Injections

Question 1

When are intradermal injections done?

Answer 1

Allergy testing

Tb/Manatoux skin test

Question 2

Where are the sites of interdermal injections?

Answer 2

In the skin dermis at the inner arm or upper back

Question 3

What gauge needle and syringe type is used for intradermal injections?
What angle is ID injections done at?

Answer 3

1mL tuberculin syringe with 26-27G needle (1cm long) at 5 to 15 degrees

A small bleb should appear

Question 4

What is the Max volume for an ID injection?

Answer 4

0.01-0.1 mL

Question 5

When do we do subcutaneous injections?

Answer 5

Insulin
LMWH
Immunizations (like measles mumps rubella and shingles)

Question 6

What needle Gauge and length, and angle should we inject subcutaneous injections at?

Answer 6

25G - 30G
5/8” needle length
at 45 degrees (if limbs or abdomen has less subcutaneous tissue) or 90 degrees (not within 5 cm of umbilicus)

Question 7

What is the max volume for a subcutaneous injections?

Answer 7

0.5 to 1 mL

Question 8

Sites for subcutaneous injections

Answer 8

Upper arm
Abdomen
Sides of thighs
Upper back

Question 9

Sites of IM injections

Answer 9

Ventrogluteal
Vastus lateralis
Deltoid

Question 10

Why do we choose to do an IM injection?

Answer 10

Fast absorption due to high vascularity (10-30min)

Less risk of tissue damage when injecting deep into the muscle

Good for irritating medications as there are fewer nerve endings in the muscle

Flu, pneumonia, HPV vaccines

Question 11

What is needle gauge and length for IM injections? Angle of injection?

Answer 11

22-25G
7/8” to 1” for infants, toddlers, older children

1” to 1.5” for adolescents and adults

At 90 degrees

Question 12

What is the max vol to be injected for IM Injections?

Answer 12

1mL for small kids and infants

2mL for older children and thin adults

3mL for older adults

BUT Deltoid is 1mL for all ages

Question 13

What is the preferred site for IM injections for adults and children over 1?

Answer 13

Ventrogluteal because it is the safest site:
Free of nerves and blood vessels

Underlying muscles are well developed and thick

Easily palpable bony landmarks

The subcutaneous fat is thinner than the dorsogluteal (which we don’t inject into anymore anyway)

Question 14

What is the site of choice for all immunizations for teens and adults?

Answer 14

The deltoid

Question 15

You need to give an infant an immunization, where is the preferred site and type of injection?

Answer 15

For infant immunizations the vastus lateralis is preferred because it is thick and well developed

Free of major nerves or arteries

Easy to access

Question 16

You see a nurse doing an IM injection at a site right above the back of the butt. Is that okay? Should you intervene? And why?

Answer 16

The dorsogluteal injection is not supposed to be used and you should stop her because it has the greatest risk of complications:

Thicker subcutaneous tissue so more risk of injecting into the fat instead of the muscle tissue

Risk of puncture to superior gluteal artery or sciatic nerves causing problems like foot drop or lower limb paralysis

Question 17

You have a highly irritating substance to inject, what is a method of injection that can reduce irritation for the patient?

Answer 17

Z track method:
Pull skin and underlying tissue to the side

Hold skin taught as you inject slowly, leave needle in place for about 10 seconds

Withdrew and release skin

…this method makes sure that the substance stays in the muscle as the medication is sealed away by the overlying subcutaneous layer

Question 18

Where do you immunize for children under one year? For adults?

Answer 18

The vastus lateralis for infants

The deltoid for adults

Question 19

A nurse does an Subcutaneous injection and aspirated out of habit, she notices blood returning into the syringe. What should she do?

Answer 19

Discard the med and repeat the whole procedure.

Question 20

You’re injecting medication in a child. What is the rate of injection?

Answer 20

Use a rapid injection technique (1-2 seconds) to reduce pain.

If you’re injecting medication into an adult, inject a 1mL per 10 seconds

Question 21

An older client needs multiple medications that is administered IM. What are some comfort considerations that can be enacted?

Answer 21

See if the medications are compatible and can be mixed into one syringe to reduce the number times you need to poke them. Older clients have less adipose tissue so consider using a shorter needle length (between 5/8 and 1”)

Question 22

Name 5 comfort techniques when giving children and infants injections

Answer 22

Breastfeeding
Oral sucrose
Topical anaesthetics
Seated position 
Gentle rubbing or skin near injection site 
Distraction

Question 23

What are the 4 common causes of needle stick injuries?

Answer 23

1. Patient actions
   Combative patients
   Unexpected movements

2. Sharps disposals 
Overfilled containers
Lack of access to containers 
REcapping 
Poorly designed safety devices (needles remain exposed, disassembly of parts)

3. Equipment
   Devices with tubes (butterfly tubes with needles can fly back at you when you pull on them)
4. Work conditions
   Rushing
   Crowded work environment
   Breaks in concentration

Question 24

What are ways to avoid needle stick injuries?

Answer 24

Taking your time
Wear gloves
Never recap

Horizontal drop into sharps container
Don’t overfill containers
Have sharps container close to place where vaccine administered

Report incidents and near misses

Question 25

You pricked your finger after doing an injection on a patient. What should you do?

Answer 25

Wash areas with soap and water

Allow to bleed gently for 30 to 60 sec

Report exposure to supervisor immediately

Seek emergency medical attention
-ER for bloodwork and possible post exposure prophylaxis (ideally taken within 4 hrs of exposure)