2496_Ch10_179-193 25/08/16 4:38 PM Page 179

CHA P T ER 10

Syringes and Needles

L EAR N I N G OU T C OM E S
Describe the parts of a syringe and a needle.
Identify the zero line and the calibration lines on syringes commonly
used in clinical practice.
Choose the correct syringe and fill line for a variety of drug doses.
Choose the appropriate syringe to administer parenteral
medications.

Many medications are administered by a route other than the oral route. The term
parenteral is used to indicate routes other than the oral or gastrointestinal route. Com-
mon parenteral routes include the intradermal route (ID—under the skin or dermis), the
subcutaneous route (subcut—into the subcutaneous tissue), the intramuscular route
(IM—into the muscle), and the intravenous route (IV—directly into the vein).
Parenteral medications are administered using a syringe, a device used to inject med-
ications into a body tissue or into a vein. The choice of syringe and needle size is deter-
mined by the nurse and is based on the properties of the medication and the route of
administration. Nurses must choose the appropriate syringe and needle, accurately read
the calibration lines on the syringe, and draw up the correct amount of medication into
the syringe.

The P a r ts o f a S y r i n ge
To work with syringes, the nurse must know the parts of a syringe (Fig. 10-1).

Needle shaft Calibration lines Plunger

Bevel
1½

2½

mL
½

Figure 10-1. The main parts of a Tip Barrel

syringe. Needle hub

179
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180 UNIT FOUR ■ Administration of Medications

Syringes have three main parts: the needle, the barrel of the syringe, and the plunger.
● The shaft of the needle has a sharp slanted end (called a bevel) that enables it to easily
penetrate the skin and body tissues. The hub of the needle attaches to the tip of the
syringe.
● The body of the syringe that holds the medication is called the barrel. The barrel of the
syringe is marked with calibration lines that measure medication doses in mL. De-
pending on the size of the syringe, each calibration line measures from 0.01 to 1 mL of
medication.
● The rubber-tipped cylinder called the plunger fills and empties the syringe.

Using the Plunger to Measure the Amount of Medication

in a Syringe
The amount of medication in the syringe is measured by looking at the proximal end of
the plunger, which is the end closest to the tip of the syringe. The rubber section on the
proximal end has two rings. Measurement of medication is made at the first ring (the one
closest to the tip of the syringe), as shown in Figure 10-2. The first ring of the plunger
must cover the desired calibration line for accurate measurement (Fig. 10-3).

Measure volume of
medication from here
(proximal end of plunger).
1½

2½

mL
½

Do not measure from here.

1½

2½

mL
½

Many plungers have a pointed or

rounded tip. Do not use this point
to measure the medication dose.
Figure 10-2. Measuring medication volume
by looking at the proximal end of the plunger.

To accurately draw up 0.5 mL of the

medication, the proximal end of the
plunger must completely cover the
0.5 mL calibration line.
1½

2½

mL
½

This syringe contains

exactly 0.5 mL of medication.
1½

2½

mL
½

This syringe contains

too little medication.
1½

2½

mL
½

This syringe contains Figure 10-3. Measuring medication doses

too much medication. accurately.
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CHAPTER TEN ■ Syringes and Needles 181

T h e C a l i b r a ti o n L i n es on a S y r i ng e
To accurately measure medication in a syringe, the nurse reads the calibration lines on the
barrel of the syringe. Calibration lines vary according to the size of the syringe. For example,
the calibration lines on the 1 mL syringe measure hundredths of a milliliter (0.01 mL),
whereas the calibration lines on the 3 mL syringe measure tenths of milliliter (0.1 mL).
Regardless of the size of the syringe or the value of the calibration lines, the first line on all
syringes is the zero line.

T H E Z ER O LI N E
The zero line, the first line on the barrel of the syringe, represents the starting point when
there is no medication in the syringe. The zero line takes into account that a small volume
of medication is contained in the needle, hub, and tip of the syringe (called dead space).
It is important for the nurse to differentiate between the zero line and the first calibration
line on the syringe (Fig. 10-4).

Zero line

First calibration line

Figure 10-4. Zero line on a syringe.

RE A D I NG C ALI B R ATI ON LINES O N A SY RINGE

Syringes measure very small amounts of liquid medication, such as tenths or hundredths
of a milliliter. Accuracy in measurement is essential when working with syringes. Nurses
do not measure between calibration lines or estimate when measuring medications. There
is no need to memorize what the calibration lines measure on each type of syringe. Most
nurses can carefully examine the calibration lines on a syringe and determine the meas-
urements visually. Table 10-1 provides a clinical application to show the importance of
calibration lines.

