Injected medications are more quickly absorbed than oral medications, and parenteral routes are used

when patients are vomiting, cannot swallow, or are restricted from taking oral fluids.

invasive and thus pose greater risks than those associated with administering nonparenteral
medications > infection .you must use aseptic technique

1. Subcutaneous injection: Injection into tissues just under the dermis of the skin

2. Intramuscular (IM) injection: Injection into the body of a muscle

3. Intradermal (ID) injection: Injection into the dermis just under the epidermis

4. Intravenous (IV) injection or infusion: Injection into a vein

Failure to inject a medication correctly will result in complications such as an inappropriate drug
response (e.g., too rapid or too slow), nerve injury with associated pain, localized bleeding, tissue
necrosis, and sterile abscess.

Safety
1. Be vigilant during medication administration. Avoid distractions while preparing an injection.
Be sure that your patients receive the appropriate medications. Know why your patient is receiving
each medication; know what you need to do before, during, and after medication administration, and
evaluate the effectiveness of medications and any adverse effects after administration.

2. Verify that the medications have not expired.

3. Use at least two identifiers before administering medications and check against the medication
administration record (MAR). Follow agency policy for patient identification.

4. Clarify unclear medication orders and ask for help whenever you are uncertain about an order
or calculation. Consult with your peers, pharmacists, and other health care providers and be sure that
you have resolved all concerns related to medication administration before preparing and giving
medications.

5. Use technology (e.g., bar scanning, electronic MARs) that is available in your agency when
preparing and giving medications. Follow all policies related to use of the technology and do not use
"shortcuts." A shortcut bypasses a procedure, policy, or problem in a system. Nurses who use
shortcuts fail to follow agency protocols, policies, or procedures during medication administration in an
attempt to get medications administered to patients in a more timely manner. Shortcuts are not
acceptable practice.
6. Use strict aseptic technique during medication preparation and administration.

7. Educate patients about each medication they take while you are administering medications.
Often, patients are able to identify inappropriate medications. Make sure that you answer all of their
questions before administering medications. Educate family caregivers if appropriate.

8. Most of the time you cannot delegate medication administration. Ensure that you follow
standards set by the licensing body and guidelines established by your health care agency. Licensed
practical nurses (LPNs) usually can administer medications via the oral (PO), subcutaneous, IM, and
ID routes. Some facilities allow Unregulated health care providersto administer some types of
medications (e.g., oral medication) in long-term care facilities.

9. Minimize a patient's discomfort when giving an injection:

o Use sharp, bevelled needles in the shortest length and smallest gauge possible.

o Change the needle if liquid medication coats the shaft of the needle.

o Position and flex a patient's limbs to reduce muscular tension.

o Divert the patient's attention away from the injection procedure.

o Apply a vapocoolant spray (e.g., Fluori-Methane spray, ethyl chloride) or topical

anesthetic (e.g., EMLA cream) to an injection site before giving a medication when possible, or place
wrapped ice on the site for a minute before injection.

o Insert the needle at the proper angle, smoothly, and quickly. Do not hesitate, and
slowly push the needle into tissue.

o Inject the medication slowly but smoothly.

o Hold the syringe steady once the needle is in the tissue to prevent tissue damage.

o Withdraw the needle smoothly, at the same angle used for insertion.

o Gently apply an antiseptic pad (e.g., alcohol) or dry, sterile gauze pad to the site.

o Apply gentle pressure at the injection site.

o Rotate injection sites to prevent the formation of indurations and abscesses.

InfectionPrevention
Preventing Infection During an Injection
Principle
Prevent contamination of solution
Prevent needle contamination
Prepare skin
Before handling any equipment
Technique
Ampules should not remain open for an extended
period of time, and medication should be removed
quickly.
Avoid letting the needle touch a contaminated
surface (e.g., outer edges of ampule or vial, outer
surface of needle cap, your hands, countertop, or
table surface).
Avoid touching the length of the plunger or inner
part of the barrel. Keep the tip of the syringe
covered with a cap or needle.
Wash skin soiled with dirt, drainage, or feces with
soap and water. Use friction and a circular motion
while cleaning with an antiseptic swab. Swab from
the centre of the chosen site, and move outward
in a 5-cm (2-in) radius.
Perform hand hygiene for a minimum of 15
seconds to reduce the transfer of microorganisms.

Syringes and Needels

Parenteral medications are delivered to a patient by using a syringe and needle. Needles and syringes
come in a variety of sizes. It is important to determine the appropriate size of syringe and length and
gauge of needle to use. These decisions are based on the following:
The type of medication to be given

The volume of solution to inject

The route of the injection

The patient's body size

A syringe consists of a cylindrical barrel, a tip designed to fit the hub of a hypodermic needle, and a
plunger. Syringes are single use, disposable, and either Luer-Lok or nonLuer-Lok. A nonLuer-Lok
syringe uses a needle that slips onto the tip. A Luer-Lok syringe uses a needle that twists onto the tip
and locks into place. The Luer-Lok design prevents the accidental removal of a needle from the
syringe.

Types of Syringes
ranging in capacity from 0.5 to 60 mL. When you select a syringe, choose the smallest syringe size
possible, to improve accuracy of medication preparation

use a syringe larger than 5-mL for IM injections.

tuberculin (TB) syringes to prepare small amounts of medications, for intradermal (ID) and
subcutaneous injections. Insulin syringes hold 0.3 to 1 mL, and low-dose insulin syringes (30 units per
0.3 mL or 50 units per 0.5 mL) hold 0.3 to 0.5 mL.

