Injections

Question 1

Why would you use IM/SC/ID route rather than oral route?

Answer 1

Rapid action required
Drug altered by intestinal secretions
Drug not absorbed by the alimentary tract
Patient cannot take oral drug, vomiting, NBM, unconscious
Drug unavailable in oral format

Question 2

Explain clinical indications for SC, IM, ID injections

Answer 2

Subcutaneous – if the absorption needs to be slower than IM e.g. insulin / clexane

Intramuscular – if a rapid response is required or if the drug degrades quickly in sub cutaneous tissue e.g. adrenaline / vaccines / tetanus

Intradermal – allergy diagnosis, immunological test, local anaesthetic

Question 3

Outline the layers of the skin into muscle

Answer 3

Layers: epidermis, dermis, subcutaneous tissue, deep fascia, muscle

Absorption fastest in muscle because of the good blood supply

Question 4

Name 4 sites for IM injection

Answer 4

Deltoid, Ventrogluteal, Dorsogluteal or Vastus lateralis

Question 5

Name 3 sites for SC injection

Answer 5

Abdomen avoiding umbilicus, thigh or arm – advise patient to rotate site to avoid lipodystrophy

Question 6

Contraindications to injections

Answer 6

Allergy to drug
Infection at injection site
Coagulopathy (intramuscular injection)

Question 7

Explain main complications

Answer 7

Pain
Anaphylaxis
Infection and sterile abscess
Non-absorption in oedematous site
Specific to IM: haemorrhage, nerve damage, embolus
Wrong layer injected e.g. SC going IM or IM going SC

Question 8

What checks must be done prior to injection?

Answer 8

2 person check in clinical room and at bedside with all IM / SC / ID injections
Right patient – ID, verbal, drug kardex
Right drug
Right dose
Right route
Right time

Question 9

What size needles do we use for the different injection?

Answer 9

Intradermal: 26G brown or 27G grey for LA
Subcutaneous: 26G brown or 25G orange
Intramuscular: 23G blue or 21G green,
Needle length according to weight

Question 10

How are each of the injection techniques carried out?

Answer 10

Intradermal: 10° angle to skin and inserts the needle bevel up just under the skin to form a bleb when in correct space

Subcutaneous: 45° or 90° angle

Intramuscular: 90° angle to the skin and inserts two-thirds of needle - aspirate to check for blood for 5–10 seconds (dorsogluteal only)

Always complete documentation on the drug chart of the drug administered