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1. Injections
Done by : Mohammed A Qazzaz

2. Routes of Medication Administration
Parenteral medication: administration of a medication
by injection into body tissues
Subcutaneous (SC) – into tissue below dermis of skin
Intramuscular (IM) – into the body muscle
Intravenous (IV) – into a vein
Intradermal (ID)– into the dermis just under the
epidermis

3. What is an injection?
Injections are sterile solutions,
emulsions or suspensions.
They are prepared by dissolving,
emulsifying or suspending an active
ingredient and any other substances in
water for injection.
Injecting is the act of giving medication
by use of syringe and needle to obtain
the desired therapeutic effect taking into
account the patients safety and comfort

4. How are drugs for injections presented?
Single dose preparations
a pre - prepared volume of measured drug, in a
syringe for single dose use
i.e. Flu vaccines, Pneumovax and B12.
Multidose preparations
multi-dose preparations contain a
antimicrobiacteral preservative, are used on
more than the one occasion and great care is
required for its administration but especially it’s
storage between successive withdrawals
i.e Insulin

5. Why give drugs in injection form
Injections usually allow rapid absorption
Can produce blood levels comparable to those
of intravenous bolus injections
Injections can be given from 1ml and up to 2
mils in the Deltoid and up to 3 mls in the
gluteal muscle in adults
Drugs that are altered or not absorbed by
other methods of administration

6. Needle length and size
For intramuscular injections e.g flu, pneumonia
and B12, the needle should be long enough to
penetrate the muscle and still allow a quarter of
the needle to remain external to the skin
When choosing the needle it is important to
assess the amount of muscle, subcutaneous fat
and weight of the patient - which in the majority
of cases will be a blue needle

7. Syringes
 Three main parts:
– Barrel – chamber that holds the medication
– Plunger – part within the barrel that moves back
and forth to withdraw and instill medication
– Tip – part that the needle is attached to
 Calibration:
– Syringe sizes from 1 ml to 50 ml
– Measure to a 1/10th or 1/100th depending on
calibration

8. Needles
 Shaft of the needle
– Length chosen depends on the depth to
which medication will be instilled
– Tip of shaft is beveled or slanted to pierce
the skin more easily
 Gauge: width ofthe needle (18 – 27
gauge) – a smaller number indicates a
larger diameter and larger lumen inside
the needle

9. Considerations when choosing a syringe and
needle
 Type of medication
 Depth of tissue penetration required
 Volume of medication
 Viscosity of medication
 Size of the client

10. Which is which needle?
The correct needle is the key to delivering the drug to
the correct area for the maximum effect with the least
amount of discomfort
The colour at the top of the needle reflects its size
the higher the number the smaller the lumen (bore)
Orange needles = 25 gauge = 10mm long (3/8 inch)
or 16mm long(5/8 inch) or 25mm long (1 inch)
Blue needles = 23 gauge = 25mm long 9 (1 inch)
Green needles = 21 gauge = 38mm long (1.5 inches)

13. Equipment for the administration of injections
Clean tray or receiver in which to place drug and equipment
21g needle to ease reconstitution and drawing up (23g if from a glass
ampoule
Syringe of appropriate size
Swabs saturated with isopropyl alcohol 70%
Sterile topical swab if drug is presented in ampoule form
Drug to be administered
Patients prescription to check dose, route and timing
Notes available to record administration in accordance with law
Gloves, Apron

14. Clinical room preparation for the administration
of injections
Protocols/procedure/standards information is
available
Hand basin for washing hands and/or alcohol
hand rub.
Area for the client to lie down if unwell
Panic button/phone to call for assistance
sharps container
Gloves
Resuscitation /anaphylaxis equipment/drugs
Oxygen and appropriate mask if available
adequate time for procedure

15. Asepsis and reducing the risk of infection
Good hand washing
Good hand drying
Aseptic technique
Good observation and questioning
of the client
Skin preparation if required

16. The 7 Rights of Drug Administration
 Right client
 Right medication
 Right dose
 Right route
 Right time
 Right reason
 Right documentation

17. INTRADERMAL INJECTIONS

18. INTRADERMAL INJECTIONS
 Most often used for PPD
 Site: the inner aspect of the forearm
 Needle size is 25 - 27 gauge, 1/2 to 5/8 inch
 Insert needle at 15o angle
 Injection made just below the outer layer of skin
 If injection does not form a wheal or if bleeding is
noted, the injection was probably too deep and
should be repeated

