The ultimate step to step guide for injection technique

Injection technique

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In the injection technique, there are various types of syringes and needles, that are used for several procedures. It is important to select the needles and syringes carefully, according to the type of injection that administered.

For example, the length of the needle, gauge, the type of syringe should be appropriate for the injection site and viscosity, and the volume of medication. The age, weight, and condition of the patient are other key factors in the selection process.

Device and equipment for injection technique-

Anatomy of needle-

Needle is made up of stainless steel. It is siliconized for easier administration to the patient thus minimizing discomfort. It is available in different lengths and gauges to suit individual clinical and patient needs as per the requirement. Needle is consisting of these parts are-

Anatomy-Of-Needle-With-Cap-And-Hub-And-Its-Parts
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•             Lumen

•             shaft

•             bevel

•             Hub

•             Safety mechanism

Never reuse a needle.

Needle length is depending upon the age, physical condition, and medical requirement of the patient.

Anatomy of syringe-

Syringe is consisting of a cylindrical tube that is made up of plastic, glass, and others. It is a medical device that is used to inject the fluid or withdrawal fluid from the body. A medical syringe is containing a needle (removable) attached for use to it that is connected with a sliding plunger. The downward movement of the plunger rod is used to inject fluid and upward movement is for withdraws fluid in the syringe.

Syringe is available in different designs and varieties. Plastic syringes are disposable or one-time use. It is consisting of different parts are-

Anatomy-Of-Syringe-With-its-Parts
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•             Tip

•             Rubber Stopper

•             Volume marking

•             Barrel

•             Flange

•             Plunger rod

•             Thumb presser

Vial-

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Vial is made up of glass or plastic that is used to preserve the medication in solid and liquid. These are also used as vessels and small bottles also.

The single-dose vials are used only for once and the multi-dose vails can be used more than once.

Ampule-

Simple-Ampule-Used-In-Pharmaceutical-For-Solid-And-Liquid-Medication
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Ampule is a small sealed vail that used to preserve a sample in usually solid or liquid form. These are made up of glass. These are generally opened by snapping off the neck.

 Ampule having colored rings or dot on their neck to identify the substance in it because these are only for the machine as coding to read the details of the ampule.  

Conditions for assembling devices and equipment-

Before the preparation for an injection, it is necessary to assemble all the equipment first in a clean work area. This generally includes in injection technique as follow:

•             Medication with required dose

•             The order of medication

•             Route of administration

•             Documentation

•             Pair of gloves

•             Alcohol swab box

•             Required needle and syringe of appropriate size

•             Dispose in sharps disposal container

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Preparing the injection devices and equipment for use-

1.            After the instruments have been assembled, wash your hand for hygiene. Medications are generally supplied as a liquid in a single-dose ampule, vial or multi-dose vial, etc. A single-dose vial is only intended for use in a single patient. Don’t use medications from single-dose vials to multiple patients because this causes unwanted side effects or sometimes patients may die.        

In multi-dose vial contains more than one dose of medication for further use. But multi-dose vials should be dedicated to a single patient whenever it possible.  If the multi-dose vials are used then both the needle and syringe that used to access the multi-dose vial must be sterilized.  Occasionally, they are supplied in a single-dose vial in powder form, which has to be reconstituted with either sterile water or saline.

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2.            Before opening, the syringe and needle packages read the information carefully. Verify that length and gauge of the syringe and needle are correct for use. Check that the seals of the package are not broken and sterility is done only when the package is unopened and undamaged.

3.            Open the syringe and needle packages carefully. If you see the syringe and needle are not one unit then connect the syringe tip to the hub of the needle. Always ensure a secure connection between the needle and syringe and avoid direct contamination by not touching the hub of the needle or tip of the syringe. Use gloves for safety purposes.

Proper Aseptic Technique for injection-

Open the packages by holding the peel tabs, and peel them back only enough to expose the hub of the needle or the plunger rod of the syringe.

If presenting to a sterile field and performing a sterile transfer then be sure to peel the tabs back far enough to permit easy access or release of the product. If necessary, you may open the packages but leave the products inside of them.

                       Do not remove the syringe or needle from the sterile package and place it on a non-sterile surface. This will reduce the likelihood of touch contamination. It will also reduce the potential for contamination of the fluid path.

                 Connect the hub of the needle to the nozzle of the syringe by using it in a clockwise twisting motion. If using a Luer slip tip syringe then be sure to apply force to the needle hub when twisting to ensure a secure fit.

Checking the medication

It is essential to:

•             Check medication against the medication order.

•             Check the time and date the medication is to be given and that it is for the correct patient.

•             Check medication and diluent (if required) to ensure integrity (ie., not cloudy or discolored, no particulate matter).

•             Check the expiry date and dose of medication.

Passive recapping for needle-

•             If recapping is necessary for medication transport then it is preferred that clinicians use a one-handed technique for it.

•             The one-handed scoop technique is used to pick up the needle cap and for the needle itself. The cap is pushed up against a hard surface to ensure a tight fit onto the device.

•             If a hard surface is not available then the cap covers the needle completely and then use the other hand to secure the cap on the needle hub. Be careful when handling the cap at the bottom near the hub.

•             Never use two hands for the needle recapping process and perform it properly.

Skin preparation before injection-

Before administering an injection (intramuscular, subcutaneous, or intradermal technique), the skin should be cleansed.

Start in the center of the injection site.

Work in a circular motion, to the outer aspect that away from the injection site.

Use friction motion to clean the skin at the site of injection with an alcohol swab (the alcohol swab is in 70% isopropyl form).

Allow to air dry.

