IM, subcutaneous injections

Question 1

Before administering the injection, what 4 things must you confirm with the patient at start of appointment?

Answer 1

Full name

Date of birth

That they are due to receive an injection

Consent

Question 2

When confirming with the patient what injection they are receiving, what 3 factors must you confirm?

Answer 2

What drug is due to be administered

Where they are getting the drug administered and by which route

If they have any allergies

Question 3

Why must you ask if the patient has any known and new allergies before administering any injection/drug?

Answer 3

They could’ve forgotten to mention allergy or developed new allergy after their PMH was recorded

If they are allergic to the drug in the injection they could go into anaphylaxis which can be fatal

Question 4

Before filling the syringe with the injection, what 5 things must you confirm against the prescription chart?

Answer 4

Indications for the drug

You have the correct type of syringe for the ordered route of drug administration

Correct drug dose in vial, as it matches chart

Correct date and time for administration on prescription chart

Possible contraindications on BNF

Question 5

What are the 4 sites for IM injection

Answer 5

Deltoid: Upper, medial shoulder

Vastus lateralis and rectus femoris: anterolateral thigh

Ventrogluteal: Lateral side of buttock, above greater trochanter and below iliac crest (hip) (upper outer quadrant of buttock)

Dorsogluteal: Middle of buttock

Question 6

Which IM injection site is least recommended and why?

Answer 6

Dorsogluteal: Middle buttock

Risk of damaging sciatic nerve and superior gluteal nerve

Risk of damaging superior and inferior gluteal arteries

Question 7

Which 2 IM injection sites are the most recommended and why?

Answer 7

Deltoid: Not near major nerves or blood vessels, also easiest area for patient to expose

Vastus lateralis and rectus femoris: Not near major nerves or blood vessels, easiest for self-administration

Question 8

What are the 5 sites for subcutaneous injections?

Answer 8

Lower part of lateral upper arm

Peri-umbilical area of abdomen

Upper lateral thigh

Upper half of buttock

Back

Question 9

How do you choose what syringe to use for injections?

Answer 9

Look at dose required on prescription chart, then choose syringe with same/higher volume

eg. Can use 3ml syringe to administer 2ml of drug

Syringe volume stated on packaging and syringe itself

Question 10

How do you transfer the drug from the ampoule into the syringe?

Answer 10

Attach blunt fill or blunt filter drawing needle to end of syringe

Question 11

When drawing the drug up from ampoule into the syringe, when should you use a blunt fill or blunt filter drawing needle?

Answer 11

Blunt fill: ampoule has rubber bung over opening, so glass or other small fragments already won’t be drawn up

Blunt filter: ampoule doesn’t have rubber bung or top needs to be snapped off, so filter makes sure that glass doesn’t get drawn up

Question 12

What method do you use to open a glass ampoule, and what should you do before to make sure that no liquid is lost?

Answer 12

Flick sealed ampoule so that all liquid collects at bottom

Snapback method: Hold in non-dominant hand with dot facing you, hold tip in dominant thumb and pointer finger then snap of backwards

Immediately discard of glass tip in sharps bin

Question 13

How should you position the open ampoule in order to draw up the drug into the syringe, and how much should you draw up?

Answer 13

Place open ampoule on flat surface and insert blunt filter needle straight in, then draw up drug slowly by pulling plunger of syringe

Draw up total liquid drug in ampoule so that there is more than the required dose

Question 14

After the drug has been drawn up into the syringe, how do you get rid of air bubbles and adjust the dose?

Answer 14

Hold upside down so that blunt drawing needle is pointing up

Flick syringe until air bubbles disappear

Slowly push plunger so that excess drug is ejected from needle

Question 15

After the correct drug dose has been collected in the syringe, what do you do with the blunt drawing needle?

Answer 15

Put safety cap on if it has one, remove from syringe and discard in sharps bin

Place syringe back in its paper packaging so that it is kept sterile

Question 16

Before touching any equipment, how should you make sure that your hands are clean with 2 steps?

Answer 16

Wash with antiseptic soap/hand sanitizer using proper hand-washing technique

Put on sterile gloves

Question 17

What are the 3 colours of injecting needles that can be used?

Answer 17

Orange

Green

Blue

Question 18

What is the length and gauge of the green injecting needle, and when is it used?

Answer 18

40mm length, 21G/0.8mm gauge

Deep IM injection in large adults

Question 19

What is the length and gauge of the blue injecting needle, and when is it used?

Answer 19

30mm length, 23G/0.6mm gauge

IM injection in small adult or large child

Question 20

What is the length and gauge of the orange injecting needle, and when is it used?

Answer 20

Always 25G/0.5mm gauge

25mm length: IM injection to deltoid or smaller child OR 45 degree SC injection

16mm length: 90 degrees SC injection

Question 21

Before administering the injection, how should you prepare the skin?

Answer 21

Clean the area with an alcohol/antiseptic wipe and wait to dry

Question 22

How can you tell if the injection site is suitable, by looking at the skin?

Answer 22

Skin is suitable if it is clear, has no bruises, skin lesion, abscesses, oedema

Question 23

When administering an IM injection, at what degree to the skin should you insert the needle, and at what speed?

Answer 23

90 degrees

Insert needle quickly

Question 24

What method is used for administering IM injections?

Answer 24

Z track method:

1. Use thumb of non-dominant hand to pull down the skin so that it is taut
2. Quickly insert needle at 90 degrees to skin
3. Inject drug at 1ml per 10 seconds until total volume is injected
4. Wait 10 seconds before quickly withdrawing needle from skin
5. Release stretched skin

Question 25

What method is used to administer subcutaneous injections?

Answer 25

Lifted skinfold method:
1. pinch 2-inch fold of skin between thumb and pointer finger of non-dominant hand

2. hold syringe like dart and quickly insert into skin fold at 90 degrees
3. Inject drug at 1ml per 10 seconds
4. wait 10 seconds then withdraw needle from skin
5. release skinfold

Question 26

After the drug has been injected, how do you dispose of the syringe and needle?

Answer 26

Put on safety cap if it has one, discard in sharps bin immediately

Don’t need to dissemble needle and syringe

Question 27

Should you put a cotton wool over the needle wound?

Answer 27

Only if it is bleeding, but isn’t necessary

Question 28

Before recording in the prescription chart that you have administered the injection, what should you do?

Answer 28

Clear the area

Remove gloves and put in clinical waste bin

Wash/sanitize hands

Question 29

How do you record in the prescription chart that you have administered the injection?

Answer 29

Put your initials in box with most appropriate date and time band