Injectable Medications Subcutaneous – Intramuscular - Intradermal

Why Give Injectable Meds?? Patient cannot swallow Decreased LOC Drug inactivated by gastric juices Desire to increase drug effectiveness

Injectable Medications Parenteral drugs must be prepared, packaged, administered in ways to maintain sterility Vials, ampules pre-filled syringes Powder form Check dates for possible expiration Assess fluid for clarity & color Wear gloves to administer Engage safety device or needle guard after use Never re-cap a used needle!

Ampule, Vial & Pre-filled Syringe

Parts of a Needle & Syringe

Injectable Medications Vials Glass or plastic with needle-accessible rubber stopper Ready solution or powder for reconstitution Single use vial No preservative, discard after one use Multiple dose vial May contain a preservative, used for several doses IF asepsis maintained Must be labeled with date/time opened & initials of person opening If drug expires, this date & time must be labeled also

Check expiration date of drug and note when opened (drugs can be kept for varying length of time after a multidose vial is opened – contact pharmacy if unsure) Swab rubber top with alcohol wipe Add air to vial (same amount as med to be given – prevents vacuum from forming in the vial) Invert the vial – pull back on syringe plunger and draw up med (keep at eye level) After removing needle from vial, tap barrel of the syringe to remove excess air If this is a newly opened vial, label the vial with date and time opened and your initials TOUCH ONLY THE BARREL AND PLUNGER OF THE SYRINGE!!

Injectable Medications Ampules (Ampoules) Sealed glass containers Tops must be broken to allow insertion of needle and withdrawal of the medication Safety!!!!!!!! Use filter needle to prevent glass in solution Discard unused portion Discard broken ampule in sharps container

Injectable Meds Pre-filled syringes Single dose / single use Most have needle attached Several forms of these Some called “Tubexes” May require adapter to administer

Syringes The larger the gauge number, the smaller the diameter of the lumen The smaller the gauge number, the larger the diameter of the lumen Intradermal (ie: TB skin test) Needle gauge 25- 28 Needle length ½ - 5/8” Subcutaneous (ie: Insulin, heparin) Needle gauge 26-30 Needle length 3/8, - ½” Intramuscular (IM) Needle gauge 18, 20, 21, 22, 23, 25 Needle length 1, 1 ½, 2” ASSESS THE CLIENT FOR APPROPRIATE SIZE OF NEEDLE LENGTH (LONGER FOR PATIENTS WHO ARE OBESE, ETC)

Subcutaneous Drugs Use appropriate type of syringe Insulin or Tuberculin Small gauge, shorter needle Never more than 1 mL at a site Use angle of needle that insures infusion into SC and not muscle Do NOT aspirate Choose subcutaneous sites Rotate sites, avoid overuse and tissue damage ***Insulin is ONLY drawn up in Insulin syringes*** ABSORBED MORE SLOWLY THAN IM – FEWER BLOOD VESSELS IN FATTY TISSUE

Injectable Medication Sites

SubQ Injection Sites

THIS IS AN EXAMPLE OF A SC INJECTION INTO THE FATTY TISSUE AT THE BACK OF THE UPPER ARM

Intramuscular Medications Use appropriate sized syringe Use appropriate needle size Consider depth of site & type of solution Choose appropriate muscular site Ventrogluteal, deltoid & vastus lateralis Select by identifying anatomic landmarks Avoid use of same site repeatedly IM Adult: Z-Track method SMALLER GAUGE (LARGER LUMEN) THAN SC DELTOID – UPPER ARM VASTUS LATERALIS – OUTER MIDDLE THIRD OF THIGH

Ventrogluteal Vastus Lateralis Deltoid

Z-TRACK INJECTION Indications: Adult IM injections Technique: Move skin to one side, administer medication & withdraw needle. Once needle is withdrawn, displaced tissue is allowed to return to its normal position, preventing the solution from escaping from the muscle tissue

Ventrogluteal Site

Deltoid Site

Vastus Lateralis Site

Dorsogluteal Site Not a recommended site.

Intradermal Drugs Used for administration of diagnostic agents Preferred site: inner aspect of forearm Hairless, thinly keratinized Upper chest or back also used 1 mL tuberculin syringe, 26 gauge needle Position needle with bevel up Insert through epidermis so point of needle is almost visible under skin; advance needle 1/8 inch under skin Inject (0.1 mL) until wheal appears; withdraw needle 15 DEGREE ANGLE OF NEEDLE

Technique: Remember, bevel up, 5-10 degree angle, advance ~ 1/8 inch, create a wheal (bleb) & mark location

Intradermal Sites

Reconstitution of Medication Used when meds would lose potency as a liquid Drug label will identify diluent needed Diluents commonly used are sterile water, or sterile NS for injections If not found, call pharmacy for direction!! Displacement Factor (possible) The powder and solution add volume to the solution and  total volume of the mixture (i.e. Directions: add 5.6mL of sterile water, total volume of solution is 6mL after reconstitution). DILUENT IS THE LIQUID USED TO RECONSTITUTE A POWDERED DRUG INTO A LIQUID FORM (STERILE WATER, NS, BACTERIOSTATIC WATER) AFTER ADDING DILUENT, THE AMOUNT OF DRUG IS INCREASED BECAUSE THE POWDERED DRUG OCCUPIES SPACE, SO YOU MAY ADD 2.6 ML OF DILUENT BUT HAVE A DRUG YIELD OF 3 ML IN LIQUID FORM

Reconstituting (Cont) Note the length of time the medication is good for once it’s reconstituted Directions for storing once mixed Date, time and initial the vial The medication will only be able to be used for a specified time Make sure to put the expiration date and time on the label also!

Lets practice. 1. How much diluent do you add. 2 Lets practice! 1. How much diluent do you add? 2. What is the meds final concentration? ___mg/___mL 3. Order: Ceclor 500mg p.o. q12hr How much will you give?

More Practice. 1. How much diluent do you add. 2 More Practice! 1. How much diluent do you add? 2. What is the meds final concentration? ___mg/___mL 3. Order: Kefzol 300 mg IV bid How much will you give?

Last Practice. Order Tazicef 300mg IM q 12 hr 1 Last Practice! Order Tazicef 300mg IM q 12 hr 1. How much diluent do you add? 2. What is the final concentration for the IM reconstituted medication? ___mg/___mL 3. How much will you give?