LEC 7: Intradermal & Intramuscular Injections

Question 1

When is intradermal injections done?

Answer 1

For skin testing

- TB or allergies

Question 2

Where are the common sites for intradermal injections?

Answer 2

• Forearm

- Back

Question 3

Where are you doing intradermal injections?

Answer 3

Injecting into the dermis

Question 4

At what angle do you want to do an intradermal injection?

Answer 4

Angle of insertion should be 5 to 15 degrees

Question 5

How do you know if you are in the dermis of the skin?

Answer 5

Will create a bubble below the surface of the skin

Question 6

How much medication are you injecting for intradermal injections?

Answer 6

Only a small amount

- 0.5 mL

Question 7

What is the gauge and needle length for intradermal injections?

Answer 7

• Gauge: 25 to 27g

- Length: 1 to 1.6 cm (1/2 to 5/8”)

Question 8

What is the syringe size, needle, length, and gauge for intramuscular injections?

Answer 8

• Syringe: 3 mL
• Volume of medication: 3 mL MAX
• Gauge: 21 to 25g; average 22g
• Length: 2.5 to 7.5 cm (1 to 3”)’ average 3.8 cm (1.5”

Question 9

What is the angle of insertion for intramuscular injections?

Answer 9

ALWAYS a 90 degree angle

Question 10

What do you want to do before adminsitering the medication?

Answer 10

Want to aspirate

• Draw back the plunger once needle is injected
• Looking for blood, do not want any blood to come back into the syringe. Making sure we are not in a blood vessel
• If you do not see blood you can inject the medication

Question 11

How fast do you want to inject the medication for intramuscular injections?

Answer 11

Want to inject 1 mL per 10 seconds

Question 12

How long do you want to leave the needle in after doing a intramuscular injection?

Answer 12

Leave needle in for 10 seconds before pulling it out

Question 13

What do you not want to do after an injection?

Answer 13

Message the site of injection

- Want to apply light pressure with gauze

Question 14

What are the three landmarks for intramuscular injections?

Answer 14

1. Ventrogluteal
2. Deltoid
3. Vastus lateralis

Question 15

Ventrogluteal Injection

Answer 15

1. Patient lays on side with hip and knee flexed
2. Place palm of hand on the patient greater trochanter with fingers pointed towards the patient’s head; use right hand on patients left hip or left hand on patient’s right hip
3. Form a triangle with your index finger and middle finger by putting your index finger on the anterior superior iliac spine and extend the middle finger dorsally and palpate the crest of the ilium
4. Injection is given in the center of the triangle
   * Will accommodate large amount of volume

Question 16

Deltoid Injection

Answer 16

1. Ask the patient to roll onto their side
2. Draw an imaginary line one to three fingers below the edge of the acromion process of the scapula; is the base of the triangle
3. Create a triangle with the index and middle finger, where the point of the triangle is at the midpoint of the axilla
4. The injection sites is at the thickest part of the muscle over the mid-axillary line

• Will accommodate small amounts of volume, 0.5 mL no more then 1 mL
• Common site for immunization

Question 17

Vastus Lateralis

Answer 17

1. Have the patient lay on his side or in a sitting position
2. Divide the anterior thing into thirds, horizontally and vertically
3. The injection is given on the outer inner third of the thigh

Question 18

What is the preferred side for intramuscular injections?

Answer 18

The ventrogluteal site in adults

Question 19

What is the z-track method used for in intramuscular injections?

Answer 19

Used to seal medication and avoids irritation around the skin
- Used for highly irritating medications

Question 20

What are the three steps to the Z-tract method?

Answer 20

1. With dominant hand, displace the skin laterally
2. Inject the need, aspirate, give medication while the hand still displaces the skin
3. Withdraw hand once needle is out

Question 21

Needle Safety

Answer 21

• Never recap a used needle
• Use neddleless devices
• Immediately dispose of needles in sharps container

Question 22

How do you use the scoop method?

Answer 22

Only use one had and scoop the unused needle in the cap

Question 23

What do you do if you get a needle stick injury?

Answer 23

• Follow agency policies
• Allow area to bleed
• Wash area well with soap and water
• Call SHR incident reporting line
• Report the incident immediately to your instructor

Question 24

You are giving an IM injection. You have properly landmarked and performed the 10 rights and 3 checks, Upon aspiration, blood fills the syringe. What do you do?

Answer 24

Withdraw the needle completely, dispose of the syringe, redraw up the medication, re-landmark, and administer the drug

Question 25

You are giving an IM injection. You have properly landmarked and performed the 10 rights and 3 checks. Upon insertion of the needle, you feel a dull thud as the needle hits the patient’s bone. What do you do?

Answer 25

Pull back the needle a few cm and administer the drug