CHERISH COLLEGE OF NURSING & MIDWIFERY BATSARI

GNS 121 (FOUNDATION OF NURSING)

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BY: IBRAHIM MAIRUWA (RN)

INJECTION

Definition Injection is a method of introducing liquid medications into various

body tissues.

Routes of administration of injection

 Intradermal,
 subcutaneous (SC [Sub Q]),
 intramuscular (IM),
 Intravenous (IV). Other methods include
 intra-cardiac (within the heart),
 intrathecal (into the subarachnoid space around the spinal cord),
 intraosseous (within bone), and
 Intraperitoneal (within the peritoneal cavity).

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Only physicians and specially qualified nurses use these latter routes; for that
reason, they are not addressed in this text. Although the nurse may give injections
by various routes, general principles apply for every method. Because any injection
is an invasive procedure, sterile equipment is a must to avoid introducing
pathogens into the tissues or bloodstream. In addition, the nurse must also be
protected against exposure to the client’s blood or body fluids.

Purpose of injection administration

 The medication is most effective by injection.

 Quicker means of absorption
 The medication is unavailable for any other form of administration.
 The client needs the desired action quickly.
 Dosage accuracy is critical; the client must obtain the entire dose.
 The client is nauseated or vomiting and cannot retain oral medications.
 The client’s mental or physical condition renders him or her unable or
unwilling to swallow oral medications.
 The digestive system cannot absorb the drug.

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Generally, IV injection achieves the fastest method of systemic absorption.The
nurse must know the locations of common administration sites and the actions of
medications to be injected. For example, an accidental injection into a nerve could
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result in damage and paralysis. Injection directly into a blood vessel could cause
the client’s system to absorb the medication too rapidly, with an adverse, perhaps
fatal, reaction. Failure to inject certain medications, such as injectable steroids, into
deep muscle tissue may cause tissue atrophy, with resultant pitting or deformity of
the site.

SYRINGES AND NEEDLES

Syringes

Syringes are available in various sizes, ranging from 0.5 to 100 mL capacity.
Syringes consist of three parts:

Tip , Barrel & Plunge

Needles

Needles are also disposable and consist of three parts: hub, shaft, and bevel tip.
The hub or hilt is the part that attaches to the tip of the syringe. The shaft is the
elongated portion. The bevel (area containing the hole or bore) can vary from

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regular bevel (long, allowing for easy entry through the skin.

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Systems for Various Injection Methods

Subcutaneous injections usually are given using 1- or 2-mL syringes with 5⁄8- to 1-
inch needles. When injecting more than 1 mL subcutaneously, the dose usually is
divided into two syringes and administered in two injections.

Depending on the type and amount of medication, IM injections usually require 2-

to 3-mL syringes with 1- to 11⁄2inch needles. The angle of injection is also
different (72–90 degrees), depending on the type of injection to be given. For an
IM injection, 2 to 3 mL is usually the maximum volume that can safely be injected
into one site. In some cases, less than that would be considered the maximum. If a
greater volume is to be given, two separate injections into different sites must be
used.

Intradermal injections typically are given using 1-mL tuberculin syringes. Needles
should be 25- to 26-G with a 3⁄8inch intradermal bevel. The intradermal bevel is
blunter than a regular bevel and allows easier access to the epidermis.

PREPARATIONS OF INJECTIONS

Injectable medications are packaged in many ways. Some are supplied as powders
that must be reconstituted with a diluent. When mixed with a diluent, these
medications are often fairly unstable and may deteriorate rapidly. They must be
used within the time specified by the manufacturer. Common diluents include

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sterile water and sterile normal saline. The manufacturer’s instructions will specify
the diluent and the amount to be used. In other cases, both the diluent and the
powder are supplied by the manufacturer. Follow the specific instructions for
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mixing any of these solutions.

An ampule is a glass container that holds a premeasured, single medication dose.

A vial is a glass container equipped with a self-sealing rubber stopper. It may

contain a single premeasured medication dose, or may be a multi-dose vial. When
drawing up any injection, use strict aseptic technique, to prevent contamination.
Label all multi dose vials with the time, date, and initials detailing first use. (Some
medications require refrigeration before and/or after being opened.)

