|Administer Intramuscular, Subcutaneous, and Intradermal Injections|
Lesson 1: Preparation and Administration of
a. The administration of medicine by injection requires equipment (needles and syringes) that is sterile, accurate in measuring dosage, convenient to use, and that will produce as little discomfort and/or hazard for the patient as possible. A needle and syringe are used to introduce suitable liquid preparations of drugs directly into the body tissue or blood vessels. Because of the accuracy of these methods of administration, these injections provide the patient with a more precise amount of drug and a more rapid onset of drug action than with oral medications.
b. Patient safety is a critical factor for the basic medical specialist. Aseptic techniques must be strictly maintained during the preparation and administration of a drug. Foreign particles or other types of contamination on a needle could be injected directly into the body. Infection may be introduced through the needle hole in the skin. Irreparable damage to major nerves or other structures may occur due to improper technique or a dull needle. Needles and syringes are controlled items. The medical specialist is responsible for the security and control and ultimate disposal of this equipment.
a. Determine Type of Medication, Time of Administration, and Route of Injection. This step is to determine the type of needle needed.
b. Perform Patient Care Handwash. Wash hands according to instructions provided in your previous training whether you are in the clinic or field environment.
c. Gather Required Equipment.
(b) Intradermal (ID) injection. The length of the needle should be one-fourth to one-half inch with the gauge size 26.
(c) Intramuscular (IM) injection. The length of the needle should be one to one and one-half inches with the gauge size 20 to 22.
(2) Choice of syringe. The choice of syringe depends on the amount of solution and the type of solution administered (see figure 1-4).
(b) Check the calibration of the syringe so you can place the exact amount of medication in the syringe (see figure 1-5).
d. Inspect Packaging for Defects. Check to determine if the package has been opened or if it has any holes. If you note any water or discoloration that may indicate water has damaged the syringe, or if you suspect that the package has been tampered with in any way, discard the package and obtain sterile equipment.
e. Unpack the Syringe. Remove the syringe from its packaging without contaminating any sterile parts. The sterile parts of the syringe are the needle adapter and the shaft of the plunger, which goes into the barrel. Any contamination could cause infection to the patient.
(b) Grasp the syringe by the barrel with the free hand.
(c) Pull the syringe from the packaging.
(d) Dispose of empty packaging in appropriate receptacle.
(2) Syringe in hard plastic tube (cartridge package).
(b) Press until you hear a distinct click. The click indicates the seal has not previously been broken. If you don't hear the click, discard the syringe and get another tube.
(c) Lift the top (cap) off the tube (cartridge) and put it down on your working surface.
(d) Grasp the syringe by the barrel with a free hand.
(e) Pull the syringe from the tube (cartridge) on your working surface. Be careful not to contaminate the needle adapter of the syringe.
(f) Put the empty tube (cartridge) on your working surface.
(g) Using the free hand, hold the syringe between the first two fingers with the needle adapter forward, pointing away from the back of the hand.
f. Inspect Plunger of Syringe.
(2) Visually check the rubber stopper (inside the syringe) to ensure that it is attached securely to the top end of the plunger, forming a seal. The rubber stopper may become stuck or detached from the top end of the plunger, breaking the seal.
(3) Discard the syringe and select another if the plunger is stuck or does not move smoothly. Repeat steps c through e above.
g. Unpack Needle. Remove the needle from its packaging without contaminating it. Any contamination of the needle may cause infection to develop in the patient.
(3) Discard the empty wrapper in the appropriate place.
h. Assemble Needle and Syringe.
(2) Tighten the needle with a one-fourth turn to ensure that it is attached securely to the needle hub.
(3) Do not touch the needle adapter or the hub to avoid contamination of the sterile surface.
i. Remove Protective Cover from Needle.
(2) Grasp the protective cover with the nondominant hand.
(3) Pull the protective cover from the needle straight off with an upward motion. Do not use a twisting motion as this may cause the needle to come off the needle hub.
j. Inspect Needle.
(b) Barbs. Hook-like edges that extend away from the needle edge and could cause injury to the patient.
(c) Needle damage. Bent or broken needle.
(d) Contamination. Rust or foreign particles on needles.
(2) If the needle has any of these defects, discard and obtain a sterile needle.
k. Replace Cover. Place the protective cover back onto the needle.
l. Place Assembled Needle and Syringe on Work Surface.
(2) Leave the plunger pushed fully into the barrel.
(3) Put the assembled needle and syringe in a convenient place on the working surface.
(4) Keep the assembled needle and syringe continually within range of vision.
NOTE:When you assemble a needle and syringe, you are responsible for maintaining sterility of the equipment.
In this section, we will continue describing the procedures for giving an injection. These procedures will differ according to the type of medicine and from the type of vial.
a. Verify Medication. The medical specialist should check the doctor's order or the therapeutic documentation care plan for the type, route, and dose of medication to administer.
b. Perform Patient Care Handwash. Wash hands according to instructions provided in your previous training-whether you are in the clinic or field environment.
c. Gather Equipment. The following should be placed on the medication tray.
(2) Sterile syringes.
(3) Appropriate sizes of needles, including extras.
(4) Skin antiseptic IAW local policy such as alcohol or Betadine swabs, sponges, or foil-wrapped germicide wipes.
(5) Container for destruction and disposal of needle.
d. Assemble Needle and Syringe. See paragraph 1-13.
e. Check Drug Container Label. The medical specialist verifies medication against the therapeutic documentation care plan.
(b) Before the medical specialist withdraws medication from the container.
(c) When the container is returned to the place of storage.
(2) Follow directions on container regarding expiration date and follow local policy regarding use of multidose vials.
(3) Check to determine if medication was stored properly (refrigerated).
f. Examine Rubber Stopper. The rubber stopper should not be damaged. There should not be any small cores or plugs torn from the stopper due to improper injection of needles (see figure 1-6). Follow the examination procedures below:
(2) Examine the rubber stopper for defects such as small cores or plugs torn in the stopper.
(3) If a defective stopper is identified, hold the vial to the light to examine for any foreign particles and to detect any changes in the color and consistency of the medication.
(4) Check the date that the multidose vial was opened and the expiration date on the medication.
(5) Follow the directions on the container regarding expiration date and follow local policy regarding use of multidose vials.
(6) Check to determine if the medication was stored properly; e.g., refrigeration.
(7) The dosage should be verified against the doctor's orders or therapeutic documentation care plan.
Figure 1-6. Results of correctly and incorrectly inserting a needle in a stoppered vial.
g. Check Medication for Defects.
(2) If the used container is dark colored glass, insert needle and draw some solution to examine its color; if defective, discard vial, syringe, and needle and obtain new solution. You may want to obtain guidance from your supervisor.
h. Prepare and Draw Premixed Medication. The medical specialist prepares and draws medication from a stoppered vial (a vial that has been opened) in the following manner:
(2) With the dominant hand, pick up the assembled needle and syringe and remove the needle cover. Pull the plunger out and fill the syringe with air equal to the amount of medication ordered.
(3) With the free hand, pick up and invert the vial, and then insert the needle into the rubber stopper. Make certain the needle tip passes completely through the cap (see figure 1-7). When inserting the needle, the bevel should face up with a slight pressure being exerted down and forward against the needle to prevent rubber from contaminating medication. To avoid contaminating the needle, the hub of the needle should not touch the rubber cap.