2024-2025 Injection I (1.3) PDF

SAFE APPROACHES OF PARENTERAL ADMINISTRATION (INJECTION -I) Block-1.3 Objectives of the training Toraise awareness of the importance of a safe approach (for patient, doctor and environment) during medical procedures, in this case administering injections. T...

SAFE APPROACHES OF PARENTERAL ADMINISTRATION (INJECTION -I) Block-1.3 Objectives of the training Toraise awareness of the importance of a safe approach (for patient, doctor and environment) during medical procedures, in this case administering injections. Tohave sufficient knowledge of the different types of injections and injection sites. Tobe able to select the correct materials for the administration of intracutaneous/intradermal, subcutaneous and intramuscular injections.  Tobe able to perform the following in a safe and aseptic manner: To firmly connect and disconnect the syringe and needle. To remove the protective cap of the needle and to replace it if necessary. To open an ampule/a vial and to draw fluid from an ampule/a vial. To prepare a syringe correctly for drug administration. (e.g. to remove air from the syringe, to connect the injection needle, to measure the correct amount). To administer subcutaneous and intramuscular injections in a model. To deposit the needle in a sharps container after use  Introduction Parenteral drug administration means: any non-oral means of administration, but is generally interpreted as relating to injecting directly into the body, bypassing the skin and mucous membranes. An injection is a way of administering a liquid to a person using a needle and syringe In daily practice, this method of administration is used in the following tissues: in the skin: intracutaneous (i.c.) in subcutaneous connective tissue between the skin and muscles: subcutaneous (s.c.) in muscle tissue: intramuscular (i.m.) in a vein: intravenous (i.v)  Introduction The choice for a certain administration method is determined by the following factors: 1. Indication 2. Absorption rate 3. Amount of injection fluid 4. Characteristics of injection fluid The following three points of attention are important for all injection methods: Always check if the right patient, Prevent infection (aseptic procedure/safe approch), Dispose of needles and syringes in a special container immediately after injecting  Required Materials Syringes Every syringe consists of three parts : 3 1. a cylinder with calibration marks, 2. a plunger and 3. a hub to which the needle is attached. 1 2 Some syringes have a Luer lock fitting, which means that the needle is screwed onto the syringe.  Required Materials Needles Needle tip Injection needles can be divided into three parts : Needle cannula. Lumen. One side of the cannula is the needle tip, the other side is Cannula the conus. The conus is attached to the hub of the syringe. Conus The sizes are standardized and usually indicated in two ways: in millimetres, e.g. 0.8 x 40 mm. with a code between 14 and 28 (Gauge/G). Some manufacturers have given the needles a colour code to facilitate size identification.  Required Materials Injection fluids Injection fluids are usually packed in vials or Ampules Ampules Vials other Required Materials  Preparing a syringe Materials needed: syringe needle to suck up fluid (usually 0.8 x 40 mm/18G) injection needle disinfectant cotton pads kidney bowl vial or ampule with injection fluid small file (if necessary) 0.8 x 40 mm  Method (Step by step) 1. Preparation: i. Wash your hands. ii. Collect all the materials you need. iii. Compare the name and concentration of the drug with the prescription and calculate the correct amount. iv. Remove the package of the needle and syringe as indicated on the package. v. Only touch the protective cap of the needle, the cylinder and the end of the plunger of the syringe.  2A-Taking fluid from a vials- Procedure 4. Stick the needle through the rubber stopper and inject the air into the flask 1. Disinfect the rubber stopper. 2. Remove the 5. Make sure the needle tip is well protective cap of the under the fluid level to prevent needle. sucking up air. 3. Suck up an amount 6. Suck up the required amount of of air that equals the fluid plus 10% by placing the required dose index finger on the cylinder 2B-Taking fluid from a ampules- Procedure 1. If necessary, remove 2. Make a break line 5. Remove the protective cap from fluid from the neck of with the small file at the needle. Press all air out of the the vial by tapping it the height of the slit, syringe. with your fingernail unless there is a break 6. Stick the needle in the vial and line (white line) suck up the required amount of fluid already. 3. Place the vial plus 10% by pushing your between two cotton index finger against the cylinder pads to protect your fingers against pieces Make sure the needle tip is well of broken glass. under the fluid level to prevent 4. Break the vial sucking up air.  3.Removing air from a syringe  Hold the syringe precisely vertically, with the needle pointing upwards.  Check if the air bubbles in the fluid have moved upwards to the hub of the syringe. Tap with your fingernail against the syringe to remove any remaining air bubbles.  Prevent the fluid from spraying when you expel the air by replacing the protective cap on the needle or by holding the needle tip against a cotton pad.  Slowly push the plunger upwards until all air has been expelled from the syringe.  Place the protective cap on the needle and remove the needle from the syringe.  Attach a new, sterile needle to the syringe and remove the protective cap.  Holdthe syringe over the kidney bowl, the needle sloping downwards and remove the air from the lumen as well as the surplus of fluid in the syringe.  The outside of the needle should remain dry.  If necessary, shake off the drop hanging from the needle tip.  Replace the protective cap on the needle.  Check the name, concentration and dosage of the drug  Intramuscular (IM) injection Aim To administer a medicinal fluid in muscle tissue so that it enters the blood circulation by diffusion and has a systemic effect. Indications Intramuscular drug administration is basically only indicated when oral administration is not possible or not desirable, for example in: unconscious patients patients who are unable to swallow patients with gastrointestinal complaints Contraindications: include bleeding tendency and circulation disorders. Intramuscular injection in muscles showing degenerative changes or inflammatory reactions is absolutely not permitted.  