Safe Injection Techniques

Safe Injection Practices

• Always use new, sterile equipment for each injection.
• Syringes are for single use only and should be discarded after each injection.
• Needles should only be used for one patient and then discarded.
• Check packaging for dryness, rips, torn corners, and expiry date.

Syringes and Needles

• Key parts of a syringe include:
  • Plunger
  • Barrel
  • Syringe tip
• Parts of a needle include:
  • Needle
  • Needle hub
  • Rubber stopper
  • Lumen
  • Bevel
  • Shaft

Syringe Tips

• Permanently attached: Syringe has a permanently attached needle.
• Luer Lock Tip: "locking fit" secure screw type connection.
• Luer slip tip: Friction-fit connection, slip connection.
• Eccentric tip: Off center tip, perfect for injecting into a vein.
• Catheter tip: Longer slip tip, used for irrigation or with medical tubing.

Syringe Handling

• Avoid touching the inside of the plunger shaft.
• Only touch the plunger phalange and the barrel to prevent contamination.

Needle and Syringe Sizing

• Needle gauge indicates the thickness of the needle.
• Syringe size varies based on volume capacity in cubic centimeters (cc) or milliliters (mL).
• Needle length varies based on injection type.

Needle Length

• Needles come in various lengths and gauges.
• The shaft is the length of the needle.
• Needle lengths vary from approximately 3/8 in, 5/8 in, 1/2 in, 1 in, 2.5-3.0 in.
• Filter needles are used when withdrawing medication from a glass ampule.

Needle Gauge

• Gauge refers to the needle thickness.
• The needle's gauge affects the size of the hole the medication passes through.
• A higher gauge number means a smaller hole and a thinner needle.
• A lower gauge number equates to a bigger hole and a wider needle, suitable for thicker medications.
• Needle sizes (18g, 22g, 25g) vary.
• The bevel is the slanted tip of the needle.

Factors to consider in injections

• Needle length and gauge depend on the volume and thickness of the medication beingGiven.
• They also depend on the size and condition of the patient.
  • Includes the patient’s age, size, weight, the amount of muscle mass, and subcutaneous fat.
• Needle length and gauge also depend on the route of injection.
  • Varies based on the injection site.

Safe Needle Handling

• Always hold the syringe barrel with one hand when removing the cap.
• Do not hold the plunger.
• Pull the needle cap off with the other hand straight away, far enough away from you and the patient.
• Be cognizant of keeping the needle in a safe position without contaminating it.

Safe Needle Position

• Direct the needle pointed up and away from the patient.
• Never recap a dirty needle; if recapping is necessary, then use ONE Handed- Scoop Technique

One-Handed Scoop Technique for Recapping Clean Needles

1. Place the cap on a flat surface.
2. Hold the syringe in once hand; slip the needle into the cap without using the other hand.
3. Push the capped needle against a firm object to secure the cap firmly onto the needle.

Applying Needle Safety Mechanism

• Apply the needle safety immediately after injecting.
• The one-handed technique should be used.
• Put the syringe and needle into a biohazard container to be incinerated. This will happen after the needle safety is engaged.

Drug Preparation

• Prefilled cartridges: These are sealed glass cylinders of parenteral medication.
• Cartridges: These come with an attached needle. The cylinder in a specially designed syringe.
• Combining medications in a syringe: Exact amounts must be withdrawn from each drug container. Once the medications are mixed in the barrel, separate expulsion is impossible.

Injection Considerations

• Select the correct location for parenteral medication administration to ensure optimal absorption.
• Inject the correct location to prevent injury to tissues, nerves, and blood vessels).
• The needle should be inserted all the way to the hub using a smooth, quick continuous motion.
• Withdraw the needle at the same angle used for insertion.

Types of Injections

• Intradermal
• Subcutaneous
• Intramuscular
• Intravenous

Injection Angles

• Intradermal: 10°-15° angle.
• Subcutaneous: 45° or 90° angle
  • For thin patients grasp only 1 in. of skin.
  • if you can grasp 2 in. of skin
  • Can vary with type of injection.
• Intramuscular: 90° angle.
• Stabilize the skin when inserting the needle.

Subcutaneous Injections

• Medication is instilled between the skin and muscle.
• Subcutaneous medications are absorbed within minutes to hours.
• The locations for these injections sites are:
  • Abdomen: 2 inches away from the belly button.
  • Back of the upper arm: outer aspect of the upper arm.
  • Thigh: Anterior aspect of the thigh.

Injection equipment

• Injection equipment will vary based on the injection, or the amount subcutaneous fat.
  • Insulin is prepared in an insulin syringe (measured in units)
  • Heparin is prepared in a tuberculin syringe (mls)
  • Only give up to 5000 units of heparin LPN

Insulin Syringes

• Insulin syringes are always measured in units.
• The syringe indicates"Insulin" on it.

Tuberculin Syringes

• Measured in mL most often.
• Will contain only 1mL.
• The syringe will start wth readings for 0.1 mL.