19. INTRADERMAL INJECTIONS
 Review the provider’s order for accuracy
 Ask the patient/parent if the patient is allergic to the
medication
 Wash your hands and gather supplies, equipment
 Select proper needle size, length and gauge

20. INTRADERMAL INJECTIONS
 6 Rights of medication administration
 Check the expiration date of the medication
 Check for discoloration etc., discard if questionable

21. INTRADERMAL INJECTIONS
 Explain procedure to patient/parent
 Ask for assistance with children
 Position patient appropriately
 Prepare injection site with alcohol - air dry
 Support skin with thumb
 With bevel up, completely insert bevel at a 15 o angle

22. INTRADERMAL INJECTIONS
 Inject medication gently, place a cotton ball over the
site after needle removal
 A visual wheal will be produced at the site
 Dispose of needle as per policy
 Wash hands
 Document procedure and patient’s response

23. INTRADERMAL INJECTIONS
Correct Technique Incorrect Technique
Tip of needle can be seen Little resistance and a
directly beneath the shallow bulge
surface of the skin  Needle inserted too
Resistance should be felt deep
when medication is - will cause an
injected induration
Tense white wheal 5-10
that is difficult to
measure
mm in diameter appears
at the point of the needle and interpret

25. Subcutaneous
injection

26. Insulin is the most important
drug in the subcutaneous
injections

27. Insulin
Insulin
Indications
Type I diabetes mellitus, type II diabetes mellitus,
Indications
hyperkalemia, DKA/diabetic coma
Type I diabetes mellitus, type II diabetes mellitus, hyperkalemia,
DKA/diabetic coma
MOA
Stimulating peripheral glucose uptake and inhibiting
MOA
hepatic glucose production uptake and inhibiting hepatic
Stimulating peripheral glucose
glucose production
Patient Info
Patient Info
 Hypoglycemia (BG < 70 mg/dL) esp with higher doses
 Hypoglycemia (BG < 70 mg/dL) esp with higher doses
– Anxiety, blurred vision, palpitations, shakiness, slurred
– Anxiety, blurred vision, palpitations, shakiness, slurred
speech, sweating
speech, sweating
 Weight gain
Weight gain

28. Where does it work?

29. Insulin (cont)
Administration:
 Subcutaneous injection
 Rotate site
 Check blood sugars regularly
Storage:
 Refrigerate until use
 Once vial is punctured, it is good for 28 days
and can be left at room temperature (except
for glargine which is 90 days)

30. Insulin (cont)
Dosing:
 Starting daily dose: 0.5-1 unit/kg/day in divided doses
 Adjust according to fasting (premeal) blood glucose of 80-130
mg/dL and peak postprandial blood glucose < 180 mg/dL
 Provide 50% as long acting insulin and 50% as prandial insulin
 1 unit of can account for 30 grams of carbohydrate (14-50)
 1 unit can lower 50 mg/dL blood glucose (10-100)
Special Population Consderations:
 Renal dysfunction
– CrCl 10-50 mL/min: 75% of normal dose
– CrCl < 10 ml/min: 25-50% of normal dose; monitor closely
 Exercise??? ---- Acute Stress???

31. Insulin Action
Rapid/immediate
Intermediate
Blood concentration
Fast
Slow
0 2 4 6 8 10 12 14 16 18 20 22 24
Time (hr)

32. Insulin Dosing
Long-acting
Long-acting &
Short-acting
Normal insulin secretion
70/30
pre-mixed

33. Insulin Administration

34. Insulin (cont)
Cautions/Severe Adverse Reactions
 Severe hypoglycemia (seizure/coma) (BG < 40
mg/dL)
 Edema
 Lipoatrophy or lipohypertropy at injection site
CONTRAINDICATIONS
 Severe hypoglycemia
 Allergy or sensitivity to any ingredient of
the product

35. SUBCUTANEOUS INJECTION

36. INTRAMUSCULAR
INJECTION

37. INTRAMUSCULAR INJECTION

38. IM INJECTION SITES
Deltoid
Dorsogluteal
Ventrogluteal
Vastus lateralis

39. DELTOID MUSCLE

40. GLUTEUS MAXIMUS

41. GLUTEUS MEDIUS

42. VASTUS LATERALIS
Institute of Nursing Theory and Practice, Prague
2007

43. Intramuscular Injections and Pain
The needle
The technique
The speed of the injection
The solution and composition of the drug
The volume of the drug
The approach and attitude of person
administering the injection