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8/3/2019 Administration of Injections Presentations
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Preparing for theAdministration of Injections
Sue Cressey
Clinical Nurse Trainer
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Aims of this session
To understand the reasoning behind theprocess of
collecting the correct equipment administering the correct drug in the correct
form
at the correct time to the correct person
in the correct manner
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Objectives of this session
The safe administration of drugs via
intramuscular injection - in a safe andcontrolled manner - having assessed risks-and - causing minimal physical andpsychological harm, but, maximum benefit tothe patient
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What is an injection?
Injections are sterile solutions, emulsions orsuspensions.
They are prepared by dissolving, emulsifyingor suspending an active ingredient and anyother substances in water for injection.
Injecting is the act of giving medication by useof syringe and needle to obtain the desiredtherapeutic effect taking into account thepatients safety and comfort
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How are drugs for injectionspresented?
Single dose preparationsa pre - prepared volume of measured drug, in asyringe for single dose usei.e. Flu vaccines, Pneumovax and B12.
Multidose preparationsmulti-dose preparations contain a antimicrobiacteralpreservative, are used on more than the oneoccasion and great care is required for itsadministration but especially its storage between
successive withdrawals
i.e Insulin
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Where are injectable drugskept
The label on the packet should in most cases giveguidance about storage conditions for individualpreparations
Drugs should be stored away from light
The Cold Chain involves preparations being storedbetween 2 and 8 degrees and has a traceable record
Best Practice ensures all medication is stored in alocked cupboard or fridge
If you are in any doubt about the storagerequirements for any preparation you should checkwith the lead nurse, Dr or pharmacist
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Why give drugs in injectionform
Injections usually allow rapid absorption
Can produce blood levels comparable to
those of intravenous bolus injections Injections can be given from 1ml and up to
2mils in the Deltoid and up to 5mls in thegluteal muscle in adults
Drugs that are altered or not absorbed by
other methods of administration
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Needle length and size
For intramuscular injections e.g flu, pneumonia andB12, the needle should be long enough to penetratethe muscle and still allow a quarter of the needle toremain external to the skin (Workman 1999)
When choosing the needle it is important to assessthe amount of muscle, subcutaneous fat and weightof the patient - which in the majority of cases will be ablue needle
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Which is which needle?
The correct needle is the key to delivering the drug to the correctarea for the maximum effect with the least amount of discomfort
The colour at the top of the needle reflects its size
the higher the number the smaller the lumen (bore)
Orange needles = 25 guage = 10mm long (3/8 inch)or 16mm long(5/8 inch) or 25mm long (1 inch)
Blue needles = 23 guage = 25mm long 9 (1 inch)
Green needles = 21 guage = 38mm long (1.5 inches)
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How do assess the depth ofmuscle and subcutaneous fat
The deltoid and vastus lateralis muscles
should be grasped between the thumb andforefinger to determine the depth of muscleand/or the amount of subcutaneous fat at the
injection site
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Intramuscular Injections andPain
Factors that can cause pain are
The needle
The technique
The speed of the injection
The solution and composition of the drug
The volume of the drug The approach and attitude of person
administering the injection(Workman 1999 and Torrence (1989)
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Asepsis and reducing the riskof infection
Good hand washing
Good hand drying
Aseptic technique
Good observation and questioning of the client
Skin preparation if required
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Clinical room preparation forthe administration of injections
Protocols/procedure/standards information isavailable
Hand basin for washing hands and/or alcohol handrub.
Area for the client to lie down if unwell
Panic button/phone to call for assistance
sharps container Gloves
Resuscitation /anaphylaxis equipment/drugs
Oxygen and appropriate mask if available
adequate time for procedure
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Equipment for theadministration of injections
Clean tray or receiver in which to place drug and equipment
21g needle to ease reconstitution and drawing up (23g if from a
glass ampoule
Syringe of appropriate size
Swabs saturated with isopropyl alcohol 70%
Sterile topical swab if drug is presented in ampoule form
Drug to be administered Patients prescription to check dose, route and timing
Notes available to record administration in accordance with law
Gloves, Apron
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Procedure for preparation ofinjections in adults
Action Collect and check all equipment
Check the the packaging of allequipment is intact and druginformation leaflet is available
Wash hands with soap and
water or bactericidal hand rub
Prepare the needle, syringe etcon a tray or receiver
Inspect all equipment
Rationale To prevent delays and enable
full concentration on procedure
To ensure sterility. If seal or
packaging isdamageddiscardinformation leaflet for guidanceand prescriptive information
To prevent contamination of
medication and equipment
To check that none is damaged,if so discard
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Preparation cont:
Action Consult the patients
prescription and ascertain the
following : Drug
Dose is appropriate for the ptsage
date and time (if applicable) of
administration Route and method of
administration
Diluent as appropriate (ifnecessary)
validity of prescription Signature of doctor
Rationale To ensure that the patient is
given the correct drug in the
prescribed dose using theappropriate diluent (if required)and by the correct route
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Preparation cont:
Action check all details with nurse
mentor - select the drug in the
appropriate volume dilution ordosage and check expiry date
Proceed with the preparation ofthe drug using protectiveclothing if necessary
Evaluate the patientsknowledge of the medicationbeing offered. If this knowledgeappears to be faulty or incorrectrefer to nurse mentor
offer explanation of the use,
