1. Injection Techniques Aim To gain the knowledge and skills required to safely prepare and administer intramuscular and subcutaneous injections to children

2. Learning outcomes The student will be able to: Explain the rationale for selecting sites and methods for injection Demonstrate safe and evidence based techniques in SC and IM injection Discuss the care and support of the child and family

3. Children and injections Injections are given only when there is no alternative route Receiving an injection is one of the most traumatic events that children can experience Vaccination is by far the most common reason to give a child an injection

4. Route of injection Intramuscular Means ‘in the muscle’ Well perfused so rapid absorption Larger area Can absorb larger doses Subcutaneous Means ‘under the skin’ – this is the fatty layer of adipose tissue Less well perfused so slower, sustained absorption

5. SC Method(s)

6. IM Method

7. Z Track technique

9. Injection sites Type of medication and manufacturers instructions Size and age of child Safe positioning Size and condition of muscle Frequency or number of injections

10. SC Injection sites

11. IM injection sites Adults/adolescents: deltoid or antero- lateral aspect of the thigh Infants: antero-lateral aspect of the thigh NEVER THE DORSOGLUTEAL SITE Infants: deltoid? >12 months >15 months (WHO 2005)

12. Positioning

13. Needle size? Sometimes come as integral to syringe so no option to change If drawing up through a rubber bung, replace with new needle Needle length is important – it needs to be long enough to reach either subcutaneous tissue or muscle Remember, needles differ in length and gauge and the colour denotes the gauge

15. Cleansing of injection site? Only if visibly dirty – soap and water Not necessary to use steri-wipe, but if used it must dry

16. Do you need to aspirate? No – not necessary Subject of debate for some time

17. Post injection site care Gentle pressure of required Do not rub site Plasters?

18. Preparation and distraction Prepare child and parent where possible Must be age appropriate Distraction may be used before during and after procedure For infants and young children, positioning and comfort can be helpful Toys with noises!

19. Preparation and distraction Older children – behavioural contracting (informal) Reward based! Visual distraction Parental comfort

20. Remember.. Sometimes preparation does not mean that a child (and parent) will not get upset Distraction does not work for all children Continue to provide comfort and reward

21. References Hockenberry, M.J. & Wilson, D. (2009) Wong’s Essentials of Pediatric Nursing 8 th Edition. St Louis: Mosby Perry, A., Potter, P. & Ostendorf. (2014) Clinical Nursing Skills and Techniques 8 th Edition. St Louis: Mosby RCPCH (2002) Position Statement on Injection Technique. London: RCPCH Cocoman, A. & Murray, J.(2006) IM Injections: How’s your technique? [online] http://www.inmo.ie/MagazineArticle/PrintArticle/5676 accessed 30/7/2013 http://www.inmo.ie/MagazineArticle/PrintArticle/5676 HPA (2013) Correct Administration of vaccines [online] http://www.hpa.org.uk/EventsProfessionalTraining/HealthProtectionAcademy/AdditionalOpportuni tiesAndInformation/ImmunisationTrainingResources/hpacadvacc05SlideSetsforCoreCurriculumTeac hing/ accessed 30/07/2013 http://www.hpa.org.uk/EventsProfessionalTraining/HealthProtectionAcademy/AdditionalOpportuni tiesAndInformation/ImmunisationTrainingResources/hpacadvacc05SlideSetsforCoreCurriculumTeac hing/ Paediatric Nursing [practice guide] (year) Intramuscular injection technique. Paediatric Nursing. 19(2) p. 37 Hunter, J. (2008) Subcutaneous injection technique. Nursing Standard. 22(21) pp. 41-44 Workman, B. (1999) Safe injection techniques. Nursing Standard. 13(39) pp. 47-53. Department of Health (2013) Immunisation against infectious disease Green book [online] https://www.gov.uk/government/organisations/public-health-england/series/immunisation- against-infectious-disease-the-green-book accessed 30/7/2013 https://www.gov.uk/government/organisations/public-health-england/series/immunisation- against-infectious-disease-the-green-book