Most insulin syringes are U-100s, designed for use with U-100strength insulin. Each millilitre of
solution contains 100 units of insulin.

Type of Injection Needle Gauge Needle Length

Intradermal 0.5 to 0.4 mm 9.5 to 16 mm

(25 to 27) (0.38 to 0.63 in)

Subcutaneous 0.5 to 0.4 mm 9.5 to 16 mm

(25 to 27) (0.38 to 0.63 in)

Intramuscular 0.9 to 0.5 mm 25 to 38 mm

(20 to 25) (1 to 1.5 in)

LESSON 2

Ampules contain single doses of injectable medication in a liquid form and are available in sizes from
1 to 10 mL or more. An ampule is made of glass, with a constricted neck that is snapped off to allow
access to the medication.

Medication is easily withdrawn from the ampule by aspirating with a filter needle and syringe. Filter
needles must be used when preparing medication from a glass ampule to prevent glass particles from
being drawn into the syringe
*CHANGE NEEDLE BEFORE ADMINISTERTING TO A NORMAL NEEDEL

A vial is a single-dose or multidose plastic or glass container with a rubber seal at the top. After you
open a single-dose vial, discard it, regardless of the amount of medication used

Some vials have two chambers separated by a rubber stopper. One chamber contains the diluent
solution and the other chamber contains the dry medication. Before preparing the medication, push on
the upper chamber to dislodge the rubber stopper and allow the powder and the diluent to mix. Unlike
an ampule, a vial is a closed system. You must inject air into the vial to permit easy withdrawal of the
solution. Some medications, even when in a vial, may need to be drawn up with a filter needle
because of the nature of the medication.

Recommendations for Mixing Insulins

 Patients whose blood glucose is well controlled on a mixed-insulin dose should maintain their
individual routine when preparing and administering their insulin doses.

No other medication or diluent should be mixed with any insulin product unless approved by
the prescriber.

Do not mix insulin glargine (Lantus) or insulin detemir (Levemir) with any other types of
insulin and do not administer them intravenously.

Inject rapid-acting insulins mixed with NPH insulin 15 minutes before a meal.

Verify insulin dosages during preparation with another nurse (if required by agency policy).

Mixing meds > vial first then ampule , short acting drawn then long acting
Mixing Insulins

Regular (unmodified) insulin is a clear solution that can be given subcutaneously or

intravenously.

Modified insulin preparations, such as NPH, can be given only subcutaneously.

When mixing insulin, always fill the syringe with the regular insulin first to prevent contamination of
the regular insulin bottle with the modified insulin. The reason for avoiding contamination is that the
immediate effect of short-acting regular insulin can be altered if it is contaminated with longer-acting
modified insulin preparations.

General Guidelines for Insulin Administration

Store vials of insulin in the refrigerator, not the freezer. Keep vials currently being used at
room temperature. Do not inject cold insulin.

Inspect vials before each use for changes in appearance (e.g., clumping, frosting,
precipitation, change in clarity or colour), indicating lack of potency.

Do not interchange insulin types unless approved by the patient's prescriber.

Preferred injection sites include the abdomen, avoiding a 5-cm (2-in) radius around the
umbilicus, and the outer aspect of the thighs.

Have patient self-administer insulin whenever possible. Generally, children begin self-
administration by adolescence.

Patients who take insulin need to self-monitor their blood glucose.

All patients who take insulin should carry with them at least 15 g of carbohydrate (e.g., 120
mL (4 oz) of fruit juice, 120 mL (4 oz) of regular soft drink, 240 mL (8 oz) of skim milk, 6 to 10 hard
candies) in the event of a hypoglycemic reaction.

Lesson 3 Subcutaneous INJ

A subcutaneous injection involves placing a medication into the loose connective tissue under the
dermis. Subcutaneous tissue is poorly supplied with blood vessels, so medication absorption is slower
than it is in an IM injection. The exception is heparin, which is quickly absorbed when administered
subcutaneously. Physical exercise or application of hot or cold compresses influences the rate of
medication absorption by altering local blood flow to tissues. Any condition that impairs blood flow is a
contraindication for subcutaneous injections.

You give subcutaneous medications in small doses of less than 2 mL. These are isotonic, non-irritating,
nonviscous, and water soluble. There is limited research that indicates volumes up to 2 mL may be
given without tissue damage
In infants and children, the recommendation is to administer amounts up to 0.5 mL in one site

Generally, a 0.5-mm (25-) gauge, 16-mm (0.38-in) needle inserted at a 45-degree angle, or a 13-mm
(0.5-in) needle inserted at a 90-degree angle, deposits medications into the subcutaneous tissue of a
normal-size patient. A child usually requires a 0.45- to 0.31-mm (26- to 30-) gauge, 13-mm (0.5-in)
needle inserted at a 90-degree angle

If the patient is obese, pinch the tissue and use a needle long enough to insert through the fatty tissue
at the base of the skinfold. Thin patients sometimes have insufficient tissue for injections. Therefore,
the upper abdomen is the best injection site for patients with little peripheral subcutaneous tissue.
Aspiration after the insertion of the needle, forheparin and insulin, is not necessary.