action, dose and potential sideeffects of the drug involved
Rationale To minimise any risk of error - to
reduce wastage and expiry date
ensures drug is safe to give andis still pharmacologicallyeffective
The patient has a right toinformation about treatment
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Prefilled Syringes
Action Check storage conditions
check name and expiry date or
signs of damage to the packaging on removing from packaging check
name expiry date and syringe forany damage
check vaccine is free from particlesand colour is correct
If you feel that the fixed needlelength is not appropriate discusswith lead nurse, do not transfer druginto another syringe
expell air from syringe
place in receiver until ready to
administer
Rationale To ensure the drug is kept in the
appropriate manner
to ensure sterility
to ensure client/patient does notreceive unstable or contaminatedmedication
vaccine not given into the musclecan be painful and have a reducedeffect
to ensure the correct amount ofdrug is in the syringe
to ensure sterility is maintained help
reduce risk of needlestick
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Single Dose Ampoules ofSolution
Action Inspect solution for particles and
colour if either or both present
discuss appropriate methods fordiscarding with nurse mentor
Tap the neck of the ampoulegently
Cover the neck of the ampoule
with a sterile topical swab andsnap top off. If difficult use a file
Check solution for glassfragments discard if present
Rationale Ensure the patient does not
receive contaminated or
unstable drugs
To ensure the solution is at thebottom of the ampoule
To aid asepsis. To prevent
aerosol formation or contactwhich may lead tosensitivity/reaction, preventinjury to the nurse
To ensure risk of injectingforeign material into the patient
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Ampoules continued
Action Withdraw the solution, the
ampoule can be tilted if required
with a needle with a gauge nolarger than 21G
Re sheath needle, tap syringeto dislodge any air bubbles.Expel air
place in receiver until ready touse
Note replacing sheath onneedle should NOT be confusedwith resheathing needles
AFTER use
Rationale To avoid drawing up air and any
glass particles
prevent aerosol formation andensure correct amount of drugis in the syringe
maintains sterility and preventsdropping the syringe andreduces potential risk of needlestick injury
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Anxious Patients and Fainters
Adopt a calm and sympathetic approach
Prepare the vaccine if possible out of the sight of the patient
where possible keep the conversation going to distract the
patient If possible ask nervous friends to leave, discourage large groups
of supporters
explanation that an injection is not the same as having a bloodsample taken
The bigger they are the harder they fall
Fainting more common in those who have not eaten
If in doubt lay them down
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Skin Preparation
Should the skin appear dirty it should becleaned with soap and water.
Should the client/patient have reducedimmunity the skin can be cleaned with analcohol preparation prior to the injection - but- the alcohol must be allowed to evaporate asit can affect the preparation and/or sting onadministration of the preparation
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Just before you give the injection
Action fully expose the limb fully
Encourage the patient to relaxthe muscle, by hanging the arm
by their side or on their lap
Patients should sit or lay downfor their injection
Quickly review the pre injection
Rationale The injection may be given to
low and end up as subcut. A
tight sleeve can have the sameeffect as a tourniquet andencourage bleeding at theinjection site
To reduce discomfort andpromote distribution of the drug
Reduce risk of injury to thepatient and the HCA/nurse fromfalls and needle stick injury
To reduce the risk of error and
promote patient safety
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When not to give an injection
The client/patient is unable to confirm their identity using avariety of methods
The client is unsure and records cannot confirm if the client has
received the vaccine previously The Client withdraws or refuses to consent
Incorrect storage of vaccine, past expiry date
There is no prescription for the patient
The prescription does not state the clients name, drug, time,dose or route of administration or the writing is illegible
If patients have a temperature
Pregnancy
If clients report a severe local reaction or systemic reaction to
the preceding dose refer to nurse mentor
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Technique for Intramuscular (IM)Injection
Action Hold the skin firmly (not
bunched) with the free hand
Introduce the needle at a 90degree angle leaving a third ofthe shaft exposed
Aspirate (draw back) theplunger to ensure a bloodvessel has not been penetrated.If blood is aspirated remove theneedle, change it and startagain
Rationale To allow easy entry of the
needle through the skin and
displace the subcutaneous fat To ensure the needle
penetrates the muscle andfacilitate removal of the needleshould it break
To ensure the needle is in theright place.
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IM injection continued
ACTION
Inject the drug slowly
Withdrawn the needle quicklyand evenly and apply pressureto any bleeding point
Record the administration of thedrug according to policy andprocedure
Dispose of needle and syringeaccording to policy andprocedure
Ensure patient is feeling well
prior to discharge
RATIONAL
To prevent pain. To ensureeven distribution of the drug
To prevent Haematomaformation (bruising)
To maintain records, complywith law, prevent duplication,promote continuity of care
To ensure safe disposal andreduce risk of injury to self andothers
To reduce risk of injury
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Site on the Deltoid for
Intramuscular Injections
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An Intramuscular Injection
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When It Goes Wrong
You give the wrong drug
You give the right drug to the wrong person
The client/patient faints
The client remembers a previous badreaction to a previous injection
The client/patient complains The client/patient tells you post injection that
they may be pregnant/on steroids/havingchemotherapy or radiation
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REFERENCES
Kassianous George, (2001) Immunization Childhood and TravelHealth. Forth Edition. London. Blackwell Science.
Nursing and Midwifery Council
Jane Mallett and Lisa Dougherty, (2000) The Royal MarsdenHospital Manual of Clinical Nursing Procedures 233-236.FifthEdition. London. Blackwell Science
UK Guidance on Best Practice in Vaccine Administration (2002)
www.google.com. Intramuscular Injection