Table 10-1. The Importance of Calibration Lines on a Syringe

CLINICAL
CLINICAL SITUATION SYRINGE DECISION-MAKING
After calculating a drug Has Nurse A correctly
dosage, Nurse A filled the syringe?
1½

2½

mL
½

prepares 0.4 mL of Has Nurse B correctly

medication in the read the syringe?
syringe. Nurse A
shows the syringe
to Nurse B to verify
the dose. Nurse
B validates that the
syringe contains
0.4 mL of medication.
Discussion: Nurse A has not correctly measured 0.4 mL of medication in the syringe. Nurse B has not correctly read
the calibration lines on the filled syringe. The zero line must be read as “0,” and not as the 0.1 syringe calibration
line. Nurse B should tell Nurse A that there is not enough medication in the syringe.
2496_Ch10_179-193 25/08/16 4:38 PM Page 182

182 UNIT FOUR ■ Administration of Medications

C h o o si n g th e C or r ect S y r i ng e
There are many different types and sizes of syringes for the nurse to select. The nurse
makes the choice of a syringe by the volume of medication to be given. The syringes most
frequently used in clinical practice include the 3 mL syringe, the 1 mL or tuberculin
syringe, and the insulin syringes. Other available syringes include the 5, 6, 10, 12, 20,
30, 50, and 60 mL syringes.

TH E 3 M L S YR I N G E
The 3 mL syringe is the most commonly used syringe in clinical practice because it can
measure most parenteral medication doses that are ordered. The 3 mL syringe is used for
medications administered by all of the parenteral routes (Fig. 10-5).

Figure 10-5. 3 mL Safety Glide syringe from Becton Dickinson.

Look at the calibration lines on the 3 mL syringe. In the 3 mL syringe, each shorter cal-
ibration line measures one-tenth of a milliliter (0.1 mL). Every 1/2 mL is marked with a
longer calibration line and is numbered from 1/2 mL to 3 mL.

TH E 1 M L OR TU B E RCULIN SY RINGE
A tuberculin or TB syringe gets its name from its original use: administration of tuber-
culin skin tests. This is a small-volume syringe that measures hundredths of a milliliter
(0.01 mL). The nurse may choose a 1 mL syringe if the measurement of very small doses
of medication is required or if a medication dose is contained in hundredths of a milliliter.
Look at the calibration lines on the 1 mL syringe in Figure 10-6.
mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0

Figure 10-6. The 1 mL or tuberculin syringe.

Each of the shorter calibration lines on the 1 mL syringe represent one-hundredth

of a milliliter (0.01 mL). The longer calibration lines measure one-tenth of a milliliter
(0.1 mL) and are numbered. Every 0.05 mL is marked with a longer calibration line.
The calibration lines on the 1 mL syringe are small and close together. Great care is
needed in reading the calibration lines on this syringe. Figure 10-7 shows an enlarge-
ment of part of the 1 mL syringe barrel. In the enlargement, the actual calibration lines
on the syringe appear in black numbers.
mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0

0.5 (0.55) 0.6

0.52 0.54 0.56 0.58

Figure 10-7. Close-up of the calibration lines
0.51 0.53 0.55 0.57 0.59
on a 1 mL syringe.
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CHAPTER TEN ■ Syringes and Needles 183

The calibration lines on the

1 mL syringe have a number for
every tenth of a milliliter. On some
1 mL syringes, leading zeros are
not included and the 1 mL calibra-
tion line has a trailing zero
(Fig. 10-8). It is important that the
nurse recognize the numbers on a
1 mL syringe as decimal fractions
and not whole numbers.

Some TB syringes have two sets of

calibration lines: one measuring
mL, and one measuring minims,
a unit of measurement from the Figure 10-8. Smith Medical 1 mL syringe with no preceding
apothecary system. The Institute zeros.
for Safe Medication Practices
(ISMP) has included the minim on
the List of Error-Prone Abbreviations, Symbols, and Dose Designations. ISMP and other organ-
izations recommend that the apothecary system no longer be used for prescribing drugs. If the
nurse finds a syringe with both
minim and mL calibration lines, Minim calibration lines on a TB syringe
it is essential to double-check
that the correct calibration lines

10
11
12
13
14
15
16
m
1
2
3
4
5
6
7
8
9
are used to measure the dose.

mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Many syringe manufacturers
now put only the mL calibration mL calibration lines on a TB syringe
lines on the syringe.

