GIVING INJECTIONS IN ENGLISH

                                                

                                 GIVING INJECTIONS  IN ENGLISH

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TITLE OF THE PROCEDURE-

IM/SC/ID INJECTIONS-

Ø  Parenteral medications are given through a route other than the alimentary canal; these routes are intraderaml, subcutaneous, intraspinal, intra-arterial, intra-articular, intra muscular or intravenous. The angle of injection and the depth of penetration will indicate the type of injection.

Ø  Giving an injection safely is considered to be a routine activity for nurses. However, it requires knowledge of anatomy and physiology, pharmacology, psychology, communication skills and practical expertise. It is defined as putting fluid into the body, usually with a syringe and a hollow needle through the skin to a sufficient depth for the drug to be administered into the body.

SYRINGE AND NEEDLES

Ø  A syringe has three basic parts: the tip, which connects with the needle; the barrel, or outside part, which contains measurement calibrations; and the plunger, which fits inside the barrel and has a rubber tip. Most syringes are disposable, made of plastic, and individually packaged for sterility

Ø  Most needles are disposable, made of stainless steel, and individually packaged for sterility. The needle has three basic parts: the hub, which fits onto the tip of the syringe; the cannula, or shaft, which is attached to the hub; the bevel, which is the slanted part at the tip of the shaft;.

Ø  The gauge of the needle refers to the diameter of the shaft; the larger the gauge number, the smaller the diameter of the shaft. Normally 26 G needle is used for intradermal injection, 25 G or 24 G needle is used for subcutaneous injection, 21 G, 2 2 G or 23 G needle is used for intramuscular injection and 18 G to 21 G needle is used for intravenous injection.

TYPES OF INJECTION- main types of injections are-

Ø  Intradermal- In this type of injection drug is injected into the dermis, under the epidermis.

Ø  Intramuscular- in this type of injection drug is inserted into the muscle.

Ø  Intravenous- in this type of injection drug is inserted into the veins.

Ø  Subcutaneous- In this type of injection drug is injected into the subcutaneous tissue, under the dermis.

Ø  Intraspinal or intrathecal- in this type of injection drug is inserted into the spinal cavity.

Ø  Intra-arterial- in this type of injection drug is inserted into the arteries.

PROCEDURE OF IM/SC/ID INJECTION-

PREPARATION OF INJECTION TRAY-

Ø  The Injection tray should contain -

Ø  A small tray with various size of syringes.

Ø  Transfer forceps in a jar.

Ø  Spirit in a jar.

Ø  Sterile cotton swabs in a bowl.

Ø  Kidney tray

Ø  Paper bag

Ø  Boiled sterile swabs in a bowl.

Ø  Medication card

Ø  Medications and sterile water for injection

Ø  File to cut open the ampoules

Ø  Needle hub cutter.

Ø  Gloves and other PPE as needed.

Ø  If preparing injection tray for immunization to children than this tray is known as immunization tray. This tray should contain all articles discussed along with vaccines in a vaccine carrier, and immunization card instead of medication card.

PREPARATION OF  CLIENT

Ø  Always keep rights of drug administration in mind while giving injections.

Ø  Identify the client correctly (Right client)

Ø  Ask client to use washroom if desired before injection.

Ø  Explain the procedure to the client.

Ø  Provide privacy with curtains and drapes.

Ø  keep the attention of the client away from the injection by friendly conversation or curious articles or toys in case of children.

Ø  Place the client in a comfortable position suitable for the type of injection

Ø  Select right route of injection by confirming from physicians order, drug card and nursing notes

Ø  Perform hand hygiene and put on gloves.

Ø  Select site for IM injection. Mainly four sites are used gluteal muscles (dorsogluteal site and ventro-gluteal site), deltoid muscle and vastus latrealis muscle.

Ø  Take out syringe and fill it with medicine from ampule or vial. Change the needle if it as used to pierce the rubber stopper of the vial.

Ø  Ensure that air is removed from the syringe do not touch the needle’s shaft.

Ø  Clean the site with antimicrobial swab.

Ø  In case of vaccination clean the site with sterile water swab or boiled and cooled sterile swab

Ø  For dorsal gluteal site first identify greater trochanter of the femur and posterior superior iliac spine.

Ø  draw imaginary lines to make four quadrant on the buttocks as shown in the picture. Upper outer quadrant is the site of injection.

Ø  for ventro gluteal site, place the tip of the index finger on the anterior superior iliac spine and middle finger just bellow the iliac crest. The V shaped area is the area of injection site.

Ø  for vastus lateralis site find the area on lateral aspect of thigh mid part between greater trochanter and knee. For vaccination in children this is the site of choice for IM vaccines

Ø  for deltoid site locate the lower edge of acromion process and form a rectangle. This is the site for small quantity of medication.

Ø  After cleaning the site Displace the skin in a Z-track manner by pulling the skin down or to one side about 1 (2.5 cm)

Ø  Spread the tissue between thumb and the fingers to make the skin taut.

Ø  Insert the needle with quick movement to minimize the pain at 90 degree angle.

Ø  withdraw the plunger to check blood, if no blood is there in syringe than give the medication slowly by pushing the plunger.

Ø  Remove the needle quickly and clean the site with sterile swab if small amount of blood is oozing.

Ø  Give key message to the client about drug or vaccine.

Ø  For subcutaneous injection all steps will remain same, only angle is changed to 45 degree so that medicine is given under dermis in subcutaneous tissue and only three forth of the needle in inserted.

Ø  Subcutaneous sites can be selected for injection are outer aspect upper arm, upper back bellow scapula, abdomen and thigh.

Ø  For intradermal injection all steps will remain same only angle is changed to 15 degree so that medicine is given between epidermis and dermis, a wheel should be formed on skin. 

AFTERCARE-

Ø  After giving injection inspect the site, if oozing of blood is seen than apply pressure using sterile dry cotton.

Ø  Help the client to take comfortable position in the bed.

Ø  Wash hands or perform hand hygiene

Ø  Watch for post injection reactions for half hour.

Ø  Record the procedure in the nurses notes and other registers as per policy of the institution.