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Questions and Answers
Which factor is most important when selecting a needle for intramuscular administration?
What is the preferred site for insulin administration?
Which of the following is a critical safety protocol during parenteral medication administration?
What is the best practice for selecting an injection site for subcutaneous administration?
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Which labeling practice is considered best when preparing injections?
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What is the maximum volume that can safely be administered intramuscularly into the deltoid muscle?
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Which gauge needle is typically recommended for intramuscular injections?
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When administering insulin, what is the specific gauge size recommended for the needle?
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Which injection site is considered the preferred location for most intramuscular injections?
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What is a crucial step to take immediately after using a needle for an injection?
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What should be documented after administering an injectable medication?
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In subcutaneous injections, the optimal angle for needle insertion is typically:
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What is the best practice regarding syringe labeling during the preparation process?
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Which injection site should be used as a last alternative for intramuscular injections?
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What is an important consideration when administering anticoagulants subcutaneously?
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For intradermal injections, the correct angle of needle insertion is:
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What should be done to minimize pain during a subcutaneous injection?
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How should safety needles be utilized according to safety protocols?
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When preparing for an injection, what is an essential step in patient assessment?
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Which type of syringe should be avoided for injections exceeding 3 mL?
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What is the recommended cleaning procedure for preparing the skin before an injection?
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Which part of the syringe can be safely handled without compromising sterility?
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Which of the following is the appropriate syringe for administering 0.5 mL of medication?
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When using an insulin syringe, what should be prioritized?
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When administering subcutaneous injections, what volume is typically allowed per injection?
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Which syringe type is specifically used for drawing insulin?
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What is the maximum volume typically recommended for intramuscular injections?
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Study Notes
Routes of Parenteral Medication Administration
- Intradermal (ID): Medication is injected into the dermis, the layer of skin just below the epidermis. This route is used for medications that need to be absorbed slowly, such as allergy testing and tuberculosis testing.
- Subcutaneous (subcu or sq): Medication is injected into the subcutaneous tissue, the layer of fat and connective tissue just below the dermis. This route is used for medications that need to be absorbed faster than intradermal injections, but slower than intramuscular injections.
- Intramuscular (IM): Medication is injected into a muscle. This route provides for quicker absorption of medication as muscular tissue has many blood vessels.
- Intravenous (IV): Medication is injected directly into a vein. This route provides the fastest absorption of medication.
Why Administer Medications by Injection?
- The patient is unable to take medication orally (NPO).
- The medication is only available in an injectable form.
- The injection route may provide increased efficacy of the medication.
Preventing Infection
- Sterile Technique: Must be followed when preparing and administering medications by injection.
- Injections are invasive procedures: They create a portal of entry for microorganisms.
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Measures to prevent infection:
- Use sterile equipment.
- Cleanse the injection site with an antiseptic wipe.
- Wear gloves.
- Follow proper technique.
Intramuscular Volumes
- Larger Muscles (Ventrogluteal, Vastus Lateralis): Typically 3 mL, but no more than 5 mL.
- Children, Older Adults, and Smaller Adults: 1-2 mL.
- Deltoid: Up to 1 mL only.
Needle Sizes
- Gauge: Refers to the diameter of the needle. The larger the gauge number, the smaller the needle diameter.
- Length: Determined by the size and weight of the patient and the route of administration (ID, SQ, IM).
Average Needle Lengths and Gauges: Intradermal, Subcutaneous & Insulin
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Intradermal:
- Length: 1/4” – 1/2”
- Gauge: 25 – 27
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Subcutaneous:
- Length: 1/2” – 5/8”
- Gauge: 25 – 27
-
Insulin:
- Length: 1/2 “
- Gauge: 29 - 31
- Must be used for insulin ONLY.
Average Needle Lengths and Gauges: Intramuscular
- Gauge for all: 19 – 25 (usually 22 – 25)
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Deltoid:
- Length: 1” to 1-1/2”
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Vastus Lateralis:
- Length: 1” to 1-1/2”
-
Ventrogluteal:
- Length: 1” to 1-1/2”
Safety Needles
- Required by law (OSHA): All healthcare facilities must provide their employees with safety needles to protect them from accidental needle sticks.
- Healthcare providers are responsible: for using safety needles correctly.
Syringes
- Luer-lock: The needle locks into place by twisting it onto the syringe.
- Non-luer-lock (slip tip): The needle can be pulled straight off.
- Non-removable: The needle is permanently attached to the syringe (some insulin or tuberculin syringes).
Labeling of Syringes
- Patient safety issue: Unlabeled syringes pose a significant risk of medication errors.
- Best Practice - National Patient Safety Goal: All syringes must be labeled with the name of the drug and dosage during the preparation process.
- Institute for Safe Medication Practices (ISMP): www.ismp.org
General Principles: Administering Any Injectable Medication
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Universal Steps:
- Review the MAR (medication administration record).
- Note where the last injection was given.
- Perform three safety checks with the five rights.
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Patient Assessment: Select the appropriate injection site.
- Inspect the skin and avoid areas with scars, bruises, inflammation, edema, etc.
Injection Sites
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Intramuscular:
- Ventrogluteal: Preferred site for most injections.
- Vastus lateralis: Common site.
- Deltoid: Can be used but is not as well developed in most people.
