1. Injections
Hana Svobodová

2. Types of containers
Medications for injection are supplied in several types of container :
Vials
Ampules
Cartridges

3. Utilising comfort measures
! Skill in administering injections minimizes pain !

4. Prior to injecting the medication :
select the smallest gauge needle possible for the medication and injection site
inspect needle for sharpness
tap the area lightly with fingertips
rotate sites

5. During injeciton - insert the needle quickly without hesitation
- inject the medication slowly (time for absorption)

6. After injection : withdraw the needle quickly
massage the injection site to encourage absorption of the medication into the tissues – massage firmly but gently
NOTE : contraindication for massage is for intradermal injection, insulin, heparin

7. Intradermal injection
= injection between layers of skin
needle length – 0,6 – 1,3 cm
syringe size – usually 1 ml (tuberkulin), common dosage is 0,01 – 0,1 ml
needle insertion angle – 5-15 degree
usualy i.c. (i.d.) are for DIAGNOSTIC purposes
the substance injected into the skin causes a local reaction :
Wheal
Blanched or reddened area
Itches (if the test reaction is positive)

8. The most common sites: aspect of the forearm or upper back
Hold the syringe almost PARALLEL to the surface
Do NOT massage the site after injecting the solution
Observe the reaction – the first 30 minutes after
(for possibilitiy of serious allergic reaction or anaphylactic shock)
Time for reaction varies from 15 min. to 24 hours.
(MANTOUX – tuberculosis test)

9. SUBCUTANEOUS INJECTION
Environment
Preparation
Patient
Medication
Administration
Before beginning the injection process explain the procedure to the patient.
Make sure you have got enough place for medication preparation and of the patient comfortable state.
Your hands, materials and work area must all be clean. This is important because you will be handling needles, which must remain sterile.
To complete an injection successfully, you will need the following materials, which you should gather in advance: soap and water/alcohol, mixing needle, syringe, ampule(s) / vial(s), gauze pad/alcohol swabs, injection needle, disposal container.
Choose a comfortable location for your injection - It is very important for you to identify a comfortable place to administer your injection. Ideally, you should choose an area with enough space to line up all of your injection materials within easy reach. Make sure that the area is clean, and wash your hands to prevent the risk of infection.
Open the ampule(s)
The first step is to remove the liquid from the top of the ampule. To do this, hold the ampule in one hand between your index finger and thumb. With your other hand, tap the ampule to remove the liquid. Now that you have completed this step, find the dot on the ampule and turn it away from you. Place a square of gauze or an alcohol swab over the top of the ampule. Snap the top away from you.
Open the vial(s)
To open, pop off the plastic tops. Clean the top of each vial with a gauze pad/alcohol swab to prevent contamination.
Mix medication
Once you have chosen the site for your injection, cleanse the area with an alcohol swab, beginning at the center and cleaning around in a circle of about two inches in diameter. Remove the needle cap by pulling it straight off.
You are now ready to administer your subcutaneous injection. First, hold the syringe like a pencil in your dominant hand. With the other hand, pinch the injection site. Insert the needle into the pinched skin. Because the medication is being deposited into fatty tissue, the needle can be inserted at either a 45-degree or a 90-degree angle. Depress the plunger quickly and steadily. Now, remove the needle and syringe. You have successfully completed your injection.
Place the needle and syringe into the disposal container without recapping the needle.

10. Injection Sites

11. Administering subcutaneous injections
s.c. is placed just under the deep skin layer
- the medication is absorbed more slowly than inj. i.m. or i.v. (during 20 – 30 minutes)
needle length - 1,3 – 2,5 cm
syringe size – usually less than 2 ml, common dosage is 0,5 – 2,0 ml

12. Injection sites the upper arm (m. biceps brachii)
the thigh (m. quadriceps femoralis,esp.for a self-administered inj.)
the abdomen
dorsogluteal area
For daily medication (diabetics) – the inj. site is rotated on a regular schedule

13. Method of application :
grasp the injection site between thumb and forefinger to form a pad of subcutaneous tissue
needle insertion angle or 90 degree

14. Complications administration into a vessel
administration into the muscle
hypertrofy of subcutaneous tissue
lipodystrophy
atrophy of skin
infection at the injection site

15. Practical training