A P P LY LE A RN E D K N O WL E D GE 1 0 -1
Choose the correct syringe for the medication dose ordered. Shade in the syringe with the correct dose.
1. The nurse is to administer 1.2 mL of medication.
1½

2½

mL
½

Syringe A
1

mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0

Syringe B

2. The nurse is to administer 0.4 mL of medication.

1½

2½

mL
½

Syringe A
1

mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0

Syringe B

Continued
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184 UNIT FOUR ■ Administration of Medications

A P P LY LE A RN E D K N O WL E D GE 1 0 -1 — cont’d
3. The order is for 15 mg, which is contained in 0.15 mL.

1½

2½

mL
½
Syringe A

mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Syringe B

4. The nurse is to administer 1 mL of medication.

1½

2½

mL
½

Syringe A
1

mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Syringe B

5. The nurse is to administer 0.25 mL of medication.

1½

2½

mL
½

Syringe A
1

mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0

Syringe B

TH E 5 AN D 10 M L
S YR I NGES
The 5 mL and 10 mL syringes can
be used to measure doses of med-
ication larger than 3 mL and are
most often used to prepare and ad-
minister IV medications (Fig. 10-9).
With these syringes, each small
calibration line measures 0.2 mL.
Every whole mL is marked by a
longer calibration line and is num-
bered. Other syringe sizes available
include the 6 mL and the 12 mL
syringe. Although not as frequently
used in clinical practice, these sy-
ringes have the same calibration
line measurements as the 5 mL
and 10 mL syringe.

Figure 10-9. Retractable Technologies 5 mL and 10 mL syringes.

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CHAPTER TEN ■ Syringes and Needles 185

Some syringes in clinical practice still use cubic centimeters (cc) as the calibration measurement.
Some have “cc/mL” written on the syringe. Milliliters (mL) and cubic centimeters (cc) are equivalent
measurements. But because the term “cc” can be mistaken for “U” (units) in medication orders
and documentation, national safety guidelines now recommend the use of the term “mL” in the
patient care setting.

15 ½

¾
oz
mL
10

20
5
¼

1
mL oz
10

15

20

25

30
5

Figure 10-10. The 20 mL and 30 mL syringes.

¼

1¼

1½

mL 1¾
oz
10

15

20

25

30

35

40

45

50
5
¼

1¼

1½

1¾

2
oz
mL
10

15

20

25

30

35

40

45

50

55

60
5

Figure 10-11. The 50 mL and 60 mL syringes.

T H E 20, 30, 50, AND 60 ML SY RINGES

The 20, 30, 50, and 60 mL syringes can be used for administration of large volumes of IV
medication and for other clinical uses. These syringes have two sets of calibration lines:
mL and ounce. On the mL side, each small calibration line measures 1 mL, and every fifth
mL has a longer calibration line and is numbered. The calibration lines on the other side
of the syringe barrel measure ounces (Figs. 10-10 and 10-11).
2496_Ch10_179-193 25/08/16 4:38 PM Page 186

186 UNIT FOUR ■ Administration of Medications

A P P LY LE A RN E D K N O WL E D GE 1 0 -2
Determine whethr the statement is True or False. If the statement is false, write a rationale explaining the
reason.
1. The only difference between a 1 mL and a 3 mL syringe is the difference in volume. T F

2. A TB syringe can measure the following volume of medication: 0.38 mL. T F

3. A 3 mL syringe can measure the following volume of medication: 2.4 mL. T F

4. A 1 mL syringe will measure a small amount of medication with greater accuracy

than will a 3 mL syringe. T F

5. A 5 mL syringe can measure ounces. T F

I N S U LI N S YR I NGES
One additional type of syringe, the
insulin syringe, is only used to ad-
minister the drug insulin. The in-
sulin syringe measures units of
insulin, not mL, and it cannot be
used for any other medications.
See Figure 10-12. The administra-
tion of insulin and insulin syringes
are covered in Chapter 13, Admin-
istration of Insulin.
This syringe is
PR EF I LLED S YR I NGES used only for
the drug insulin.
OR C AR TR I D GES
Drug manufacturers supply cer-
tain drugs in prefilled syringes
or syringe cartridges. A prefilled
syringe has a needle and plunger
(Figs. 10-13). A syringe cartridge
needs a special holder (usually
with a plunger) to administer the Figure 10-12. Insulin syringe showing the measurement of
medication (Figs. 10-14). units, not mL.
The prefilled syringe or syringe
cartridge may be completely filled
with medication, or it may have empty space to allow for adding a second medication
to the syringe. Like all syringes, calibration lines enable the measurement of the or-
dered dose.
When using a prefilled syringe or cartridge, the nurse must calculate the ordered dose
prior to the administration of the medication. The prefilled syringe contains a certain vol-
ume of medication. The nurse may administer the exact amount in the prefilled syringe.
Or, if the ordered dose is contained in a smaller volume of medication, the nurse may
need to discard some of the medication. The exact dose must be in the syringe prior to
administration of the medication.
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CHAPTER TEN ■ Syringes and Needles 187

Adenosine 6 mg in 2 mL

Adenosine 12 mg in 4 mL

Figure 10-13. Prefilled syringes.

