Injections Sites, Techniques and Criteria

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NUR 101 Fundamentals CCTC Fall 2011

Intradermal injections

are administered into the dermis, just below the epidermis.

The intradermal route has

the longest absorption time of all the parenteral routes.

intradermal injections are used for

sensitivity tests,such as tuberculin and allergy tests, and local anesthesia.

What syringe is commonly used for Intradermal injections?

a tuberculin syringe calibrated in tenths and hundredths of a milliliter.

What length of needle is used for ID injections?

A 1/4" to 1/2"

What gauge needle do you use for ID injections?

26- or 27-gauge needle

What is the fluid limit for ID injections?

The dosage given intradermally is small, usually less than 0.5 mL

The angle of administration for an intradermal injection is?

5 to 15 degrees.

Sites on the body where subcutaneous injections can be given?

the outer aspect of the upper arm, the abdomen (from below the costal margin to the iliac crests), the anterior aspects of the thigh, the upper back, and the upper ventral or dorsogluteal area. Avoid sites that are bruised, tender, hard, swollen, inflamed, or scarred. These conditions could affect absorption or cause discomfort and injury

How are absorption rates different for SQ sites?

Injections in the abdomen are absorbed most rapidly
ones in the arms are absorbed some what more slowly
those in the thighs, even more slowly
and those in the upper ventral or dorsogluteal areas have the slowest absorption

The syringe used for a subcutaneous injection includes?

a syringe of appropriate volume for the amount of drug being administered.

What length of gauge do you use for SQ injections?

A 25- to 30-gauge

What length of needle do you use for SQ injections?

3/8" to 1" needle can be used.
The 3/8" and 5/8" needles are most commonly used.
Choose the needle length based on the amount of subcutaneous tissue present, which is based on the patient's body weight and build.

what is the fluid limit for SQ injections?

no more than 1 mL of solution is given sub-cutaneously. Giving larger amounts adds to the patient's discomfort and may predispose to poor absorption.

Subcutaneous injections are administered at what angles?

a 45- to 90-degree angle. Choose the angle of needle insertion based on the amount of subcutaneous tissue present and the length of the needle. Generally, the shorter, 3/8"needle should be inserted at a 90-degree angle, and the longer, 5/8" needle is inserted at a 45-degree angle.

Insulin is prepared using an?

insulin syringe.
Insulin syringes are available with 28- to 30-gauge, 5/16" and 1/2" length needles, and in 3/10-mL to 1-mL sizes. The shorter needles (5/16" ) are becoming the more common length used.

Other drugs are never administered with an insulin syringe.

How is Heparin administered?

subcutaneously.

What sites are heparin administered in?

The abdomen is the most commonly used site. Avoid the area 2" around the umbilicus and the belt line.

What sites are low molecular weight heparins like enoxaparin (Lovenox) administered?

Administer enoxaparin in an area on the abdomen between the left or right anterolateral and left or right posterolateral abdominal wall

What is the technique for administering LMW heparins?

pinch the tissue gently and insert the needle at a 90-degree angle.
In addition, enoxaparin is packaged in a prefilled syringe with an air bubble. Do not expel the air bubble before administration.

Why use a intramuscular injection instead of a SQ injection?

Intramuscular injections deliver medication through the skin and subcutaneous tissues into certain muscles. Muscles have larger and a greater number of blood vessels than does subcutaneous tissue, allowing faster onset of action than with subcutaneous injections.

Intramuscular site location by patient age:

Infants: Vastus lateralis
Toddlers and children: Vastus lateralis or deltoid
Adults: Ventrogluteal or deltoid

Intramuscular site location by medication type:

Biologicals (infants and young children): Vastus lateralis Biologicals (older children and adults): Deltoid
Hepatitis B/Rabies, Medications that are known to be irritating, viscous or oily solutions: Ventrogluteal and Deltoid

How do you locate the ventrogluteal site:

place the palm of your hand over the greater trochanter, with your fingers facing the patient's head. The right hand is used for the patient's left hip, or the left hand for the right hip, to identify landmarks. Place the index finger on the anterosuperior iliac spine and extend the middle finger dorsally, palpating the iliac crest. A triangle is formed, and the injection is given in the center ofthe triangle.

How do you locate the vastus lateralis site?

divide the thigh into thirds horizontally and vertically and administer the injection in the outer middle third. This space provides a large number of injection sites.
The vastus lateralis site is particularly desirable for infants and children, whose gluteal muscles are developed poorly.

Why use the deltoid site for IM injections?

It is the recommended site for vaccines for adults and may be used for children between 1 and 18 years of age for vaccine administration. The deltoid muscle is not developed enough in infants to absorb medication adequately.
Damage to the radial nerve and artery is a risk with use of the deltoid site.
Intramuscular injections into the deltoid muscle should be limited to 1 mL of solution.

How do you locate the deltoid site?

Locate the deltoid muscle by palpating the lower edge of the acromion process. A triangle is formed at the midpoint in line with the axilla on the lateral aspect of the upper arm, with the base of the triangle at the acromion process.

IM injection needle length based on site/age:

Vastus lateralis: 5/8" to 1"
Deltoid (children): 5/8" to 1 1/4"
Deltoid (adults): 5/8" to 1 1/2"
Ventrogluteal (adults): 1 1/2"

What gauge needle should be used for IM injections?

Generally, biological agents and medications in aqueous solutions should be administered with a 20- to 25-gauge nee-dle.
Medications in oil-based solutions should be adminis-tered with an 18- to 25-gauge needle.

What is the fluid limit for IM injections?

The volume of medication that can be administered intra-muscularly varies based on the intended site. Generally, 1 to 4 mL is the accepted volume range, with no more than 1 mL given at the deltoid site.
The less-developed muscles ofchildren and elderly people limit the intramuscular injection to 1 to 2 mL

How to properly administer an IM injection:

Administer the intramuscular injection so that the needle is perpendicular to the patient's body. This should ensure that it
is given using an angle of injection between 72 to 90 degrees

Why use the Z-track technique for IM injections?

it is recommended for all intramuscular injections to ensure medication does not leak back along the needle track and into the subcutaneous tissue

How do you perform the Z-track?

attach a clean needle to the syringe after the syringe is filled with the medication to prevent the injection of any residual medication on the needle into superficial tissues. Pull the skin down or to one side about 1" (2.5 cm) and hold in this position with the nondominant hand. Insert the needle and inject the medication slowly. Withdraw the needle steadily and release the displaced tissue to allow it to return to its normal position.

ID, SQ and IM Injection comparison:

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