Parenteral Medication Administration

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Ethical Legal FactorsRight to refuseLiabilityNerve DamageInto a vein or arteryInfiltration / ExtravasationTissue DamageUnapproved siteDorsal Gluteal may be unacceptable at your facility

Minimize DiscomfortPosition muscle for relaxed toneDistraction with conversation & instructions, visual imagery, relaxation techniques Dart-like quick entry for smooth tissue separation (its in the wrist action!!)

What are other ways to Minimize Discomfort

Safety ConsiderationsWhen preparing multiple injections, always label the syringe immediatelyKeep the medication container with the syringeDo not rely on memory to determine which solution is in which syringeCarefully monitor the patient for any adverse effects for at least 5 minutes after administration of any medicationHandle multi-dose vials carefully and with aseptic technique so that medicines are not wasted or contaminated

Whats SterileWhen can contamination occur?How can contamination be avoided?

What do you need to know about Injection Sites?

Injection Sites - DeltoidLocation: upper armLandmarks: Acromion Process, axillary foldMuscle mass: triangle apex at axillary line and base of triangle 2-3 finger breadths below acromion process.Injection area: in the middle of the triangle / into belly of the muscle mass. Avoid Brachial artery & Radial nerve (BARN)http://www.austincc.edu/health/rnsg/skills/injectionSites.htm

Deltoid Should not be used in infants or children because of the muscles small size.

Injection volume should not exceed 1ml in the adult

Use a 23-28 gauge, 5/8 to 1 inch needle

Rarely used for hospitalized patients. Primarily used for immunizations.

Injection Sites - VentroglutealLocation: lateral (ventral) side of the hipLandmarks: Iliac crest, anterosuperior illiac spine, greater trochanter of femurMuscle mass: Gluteus medius and minimusInjection area: opposing palm of hand over greater trochanter, middle finger pointed toward the iliac crest, index finger toward anterosuperior iliac spine. Inject into the triangle created by these fingers. No major vessels / nerves.

Ventrogluteal

Vastus LateralisLocation: anterolateral aspect of the thighLandmarks: greater trochanter, lateral femoral condyleMuscle mass: vastus lateralis muscle Injection area: between one handbreadth below the greater trochanter and one handbreadth above the knee. Width of area is from the midline on the anterior surface of the thigh to midline on the lateral thigh. Best to inject into outer middle third of the thigh.No major vessels or nerves to avoid.

Vastus LateralisIdentify the greater trochanter and the lateral femoral condyle Select the site using the middle third and the anterior lateral aspect of the thigh.

Dorsal Gluteal Most Dangerous site, Trend is away from useLocation: Upper lateral aspect of the buttockLandmarks: Posterior superior iliac spine,greater trochanter Muscle mass: Gluteus maximus muscle Injection area: Draw an imaginary line between the anatomic landmarks listed above. Administer the injection lateral and slightly superior (2 inches) to the midpoint of this line.Avoid the sciatic nerve & superior gluteal artery

Dorsal Gluteal

Z - trackSeals the medication into the muscle tissue.Minimizes subcutaneous tissue irritation from tracking of the medication as the needle is withdrawn. Used more frequently now to decrease discomfort and pain.Used for irritating medications (Vistaril) and tissue staining meds (iron dextran Imferon).Use in ventrogluteal or dorsogluteal sites

Z - track: An intramuscular injection technique designed to deposit medications deep into muscle tissueRelease the lateral slide of tissue ONLY after needle has been completely withdrawn.

Subcutaneous (SC or SQ)Common drugs given SQ:AnticoagulantsInsulinErythropoitic agentsSome Analgesics (-caine type drugs)

Injection Technique - AnticoagulantsHeparinAlways lookup and read about med prior to administrationCheck dosage carefully: some policy req. 2nd nurseRequires drawing up from vial; needs air lockAbdomen SQ area only; deep into tissueNo aspiration; no massage after withdrawal due to risk of precipitating bleedingRotate sites

Anticoagulant Injection TechniqueLovenox (enoxaparin sodium)Look up med prior to administrationCommonly dispensed in pre-filled syringeSafety syringe: firmly depress plunger AFTER removal from tissue to activate safety seal

Lovenox Bruise site correct??

What do you think of this site for heparin?

IntradermalDrugs that are intradermally injected are agents for diagnostic determinations, desensitization, or immunization. For this route of administration, 0.1 ml of solution is the maximum volume that can be administered.Document date, time, and location of ID site in med record; include projected date to be read

Patient education: may sting like an ant bite

ANY QUESTIONS SO FAR?

**Withdraw needle smoothly and quickly after complete emptying of syringeGently apply pressure to withdrawal site with alcohol wipe unless contraindicated.Reposition patient

*Contamination of Solution, equipment, skin, the nurse

Solution contamination alcohol swab prior to piercing, date/time/initial, 30 days or as directed specifically with multidose vials

Needle contamination avoid letting needle touch contaminated surfaces: outer edges of vial/ampule, outer surface of needle cap, hands, countertop/worksurface

Syringe contamination avoid touching length of plunger/ inner part of barrel, keep tip covered with cap or needle

Prepare skin wash with soap/water if grossly contaminated, use alcohol swab, from center outward (2inches)

Prior to handling wash hands*You must know the following information for each injection site:Name of the IM siteName of landmarks Name of the muscle injected at IM sitesName of major blood vessels & nerves to be avoidedLocation of all SQ and ID sites

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