Prefilled cartridge Cartridge holder

Figure 10-14. Prefilled syringe cartridge and holder.

Nu mb er i n g S y s tem f or N eedles
Parenteral medications are injected into a variety of body tissues. The nurse must decide
what needle size is most appropriate to administer the medication to the patient. Every
needle has two measurement numbers: the first number refers to the length of the needle
and the second number refers to the gauge of the needle.

N E ED LE LENGTH
Needles vary in length so that the
injected medication can reach the IM
desired tissue. The route of admin-
istration, injection site, and the ID Subcut IV
size of the patient determine
the length of needle. For example, Epidermis
the more superficial that the injec- Dermis
tion is, the shorter the needle
used. An injection deep into the Subcutaneous
muscle requires a longer needle. tissue
Large patients may need a longer
needle to deliver the medication to
the desired tissue (Fig. 10-15). Muscle

Vein

Cross section of the skin

Figure 10-15. Route of administration and needle length.

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188 UNIT FOUR ■ Administration of Medications

The length of a needle is meas-

ured in inches. Standard needles 5 16 Subcut
come in a variety of lengths, from
38 Intradermal
5/16 inch to 2 inches (Fig. 10-16).

NEED LE GAU G E ½" Subcut, ID

58
Needle gauge is a measurement of Subcut
the diameter of a needle and is de-
1" IM, IV
scribed by a number followed by a
“G” (gauge). Standard gauge num- 1½" IM
bers range from 16G (a very large
needle gauge) to 31G (a very small 2" Deep IM

needle gauge). See Figure 10-17.

The determination of needle Figure 10-16. Standard needle lengths.
gauge requires the nurse to con-
sider the viscosity of the medica-
tion, the ease of withdrawing and
administering the medication, and Needle Cross Section
Uses
Gauge of Needle Diameter
recommended needle gauges for
various injection sites and routes. 31G, 30G, Common needle gauges
Taking these factors into consider- 29G, 28G, used for subcutaneous and
27G, 26G intradermal injections
ation, the nurse also considers the
Standard needle gauge for
smallest needle gauge for the com- 25G most subcutaneous
fort of the patient. injections
Standard needle gauge for
23G, 22G,
most IM injections
21G

Can be used for IV

19G, 18G medication preparation

Figure 10-17. Standard needle gauges.

S y r i n g es a n d Needles C ommonly Used i n C li ni cal Practice

Syringe manufacturers package syringes
and needles together so that commonly
used syringe and needle combinations are
readily available (Figs. 10-18, 10-19, and
10-20).
Prepackaged syringes and needles are a
time-saving convenience for the nurse in
the busy clinical setting. However, the
nurse still needs to choose the most ap-
propriate syringe and needle size for the Figure 10-18. BD SafetyGlide syringe package: 3 mL
25G 5/8".
individual patient and medication to be
given. In some instances, the needle in a
prepackaged syringe will need to be exchanged for a needle of a different size.

Figure 10-19. Retractable Technologies syringe package: 1 mL 27G 1/2".

2496_Ch10_179-193 25/08/16 4:38 PM Page 189

CHAPTER TEN ■ Syringes and Needles 189

Figure 10-20. Retractable Technologies syringe package: 5 mL 20G 11/2".

Co l o r C o d i n g o n S y ri nges and N eedles

Syringe manufacturers conform to standards from the International Organization for
Standardization (ISO) and use standardized colors for needle hubs and syringe and nee-
dle packaging (ISO Standard 6009:1992). To ensure safe practice, the nurse should al-
ways double-check the syringe, the volume of medication, and the length and gauge of
the needle.