INTRADERMAL INJECTIONS

Intradermal injections, often used for diagnostic testing (“skin tests”), are shallow
injections given just beneath the epidermis. The inner aspect of the forearm is the
common injection site. If a number of substances are to be tested, the back may be
used. Tuberculin syringes, which identify hundredths of a millilitre and can hold a
total of 1 mL, are commonly used. Because the tuberculin syringe has a very small
diameter, it can be graduated in hundredths and tenths of a millilitre for accurate
measurement of very small amounts of medication.

SUBCUTANEOUS (SC, Sub Q) INJECTIONS

Subcutaneous injections are administered into subcutaneous or adipose (fatty)

tissues located below the dermis. This method is used for small amounts of
medication that require slow, systemic absorption. Generally, the duration of SC
medications is longer than that of other parenteral medications. Many medications
cannot be given by the subcutaneous route. If the volume of medication is greater
than 1 mL, the subcutaneous route is usually not recommended or two sites must
be used.
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Subcutaneous medications must be soluble and of sufficient strength to be
effective, yet safe for surrounding tissues. Common SC medications are insulin and
heparin. Allergy injections and some pain medications may be administered SC as
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well. Subcutaneous injections are given in areas where bones and blood vessels are
not near the skin’s surface. One common site is the outer aspect of the upper arm,
above the halfway mark between the elbow and the shoulder.

INTRAMUSCULAR (IM) INJECTIONS

Intramuscular injections are given in muscles situated below the dermal and
subcutaneous skin layers. Such medications must be injected deep into muscles.
The body absorbs IM injections much more rapidly than SC injections, because of
the greater amount of blood supply to muscle tissue. It is important for the nurse to
be thoroughly familiar with IM injection sites and the technique for administering
these injections. The most common areas for IM administration are the following:

 Dorsogluteal (back of hip)

 Deltoid (upper arm)
 Vastus lateralis (side of thigh)
 Rectus femoris (anterior thigh), used only when other sites are not available
 Ventrogluteal (side of hip)

Intramuscular injection is the best technique when medications given less deeply
irritate the client’s tissues or when large amounts of medication are necessary.
These injections are given in much the same way as subcutaneous injections.
However, a longer needle with a larger bore is used, most often a 1½- to 2-inch,
20- to 22-G needle, depending on the type of medication. Use an angle of 90
degrees for the injection. In addition to requiring a longer and larger-gauge needle,
IM injections are more difficult and dangerous than SC injections. The needle must
be injected deeper into the client’s body, penetrating the epidermal, dermal,

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subcutaneous, and muscle tissues. If the medication is thick, injecting into the
muscle may be more difficult.

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Fluids are administered via the circulatory system to correct or prevent fluid and
electrolyte imbalance in the client. For example, the client who is given nothing by
mouth (NPO) for surgery often receives IV fluids postoperatively. IV access is also
used to administer medications. Peripherally placed cannula for short-term
administration of fluids and nutrients. Central lines are used for longer-term
administration and for certain products that cannot be administered through a
peripheral line.

Intravenous injections and infusions allow the introduction of fluid solutions of

electrolytes, nutrients, vitamins, and medications directly into the bloodstream.
Medications are absorbed more rapidly via the IV route than any other commonly
used route. Large quantities of a solution may be given IV by way of an infusion.
A solution flows at a constant, continuous rate into the client’s vein with the aid of
gravity or an infusion pump or controller. IV infusions are commonly given for
fluid replacement caused by dehydration or excessive blood loss, electrolyte
replacement, antibiotic therapy, chemotherapy, or nutrition. If blood or blood
products are administered IV, the procedure is referred to as a transfusion.

ADMINISTRATION OF INTRAVENOUS MEDICATIONS

Many drugs, including antibiotics, electrolytes, and vitamins, are commonly added
to IV infusions. Many of these solutions are premixed and supplied by the
manufacturer

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