Administering Heparin

• Heparin may be administered subcutaneously and intravenously.
• It is an anticoagulant.
• Heparin prolongs the time it takes for blood to clot.
• After drawing up the medication, replace the needle with another before administration.
• Monitor labs when given heparin in large doses.
  • aPTT (activated partial thromboplastin time)
  • PTT (partial thromboplastin time)
• Use the rule of 10 to remember: Heparin (7 letters) + ptt (3 letters) = 10.
• The antidote for heparin is protamine sulfate.
  • Use the mnemonic (pms- the p stands for heparin).
• Heparin causes irritation to the tissue ( or the vein).

Injection Sites for Heparin

• Injections are always given in the abdomen.
• Stay 2" away from umbilicus.
• Do not massage the site.
  • Damage the tissues.
• LPN's can only give 5000 units of Heparin. - This is a low dose therapy.
• Rotate the sites with each injection to avoid tissue injury or previous bleeding/bruising.

Heparin Injection Administration

To prevent bruising change the needle before injecting the client.

• Do not aspirate the plunger once the needle is in place.
• Administer slowly over 5-10 seconds.
• Hold the plunger for 10 seconds; then withdraws the needle at same angle as it was inserted.
• Lovenox is a low molecular weight heparin, given subcutaneously only in the abdomen, and used in home care settings.

Considerations for Insulin and Heparin

• When administering insulin or heparin, do not apply gentle pressure to the injection site after removing the needle for better absorption.
  • It can damage the underlying tissue.
• Nurses who administer parenteral medications need to identify any nursing concerns including acute pain, anxiety, or fear of trauma.

Inspecting Medications and Vials Preparation

• Perform 6 rights and 3 checks
• Inspect medications for any floaties, specks, flecks, discoloration, or cloudiness.
• Vial is not leaking, or damaged.
• Discard after 28 days of opening
• To prepare the vial cleanse rubber stopper w/alcohol using friction for 15-30 seconds to prep the medication.
• Let the top air dry completely before inserting.
• Do not fan or blow

Needle to Vial

• When inserting consider the Vial Coring Prevention link_Needle Technique.
  • Clean the vial with alcohol for 15-30 seconds and let it air dry.
• Correct amount of air should be be injected into syringe.
• Place the bevel up and angle at a 45 degree angle.
• Stabilize the vial on a hard surface and move the needle towards the rubber stopper.

Getting Bubbles out of Syringe

• When preparing injection, getting correct bubble control helps.
  • Tap to move bubbles to the top before administration.

Preparing the Skin

• Wash with water if soiled with dirt, drainage, or fecal matter.
• Use a circular wiping motion with alcohol from center to outward for 15 seconds
• The radius using friction is 5 cm (2 in).
• Let it dry before.

Medication Injection

• The medical professional should select the site, and clean the site in advance.
• Insert the needle with a "Dart Like Motion"
• Do not hesitate at the skin before.
• Do not drag your needle on the skin until administering medication.
• One should stabilize the syringe once needle is entered before administering.
  • Can stop needle from damaging tissue and decreases pain

Administration Rate

• It has been shown that administration should be 10 seconds with each mL.
• Be sure to assess the patient's tolerance and tolerance of the medication.
• Always confirm drug administration with the medication specifications.
• Remove syringe and needle should at same rate as insertion while stabilizing patients skins.
• Apply the needle safety with one-handed technique, then discard in the Sharps box.
• Document and perform skin assessments
• Stabilize the skin while. It happens when administering needle and as your removing needle for a patient.
• Withdrawing at inserted.

Selecting Safe Medications

• Rapid and Long-acting insulins should not be used if it does not not appear "clear".
• These should be avoided if a patient observes “cloudy” or straw-colored.

Selecting Safe Intermediate Acting Medications

• Avoid "cloudy” intermediate-acting insulin if:
• When mixing, check for floating particles or lumps are.

Mixing Regular And Intermediate Acting Insulin

1. Draw up air equal to the NPH dose
2. Inject air into cloudy insulin NPH vialDo not touch the insulin with the needle
3. In same syringe, draw up air equal to the clear insulin dose amount
4. Inject air into clear vial
5. Leave needle in vial Flip the vial and withdraw the dose amount of 6. Insert needle into "cloudy” NPH insulin and do not push the plunger. Withdraw the exact amount of cloudy” insulin for dose amount. The " NPH does in NPH insulin or the clear in Clear Insulin .

Two Medications

• One must find double verification.
• Dosage verification With Another Nurse -Insulin -Very rapid-acting, rapid-acting, intermediate-acting, long-acting, and very long-acting -Heparin This may vary at different facilities -1,000 units/mL,5,000 units/mL -10,000 units/mL, and 20,000 units/mL -Can be life threatening if incorrect dosage is administered
• It can be a risk for nursing trauma.

Insulin Pens

• Easy to read
• Easy to self administer
• Easy to use for those w/disabilities
• Can be expensive
• Needle needs to be primed

Answer to Question

• When administering insulin or heparin, the nurse should not gently pressure to the injection site after removing the needle for better absorption.
• This can damage the underlying tissue.

Learn the safe injection practices for healthcare settings. Using sterile equipment can prevent infections. This covers syringes parts and handling techniques.