A P P LY LE A RN E D K N O WL E D GE 1 0 -3
Choose the best syringe and needle to use in the situations below.
1. The nurse is to draw up a medication for subcutaneous injection. Which of the following is the most
appropriate needle size for the nurse to choose?
a. 27G 1" c. 22G 11/2"
b. 25G 5/8" d. 19G 1"

2. The nurse is to draw up 2.4 mL of medication for IM injection. The patient weighs 235 pounds. Which of
the following is the best syringe and needle for the nurse to choose?
a. 3 mL 27G 1/2" c. 3 mL 23G 2"
b. 3 mL 25G 5/8" d. 3 mL 18G 11/2"

3. The nurse in the allergy clinic prepares an intradermal injection. The dose is contained in 0.3 mL. Which
syringe will the nurse choose?
a. 3 mL 27G 1" c. 1 mL 21G 1"
b. 3 mL 25G 5/8" d. 1 mL 26G 1/2"

4. The nurse draws up a viscous medication into a 3 mL syringe with an 18G 1" needle. The nurse changes
the needle before giving the IM injection to the patient. Which of the following needles will the nurse
choose for the IM injection?
a. 27G 1" c. 22G 11/2"
b. 25G 5/8" d. 19G 11/2"

5. The nurse is preparing 1 mL an intravenous medication for direct IV injection into the IV tubing. The
medication is contained in a vial. The nurse is most correct to use which of the following to withdraw the
medication?
a. 1 mL 27G 3/8" c. 3 mL 23G 1/2"
b. 1 mL 25G 5/8" d. 3 mL 19G 1"
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190 UNIT FOUR ■ Administration of Medications

CLINICAL REASONING 10-1

The nurse is visiting a patient who was discharged from the hospital yesterday. The patient’s wife
is to give her husband injections of 3,000 units of heparin subcut daily. The ordered dose is con-
tained in 0.6 mL. During the visit, the nurse has the wife demonstrate drawing up heparin into
the syringe. The wife shows the nurse the heparin medication and the following syringe:

mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
The nurse tells the wife that she needs to draw up more heparin into the syringe. Has the nurse
evaluated the wife’s return demonstration correctly? Provide a rationale for your answer.

In summary, the nurse considers the amount and route of medication ordered, the size
of the patient, and the viscosity of the drug when making the choice of syringe and needle.
The most important skill for the nurse to master is reading of the calibration lines on each
syringe used.

Dev e lo pin g Co m pe t e n c y
For questions 1 through 8, read the dose of medication measured in the syringes.
1.
mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0

2.
1½

2½

mL
½

3.
mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0

4.
1½

2½

mL
½

5.
mL
10
1
2
3
4
5
6
7
8
9
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CHAPTER TEN ■ Syringes and Needles 191

6.

mL
1

5
7.

1
mL oz
10

15

20

25

30
5
8.
¼

1¼

1½

mL 1¾
oz
10

15

20

25

30

35

40

45

50
5

For questions 9 through 16, fill in the syringe with the dose indicated.
9. 0.68 mL
mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0

10. 0.5 mL
mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0

11. 1.8 mL
1½

2½

mL
½

12. 2.2 mL
1½

2½

mL
½

13. 0.33 mL
mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0

14. 3.2 mL
mL
1

5
2496_Ch10_179-193 25/08/16 4:38 PM Page 192

192 UNIT FOUR ■ Administration of Medications

15. 18 mL

15 ½

¾
oz
mL
10

20
5
16. 6.8 mL

mL
10
1
2
3
4
5
6
7
8
9

For questions 17 through 20, use the physician’s order on the electronic medical record and the medication label to
determine the amount to administer to the patient. Fill in the syringe with the correct amount.
17. Electronic Medical Record Provider Orders

Name J. Patient Age 20 Gender F DOB 3-10-xx

MR # 12345 Allergies NKDA Room 317-B

Provider M. Physician, MD Date 4-08-xx

Order
Digoxin 150 mcg IV now.
1½

2½

mL
½

18.

Electronic Medical Record Provider Orders

Name L. Patient Age 10 Gender M DOB 7-19-xx

MR # 12587 Allergies NKDA Room 320-A

Provider M. Physician, MD Date 3-01-xx

Order
Lorazepam 0.2 mg IV on call to surgery.
mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
2496_Ch10_179-193 25/08/16 4:38 PM Page 193

CHAPTER TEN ■ Syringes and Needles 193

19.

Electronic Medical Record MAR

Name Z. Patient Age 53 Gender M DOB 1-21-xx

MR # 12345 Allergies NKDA Room 207-B

Date 7-08-xx Time 1900

Scheduled Medications

Time Drug name Dose Route Freq. Adm.

1900 Robinul 150 mcg IV one

time
dose

mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
20. Electronic Medical Record Provider Orders

Name B. Patient Age 76 Gender M DOB 7-23-xx

MR # 12345 Allergies Sulfa Room 1330-A

Provider T. Physician, MD Date 1-10-xx

Order
Enalaprilat 312.5 mcg IV q.6h.
mL
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0