Injection Routes

•             Intramuscular

•             Subcutaneous

•             Intradermal

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Site for injection-

For intramuscular (IM)-

Vastus laterals muscle- The site is located in the lateral middle third of the thigh between the greater trochanter and the knee. When injecting then lift the vastus lateralis muscle away from the bone.

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Intramuscular injection site

NOTE: The rectus femoris muscle is located in the anterior middle third of the thigh.

Deltoid muscle- The thickest section of the deltoid muscle is located 1”-2” (1-3 fingerbreadths) under the lower edge of the acromion process of the scapula over the midaxillary line.

Ventrogluteal site- The ventrogluteal site is located by placing the palm of the hand over the greater trochanter with the middle finger reaching toward the iliac crest and the index finger angled toward the anterior superior iliac spine, that forming a ‘V.’ Inject within the center of the ‘V,’ below the anterior superior iliac crest.

Dorsogluteal site- The dorsogluteal site is located above an imaginary line between the greater trochanter and the posterior superior iliac crest. The injection is administered horizontally and superior to this imaginary line.

Subcutaneous (Sub)-

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In most patients, the injection should be inserted at 90° at the length of 4mm and 5 mm (.157″-.2″) without a raise skin fold (skin pinch). In young children and lean adults, this may also require a raised skin fold 9akin pinch) with 6mm (.24″) longer always be used for injection. In the thin patients, they may also require a 45 insertion with 6mm (.24″) longer length needle used for injection. To avoid accidental needle-stick a raised skin fold should be wide in >1” between finger and thumb.

•             The outer aspect of the upper thigh

•             Abdomen- avoid to injecting within 1-2″ around the umbilicus

•             Upper buttocks

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Intradermal (ID)-

•             Anterior aspect of the forearm

•             Upper chest

•             Upper back/Back of arm

Standard injection procedure-

For intramuscular (IM)-

  1. •             Spread the skin taut, and insert the needle with a darting motion at a 90˚ angle.
Standard-Injection-Procedure-For-Intramuscular-Injection
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  1.           For IM injection of vaccines, aspiration of blood return is not recommended. If injecting Dorsugluteal site only: Pull back slightly on plunger. IF blood appears in the syringe, remove the needle, dispose properly and prepare a new injection. Follow your facility’s protocol.
  2. •             Inject medication slowly.
  3. •             Withdraw needle and place sterile gauze firmly over the site.
  4. •             Engage safety mechanisms on the needle or syringe.
  5. •             Dispose of properly. Record injection on medication administration records.

For Subcutaneous (SubQ)-

Standard-Injection-Procedure-For-Subcutaneous-Injection
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If raised skin fold is used, avoid accidental needlesticks by maintaining a distance of >1” between your finger and thumb. Plus, the raised akin fold must be maintained throughout the injection until the needle is removed from the skin.

  1. Insert the needle at a 90˚ or 45˚ angle.
  2. Inject medication slowly.
  3. Withdraw needle, and place sterile gauze firmly over the site.
  4. Engage safety mechanism on needle or syringe.
  5.  Dispose of properly. Record injection on medication administration records.

For intradermal (ID)-

  1. Spread the skin taut, and then insert the needle tip at a 10-15˚ angle.
  2. Inject the medication slowly: a small fluid bleb(wheal) forms. If a wheel does not appear. It was administered in the subcutaneous tissue.
  3.  Withdraw the needle, and place sterile gauze over the site. Do not massage.
  4. Engage safety mechanism on needle or syringe.
  5. Dispose of properly. Record injection on medication administration records.

Preparing to fill the syringe-

•             Gather your supplies.

•             Read the literature provided.

•             Always examine the medicine.

Filling the syringe-

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•             Check the syringe and needle.

•             Check that you have the select correct type of syringe.

•             Wash your hands.

•             Know that if you require to gently mix the medication.

•             Remove the cap from the vial/ampule.

•             Pull the plunger rod back on the syringe.

•             Remove the needle cover.

•             Insert the needle into the tip of the syringe.

•             Push the plunger rod of the syringe down.

•             Turn the bottle upside-down.

•             Pull the plunger rod back.

•             Observe the medication in the syringe for air bubbles.

•             Push the plunger rod gently.

•             Draw more medication if needed.

•             Remove the needle from the vail/ampule.

•             Give the injection.

•             Use safe injection practices.

•             Never re-use a needle.

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Safe Use and Disposal of Sharps Equipment in injection technique-

Sharp waste is the biomedical waste compound that includes needle, syringe, vial, lancets, and another medical biowaste that are used frequently. The sharp waste container should keep out of reach from children. Sharps waste is classified as biohazardous waste and must be handle carefully.

Common medical materials treated as sharps waste in injection technique are-

•             Needles

•             Syringes

•             Glass (ampules)

•             Vials (empty/partial)

•             Razor blades

•             Surgical blades

•             Safety & disposal

Safe use and disposal of sharps-

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Care must be exercised during the use and disposal of sharps. Good practice in the disposal of sharps includes the following key points-

•             All staff must dispose of sharps correctly.

•             The person using the sharp is responsible for disposing of it in an approved sharps disposal container.

•             The facility is responsible for ensuring the disposal of the container.

•             The sharps container should be at the place where sharps are used so that they can be disposed of immediately after use.

•             Sharps containers should never be overfilled. The used needles never should be recapped, cut or bent.

•             All incidents or accidents involving needlestick injuries and/or accidents involving body fluids should be recorded and reported in line with local policies.


This Post Has 4 Comments

  1. chanchalsharma

    thanks …….for sharing this elemental info👍

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