Injection sites Musculus quadriceps The injection site is determined as follows: Musculus gluteus maximus  Ask the patient to lie on their back.  Slightly flex the hip and knee of the leg you want to The horizontal line inject. This leg may rest on the other leg. lies between the  Place both hands on the upper leg so that the base of anterior superior your little finger of one hand touches the trochanter iliac spine and the and that of your other hand touches the patella. posterior superior  Stretch your thumbs towards each other parallel to iliac spine ; the femur.  The injection site is the point between your the vertical line in thumbs at the level of the trochanter and patella the middle between line. This is also the line between the bases of your these two points. little fingers (Figure 2). The injection point is located in the upper outer quadrant (Figure 1) Injection sites Musculus gluteus maximus Musculus quadriceps The needle is inserted perpendicular to the skin in the direction of the femur.  Injection needle leangth: The choice of needle length is determined by: the thickness of the muscle the thickness of subcutaneous tissue the patient's condition and age The thickness of the muscle and subcutaneous tissue can be estimated by inspection and palpation. Procedure 6. Determine the insertion point (see: Insertion sites). 7. Palpate the subcutis and muscle to determine the thickness of the tissues and to detect pathological changes in the tissues. 8. Attach a sterile injection needle of the appropriate length to the syringe (see: Preparing a syringe) 9. Disinfect the skin. Wait until the disinfectant has dried before you administer the injection. 10. Remove the protective cap of the needle. 11. Take the syringe, needle pointing downwards, between your thumb and index and middle finger. Place your little finger and/or ring finger beside the needle to prevent that you insert the needle too deeply into the muscle. The number of fingers and the position of the fingers depend on the tissue thickness and needle size. Do not touch the needle. 12. Hold a dry cotton pad firmly between the middle and index fingers of your other hand. 13. Stretch the skin between your thumb and the middle and index fingers of this hand (Figure 3). 14. Insert the needle with a 90-degree angle swiftly into the tissues (Figure 3). If you push the needle slowly through the skin, the needle tip will cause pain which increases the risk of the patient withdrawing their leg. 15. Let go of the skin. Hold the syringe with your thumb and index finger while the rest of your hand rests on the skin. 16. Carefully pull the plunger upwards to check if the needle has hit a vein (Figure 4). Check if the fluid in the syringe is mixed with blood. If so, remove the needle from the body, fill a new syringe and start the procedure again. 17. Inject the fluid slowly into the muscle; 1 ml. in 4-5 sec. (Figure 5). Figure 5 18. Take the dry cotton pad you are holding between your fingers. Swiftly remove the needle in a 90- degree angle. Press the cotton pad on the insertion point and massage the tissue (Figure 6). Figure 6 19. Dispose of all contaminated materials in the appropriate containers. 20. Check the insertion point for bleeding. If necessary cover with a plaster. 21. Wash your hands. Ref: 22. Write the time, name of the fluid, dose and your name in the file. MU standard Therapeutic skills Injections Complications - Severe, radiating pain when the needle is inserted. This suggests that a nerve has been hit. Remove the needle immediately. Examine the patient for possible consequences of nerve damage. Administer the injection in an other muscle. - Discolouration of injection fluid with blood is a reason to stop the injection immediately. It means that the needle tip is in a blood vessel. Prepare a new syringe and start the procedure again.  Z-tract technique Some drugs cause inflammations and necrosis in subcutaneous tissue. In intramuscular injection, the fluid can get into contact with subcutaneous tissue by leaking through the insertion channel or if the outside of the needle is contaminated with fluid due to incorrect de-airing. The Z-tract technique limits leakage via the insertion channel.  Subcutaneous (SC) injection Aim: To administer a medicinal fluid into subcutaneous tissue so that it enters the blood circulation by very gradual diffusion and has a systemic effect. Indications: The indications of subcutaneous injection are based on the ability of subcutaneous tissue to keep fluid in a depot, as it were, and to release it very gradually into the blood stream. The main indication is the administration of insulin. Injection sites: The following parts of the body are suitable for subcutaneous injection, because they do not contain joints, nerves or large blood vessels: the outside of the upper arm the front and sides of the thigh the buttocks the abdomen Injection needle: The thickness of the subcutaneous tissue and the patient's age determine the needle length. In general, needles used in adults are 25 mm long and have a diameter of 0.6 mm.  Procedure: 3. Inform the patient about the aim of the procedure. 4. Remove clothes to uncover the injection site. 5. Palpate the skin and the subcutaneous tissue to estimate the thickness of the tissues. 6. Attach a sterile injection needle of the appropriate length to the syringe. 7. Disinfect the skin. Wait until the disinfectant has dried before you administer the injection. 8 Hold the cylinder of the syringe between your thumb and index finger (Figure 1). The syringe is now at the side of the palm of your hand. 9. Place a dry cotton pad near you. 10. Remove the protective cap of the needle. 11. Make a skin fold with the thumb and index finger of your other hand (Figure 1). 12. Insert the needle into the base of the skin fold at a 30-degree angle (Figure 2) 13. Let go of the skin fold. 14. Check if the needle tip is inserted in the subcutaneous tissue. 15. Hold the syringe with the thumb and index finger of the hand you used to make the skin fold. The other fingers rest on the skin. 16. Carefully pull the plunger upwards to check if the needle is in a vein (Figure 3). If the fluid in the syringe is mixed with blood, remove the needle from the body, fill a new syringe and start the procedure again. 17. Inject the fluid slowly into the tissue; 1 ml. in 4-5 sec. (Figure 4). 18. Remove the needle from he tissue and pat the insertion site with a dry cotton pad. Avoid massaging! 19, 20, 21 (same as slide for IM procedure)  References: -MU.. standard Therapeutic skills Injections - SIM booklet