- Dorsogluteal: Last choice (not mentioned in the textbook).
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Subcutaneous:
- Most common: Outer, posterior aspect of the upper arm, abdomen, & the anterior surface of the thigh.
- Alternative sites: Upper back.
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Intradermal:
- Forearm: Most common.
Injection Site Selection: Ventrogluteal
-
Landmarks:
- Place the heel of your hand over the greater trochanter (bone on the side of the hip) - Your right hand if the patient is on their right side, left hand if the patient is on their left side.
- Point your thumb toward the groin.
- Point your index finger toward the anterior, superior iliac spine.
- Extend your middle finger toward the buttock. You have now formed a V-shaped triangle.
- Inject into the middle of the V.
Injection Site Selection: Vastus Lateralis
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Landmarks:
- Place one hand over the knee.
- Place one hand at the greater trochanter.
- The injection site is in the center of the muscle.
Injection Site Selection: Deltoid
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Landmarks:
- Place one finger directly on the acromion process (bony bump at the top & side of the shoulder).
- The site is about 2-3 finger widths below the acromion process. The injection site is in the middle of the muscle.
Injection Site Selection: Dorsogluteal
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Landmarks:
- Posterior, superior iliac spine (bony bump on the back of the hip).
- Greater trochanter (bone on the side of the hip).
- Draw an imaginary line between these landmarks.
- The upper outer aspect of the buttock is the injection site.
General Principles: Intramuscular Administration
- Follow guidelines and competency evaluation sheet.
- Hold the skin taut (tight).
- Dart the syringe/needle at a 90-degree angle.
- DO NOT RECAP THE NEEDLE.
- Discard needle/syringe into the sharps container.
- Position the patient in a comfortable position.
- Document on the MAR.
- Do not leave the syringe/needle in the bed.
Z-track Method: Intramuscular Injections
- Used to prevent leakage of medication after administration.
- Minimizes skin irritation with irritating medications administered IM.
- Always change the needle after preparation.
- Pull the skin and subcutaneous tissue to the side and inject.
- Aspirate (if facility policy) and inject slowly as you continue to hold the tissue to the side; keep the needle in for 10 seconds.
- Withdraw the needle and release the skin.
Subcutaneous Injection and the Older Adult
- Age-related changes in the skin: Thinning of the epidermis, decreased blood flow, loss of subcutaneous fat.
Subcutaneous Injections: Medication Considerations
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Anticoagulants:
- Abdomen is preferred site.
- Choose site at least 2 inches from the umbilicus.
- Never massage the area after administration.
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Insulin:
- Do not rub or massage area after administration.
- Apply light pressure to the area to prevent leakage of insulin.
- Rotate sites of administration to avoid irritation.
- Always use an insulin syringe (which typically has an orange cap).
Intradermal Injections
-
Site selection:
- Forearm (most common).
- Inner aspect of the forearm, 3-4 finger widths below the antecubital space (elbow crease) and one hand width above the wrists.
- Preparation: Relax the arm with the elbow and forearm extended on a flat surface.
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Injection:
- Stretch the skin over the site with your forefinger and thumb.
- Insert the needle slowly at a 5-15-degree angle, keeping the bevel up.
- Insert until resistance is felt.
- Advance to no more than 1/8 inch below the skin.
- Do not aspirate.
- Slowly inject the medication.
Preventing Infection
- Needle Contamination: Avoid letting the needle touch any surface.
-
Syringe Contamination:
- Avoid touching the plunger.
- Avoid touching the inside of the barrel.
- Keep the tip of the syringe covered with the needle.
- Medication Vial Contamination: Maintain aseptic technique when preparing medication from a vial.
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Prepare skin properly:
- Wash soiled skin with soap and water.
- Use friction and a circular motion while cleaning with an alcohol swab, moving from the center of the site to the outside.
Equipment Needed for Parenteral Medication Administration
- MAR (medication administration record).
- Alcohol swabs.
- Safety needle.
- Medication.
- Non-sterile gloves.
- Syringe.
Syringes and Needles: Sterile Areas
-
Syringe:
- Tip of barrel
- Inside of barrel
- Hub
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Needle:
- Shaft
- Needle
- You may only handle the outside of the syringe and the handle of the plunger.
Syringe Sizes
- 0.5 ml - 60 ml
- Never need to use a syringe larger than 3 ml for injections.
Types of Syringes
- Hypodermic: Measures in tenths of a milliliter.
- Insulin: Measures in units (0-100 units) and is ONLY to be USED for insulin.
- Small Volume (1 mL): Hundreds of a milliliter.
Choosing the Correct Syringe
- Less than 1 mL: Tuberculin (TB) syringe or hypodermic syringe.
- More than 1 mL: Hypodermic syringe.
- 1 mL: Tuberculin (TB) syringe or hypodermic syringe.
Volumes of Medication That Can Be Given by Route
- Intradermal: 0.01mL-0.1mL
- Subcutaneous: 1-2mL
- Intramuscular: No greater than 5 mL. If greater than 3 mL, consider dividing into 2 doses.
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Description
Explore the different routes of parenteral medication administration, including intradermal, subcutaneous, intramuscular, and intravenous methods. Understand the reasons for using injections based on patient needs and medication characteristics. This quiz is essential for nursing and medical students focused on pharmacology.
