Injection

Question 1

What is an injection ? What are the different type ?

Answer 1

It is the administration of a fluid in a tissue or blood vessel using a syringe and needle.
Injections : intradermal, subcutaneous, intramuscular, intravenous.

Question 2

What is the purpose of intradermal injections where are they done ?

Answer 2

Used for diagnosis, only a minimal amount of fluid is injection. Inner side of the arm and in the back.

Question 3

What is the purpose of subcutaneous injection and where are they done ?

Answer 3

Administered in the abdomen, lateral upper arm, front and lateral side of the thigh.
Small amount of fluids slowly absorbed by the surrounding tissues.

Question 4

What is important about intramuscular injections, where are they done ?

Answer 4

Administration of large amount of fluid 5mL quickly absorbed. It is important to avoid hitting blood vessels.
Administered in the buttock (upper outer quadrant), thigh (middle lateral side), upper arm (lateral side).

Question 5

What is intravenous injection where is it done ?

Answer 5

Fluid administered into the blood stream, direct result.
Generally below the elbow in the inside.

Question 6

What should you check before the injection ?

Answer 6

Verify the medication and its dosage.
Verify all expiration date
Verify the identity of the patient
How is the medication given
Document properly
The contra-indication possible : coagulation disorder, allergies, inflammation, haematoma, scar tissue

Question 7

How do you prepare the injection ?

Answer 7

Hand hygiene and non sterile glove. Clean work surface, check package. Open package put leave seringue in it. Open the package of the drawing up needle. Connect syringe and drawing up needle. Check expiration date.

Take the good amount of the liquid using an ampoule or a vial.

Question 8

Preparing injection with an ampoule ?

Answer 8

Put 3 gauzes around the ampoule and break the head.
Insert needle inside ampoule.
Hold the ampoule inside down and draw the correct amount of liquid.
Dispose of the empty ampoule in the glass container.

Question 9

Preparation of injection with a vial ?

Answer 9

Disinfect the rubber stopper of the vial with alcohol.
Draw up air in the seringue (10% more than the amount needed.
Insert the needle with 90° degrés angle through the vial.
Inject the air in the vial - tip of needle above fluid level.
Turn vial upside down and draw correct amount of fluid -tip of needle under fluid level.
Withdraw the needle.

Question 10

What are the step after getting the right liquid into the needle ?

Answer 10

Push seringue a little bit to get rid of air and get the good amount of fluid to inject.
Remove drawing up needle by rotating the seringue and dispose.
Take safety needle and attach it to the seringue by rotation.
Put final material in kidney dish.

Question 11

How do you perform an injection ? General

Answer 11

Introduce yourself, identify the patient, inform them about the procedure and check for contraindication.
Perform hand hygiene and wear non sterile glove - not mandatory except in case of wounds in your hands.
Choose skin spot and disinfect the skin.
Remove excess medication
Push safety cap backward.

Question 12

How do you perform an intramuscular injection ?

Answer 12

Pull skin tightly at the injection site.
Insert needle with 90° angle.
Draw back needle to see if there’s blood.
Inject fluid slowly
Withdraw the needle in one mouvement.
Flip safety cap on with thumb.

Question 13

How do you perform an subcutaneous injection ?

Answer 13

Pull the skin tight at injection site.
Insert needle with 30-45° angle.
Let go of fold.
Move needle side to side.
Draw back the seringue to see if there’s blood.
Inject fluids slowly.
Withdraw the needle in one mouvement.
Flip safety cap on with thumb.

Question 14

How do you perform intravenous injection ?

Answer 14

Apply tourniquet with release strap.
Find accessible vein and disinfect the spot.
Pull the skin tight in the opposite direction from the needle.
Align seringue and needle with vein.
Insert needle with 45 angle then decrease to 30° angle.
Drawback to see if there’s blood.
Release the tourniquet.
Inject fluids slowly.
Withdraw the needle in one mouvement.
Flip safety cap on with thumb.
If necessary apply bandage.

Question 15

Why are injection needle and filling needle different ?

Answer 15

Injection needle has a cap because there’s risk of transmission of disease.
Injection needle size tell for which injection to do.

Question 16

What are different contraindications for an injection ?

Answer 16

Allergies : egg => avoid influenza and yellow fever vaccine

Coagulopathy : for intramuscular injection

Pregnant patient : avoid live virus vaccine

Active infective, multiple puncture or scars at the site

Varicose veins

Axillary dissection side : more prone to infection

Dialysis shunt side

Thrombosis side

Question 17

Potential complication of an injection ?

Answer 17

Pain, burning, erythema
Infection
Lidodystrophy : in patient with multiple repeated injection s at the same site
- rotate injection site
Injury to surrounding structures
Allergic reaction
Medical error

Question 18

How to reduce injection pain ?

Answer 18

Ensure patient is relaxed : muscular contraction intensify pain
Allow antiseptic solution to dry completely and gently massage the area after.

Question 19

How do you perform an intradermal injection ?

Answer 19

Ventral forearm lying on hard surface, patient seated.
- prepare site (10cm from antecubital fossa)
- disinfect and dry
Hold forearm and stretch skin with thumb
- insert needle at 15° angle into upper skin layer
Inject slowly : can see a blob signalling proper intradermal placement
Withdrawal needle at 15° angle
- blob disappear gradually
Dispose of supplies

Question 20

What should you remember for an insulin administration ?

Answer 20

Only compatible type of insulin should be combined.
Roll gently the vial in your palm to ensure proper distribution.
Rotate site to avoid lipodystrophy

Question 21

What is the purpose of venipuncture ?

Answer 21

Draw blood from a vein, used for diagnose purpose.

Question 22

Where should you perform venipuncture ?

Answer 22

At the antecubital fossa : cephalic vein, median cubital vein, basilic vein (never on proximal side because brachial artery and nerve run here).
- inspect right/left arm using tourniquet to choose the best vein
- choose accessible vein to avoid hitting artery or nerve

Question 23

What materials are needed for a venipuncture ?

Answer 23

Sharp container and kidney dish
Tourniquet
Vacuum extraction tube
Non sterile glove
Gauze pads
Disinfectant
Chux protective underpad
Bandage

Question 24

What do you prepare before venipuncture ?

Answer 24

Wash hands and collect all materials needed on clean surfaces. Check if they are all sealed, dry with adequate date.
Check patient information.
Make patient sit/lie down with arm extended and supported.

Question 25

Venipuncture technique : finding the vein

Answer 25

Connect vacutainer needle holder and needle while leaving the protection on the needle.
Apply tourniquet around upper arm (10 cm above antecubital fossa).
- put the release strap on the side of non dominant hand so it can be loosened easily

Once you have found suitable vein.
- loosen tourniquet
- disinfect skin, put non sterile gloves

Question 26

Venipuncture technique : drawing blood

Answer 26

Apply tourniquet again.
Hold vacutainer needle holder between thumb and index with bevel upward.
Be aligned with vein.
Pull skin taunt with non dominant hand.
Enter vein at 45° then reduce it to 30°
- support dominant hand on arm to hold needle steady

Use non dominant hand to pick up a vacuum extraction tube and slide it into the vacuum holder
- middle and index finger on the vacutainer wings and thumb push tube in
- avoid pushing the needle as well
When vacuum tube start to fill release tourniquet
- leaving it on for too long can affect laboratory result
Remove filled vacuum tube
- hold it between thumb and middle finger
- push wings with index finger
- gently mix content of tube x8

After removing the last tube, remove needle.
Apply pressure using gauze.
Deposit needle in sharp container and press green button to disconnect it.