rotation

Enter the skin firmly with acontrolled thrust, positioning theneedle at an angle as near to 90aspossible, to prevent shearing andtissue displacement

8/14/2019 Safe Injection Techniques[1]

19/27

Inject medication steadily andslowly: about 1ml per ten seconds to

allow the muscle to accommodate thefluid

Allow ten seconds after completion

of injection to allow the medication todiffuse and then withdraw needle atthe same angle as it entered

Do not massage the site afterwards,but be prepared to apply gentlepressure with a gauze swab

8/14/2019 Safe Injection Techniques[1]

20/27

8/14/2019 Safe Injection Techniques[1]

21/27

Patients are often afraid of receivinginjections because they perceive that it will

be painful. The pain of IM injections may beregistered in the pain receptors in the skin,or the pressure receptors in the muscle.listed a number of factors which cause pain:

The needleThe chemical composition of the drug or itssolution.The technique.

The speed of injection.The volume of drug.

8/14/2019 Safe Injection Techniques[1]

22/27

Patients may have a needle orinjection phobia which causes themanxiety, fear and increased pain everytime they require an injection .

Good technique, appropriate patientinformation and a calm and confidentnurse will help to reduce anxiety.

8/14/2019 Safe Injection Techniques[1]

23/27

Distraction or behavior modificationtechniques may be useful,

particularly for long courses oftreatment, and the use of needle lesssystems may reduce needle relatedanxiety.

It has been suggested thatnumbing the skin with ice or freezingsprays before inserting the needlemay reduce pain

8/14/2019 Safe Injection Techniques[1]

24/27

Nurses need to be aware that patientsmay experience syncope or dizziness

after a routine injection, even ifotherwise apparently fit and well.

Ascertaining the patients history and

usual response to injections, ensuringthat the area is safe and that a couch isreadily available for them to lie down,will reduce the risk of injury.

Experience suggests that those mostprone to fainting, though notexclusively, are teenagers and youngmen.

8/14/2019 Safe Injection Techniques[1]

25/27

8/14/2019 Safe Injection Techniques[1]

26/27

Complications that occur as a resultof infection can be largely prevented by

strict aseptic precautions and goodhand-washing practice.

Sterile abscesses may occur as a

result of frequent injections to one siteor poor local blood flow. Sites that areedematous or paralyzed will havelimited ability to absorb the drug and

should not be used.

8/14/2019 Safe Injection Techniques[1]

27/27