Procedures - IM & SC Flashcards
Contraindications of IM injections
- Coagulation disorders
- Use of any anticoagulants (blood thinner) e.g. warfarin, heparin
IM Injection - Assessment
Patient assessment for appropriate injection site. Inspect and palpate for any:
* POET: Pain, Oedema, Erythema, Temperature and Warmth
Review doctor’s order in IMR and check for any drug allergy
*Note any coagulation disorders (e.g. haemophilia, or use of any anticoagulants)
Side effects of the drug
PRN metoclopramide?
IM Injection - Planning and prep
Identification – Use 2 patient’s identifier and check ID band against IMR
Explain purpose and indication for administering IM medication to patient.
Requisites:
1. Ampoule
2. Gauze
3. Syringe 3ml
4. Alcohol swab
5. Kidney Dish
6. Needle
➢ Drawing Needle: 18G
➢ Injection Needle: 20-25G
Vastus lateralis (thigh)
Deltoid (arm)
Ventrogluteal (hip)
IM Injection - Implementation 1
when 3 checks (medication)?
1. When retrieved from stock
2. When preparing for administration
3. Pt bedside before administering
5 Rs
1. Patient
2. Medication
3. Dosage
4. Time
5. Route
Check ampoule for expiry date, clarity, consistency and any change in colour
Drawing up medication:
Hand Hygiene
➢ Attach a drawing needle (18G) to the syringe without touching the key parts
➢ Disinfect neck of the ampoule (key parts) thoroughly with an alcohol swab
➢ Use a clean piece of gauze, grasp the neck of the ampule and snap off the top
➢ Use the drawing needle to withdraw the medication, keeping the needle bevel tip below the level of the solution
➢ Tap the syringe to clear air from it
➢ Cover the needle with the needle sheath using one hand scoop technique.
➢ Discard the drawing needle into the sharp box.
➢ Attach the appropriate injection needle (20-25G) to the syringe
➢ Do not discard the ampoule. Keep it on a kidney dish for 3rd check
IM Injection - Implementation 2
Hand hygiene
Check Patient identification
Final medication check (PMDTR)
➢ Locate IM injection site (Deltoid: Locate the lower edge of the acromial process. Site for injection is two or three fingerbreadths below the acromial process)
➢ Sanitize the area (key site) with an alcohol swab
➢ Pull the skin 2 to 3 cm away from the injection site with the non-dominant hand (Z-track)
➢ Insert the needle smoothly at an angle of 90 degrees to the skin
➢ Stabilise the syringe with the thumb and index finger of the non-dominant hand while maintaining the Z track.
➢ Pull back the plunger to check backflow. Wait for 5-10 seconds (as per hospital protocol, no need to be done for vacccines)
➢ Inject the medication slowly
➢ Withdraw needle then release skin
➢ Discard needle and syringe into sharp box
➢ Remove and discard gloves
➢ Hand Hygiene
➢ Apply band aid
IM Injection - Documentation and evaluation
Document the following in the patient’s medical records.
- Inpatient Medication Record
Evaluation of therapeutic/side effects of medication. Observe site for any complications.
Check with patient if he/she has any questions
Contraindications of SC injections
Circulatory shock
Reduced local tissue perfusion
Very thin patients (may have inadequate adipose tissue for subcutaneous injection)
Bleeding diathesis
SC Injections - Assessment
Perform 5 moments of hand hygiene
Patient assessment for appropriate injection site.
Inspect and palpate for any
* POET: Pain, Oedema, Erythema, Temperature and Warmth
Assess for presence of skin lesion, rashes, lipohypertrophy or lipoatrophy
Assess diabetes chart for the latest blood glucose level
Review doctor’s order in IMR and check for any drug allergy
SC Injection - Preparation
PMDTR medication check
Drawing up medication for injection
➢ Roll the vial between your palms to ensure the drug is equally mixed throughout (cloudy insulin).
➢ Hand Hygiene
➢ Clean the vial’s rubber stopper with alcohol pad.
➢ Pull the syringe plunger back until the volume of air in the syringe equals the volume of drug to be withdrawn
from the vial.
➢ Without inverting the vial, insert the needle into the vial.
➢ Inject the air, invert the vial, and keep the needle’s bevel tip below the level of the solution as you withdraw the prescribed amount of medication.
➢ Cover the needle with the needle sheath using one hand
scoop technique.
➢ Tap the syringe to clear any air from it.
SC Injection - Implementation
Hand Hygiene
➢ Select an appropriate injection site.
Rotate sites according to a schedule for repeated injections, using different areas of the body unless contraindicated
(heparin, for example, should be injected only in the abdomen, if possible).
➢ Clean the injection site with an antiseptic pad, beginning at the center of the site and moving outward in a circular motion.
Allow the skin to dry before injecting the drug to avoid a stinging sensation caused by introducing antiseptic into the subcutaneous tissue.
➢ Loosen the protective needle sheath.
➢ With your non-dominant hand, grasp the skin around the injection site firmly to elevate the subcutaneous tissue,
forming a 1” (2.5-cm) fat fold.
➢ Grasping the skin, insert the needle quickly in one motion at a 90-degree angle.
➢ Inject medication and hold the syringe steadily for 5 to
10 sec.
➢ Remove the needle gently but quickly and release the grasped skin
➢ Cover the site with an alcohol pad, and apply gentle pressure. Don’t massage the site.
➢ Throw needle in sharp box
SC Injection - Evaluation
Document the following in the patient’s medical records.
- Inpatient Medication Record
Evaluation of therapeutic/side effects of medication. Observe for any complications i.e. hypoglycemia
