SC and IM injections Flashcards
when is SC and IM used
if oral or IV route not possible, small volume, or medication formulation requires.
- Anatomy
- absorption
- volume
- site
- needle
for SC
- Anatomy = adipose tissue beneath dermis
- absorption - slow as less blood supply
- volume - 1ml or less
- site - abdomen (umbilical region), thigh (beneath Gt trochanter), upper lateral arm
- needle - orange 25G or blue 23G
- Anatomy
- absorption
- volume
- site
- needle
for IM
- Anatomy = Muscle layer
- absorption = faster than SC but slower than IV
- volume = 2-5ml
- site = deltoid, upper outer gluteal, lateral thigh
- needle - blue 23G or green 21G
SC injection sites
Lateral upper arm Lower abdomen near umbilicus Proximal lateral thigh Buttocks Back – less often
what are examples of SC injections
LMWH
Insulin
Palliative care medications
IM injection sites
Quadriceps 1-5ml
Deltoid 1-2ml
Upper outer quadrant gluteal (caution sciatic nerve and gluteal artery) 2-4ml
What are examples of IM injections
Vaccines (not gluteal) Antibiotics Antiemetics Sedatives Analgesia Contraceptives Antipsychotics
How to administer an IM injection
Spread skin
90 degree insertion
How to administer an SC injection
Grasp fold of subcutaneous tissue
45 degree insertion (90 for insulin
What should you do for those that have a bleeding risk
Avoid IM injections with those on warfarin or other anticoagulants due to risk of haematoma and consider another route if possible.
Public Health England “green book”, Immunisation Against Infectious Disease, concludes that for influenza vaccines “there is a lack of evidence that the SC route of vaccination is any safer than the IM route in people taking anticoagulants”
If possible, give via subcutaneous injection (if medication in licensed for this route).
For NOAC/DOAC with fast onset and short half life e.g. apixaban, giving injection 24 hours after the last dose is an option
What are the practical points of there is a bleeding risk present
IM injection into an upper extremity for easy observation and access for monitoring the injection site or applying compression if needed.
Use a small needle
Compress for 2 minutes after
Advise the patient to monitor for signs of bruising/ haematoma
How is insulin given
Insulin can be given from pre-filled syringes or also drawn up for acute doses e.g. novorapid
If insulin is being drawn up it is important to be very careful about the amount and use an insulin syringe for this to avoid overdosing and risk of hypoglycaemia.
describe how to give adrenaline
IM use in emergency situations e.g. anaphylaxis using antero-lateral aspect of the middle of thigh for best absorption.
Monitoring: BP, pulse, ECG, pulse oximetry
Dose adults:
- 0.5mg = 500 micrograms = 0.5ml of 1:1000
Concentrations of ampoules/ devices:
- 1mg/1ml = 1:1000
- 1mg/10ml = 1:10 000 CAUTION different concentration!
- Prefilled syringe EpiPen 300 micrograms (child 150 micrograms)
Repeat doses if no improvement, and further doses at 5-minute intervals.
IV route ONLY for anaesthetists, emergency physicians, ICU doctors, paramedics
what are the safety risks to consider when doing an IM/SM injection
- correct patient
- consent
- drug allergies
- correct does and medication
- batch number and expiry date
- bleeding/bruising risk
- infection risk
- tissue damage risk
- after care
IM injection doses should not exceed ..
5ml
The syringe plunger should be…
The syringe plunger should be withdrawn with IM injections to avoid intravascular injection
why should you rotate insulin sites
- insulin injection sites should be rotated to avoid lipoatrophy
How do you IM and SC injections
equipment
- gloves
- sharps bin
- needles to draw up and deliver the medication
- gauze/cotton wool
- prescription chart
- syringes
- drug to be administered
- tray
- cleaning products: detergent wipes and 70% alcohol wipes
- face mask
- apron
- Wash your hands
- prepare the tray and clean it with detergent wipes and then allow to dry and then clean it with alcohol wipes and allow to air dry again
- Start putting the equipment into the tray
- attach he drawing up needle to the syringe
- check the details on the medication - the name and expiratory date
- draw the drug up using syringe and drawing up needle
- after the drug is drawn up remove the drawing up needle and adipose immediately in the shapes bind
- attach the administration needle - in IM injections this can be a green needle which is 21 gauge or a blue needle which is 23 gauge
- clean the skin
- with the non dominant hand stables the skin
- with the dominant hand take the needle and syringe and insert into the skin at 90 degrees
- draw back on plunger to ensure you haven’t entered a blood vessel
- pressure plunger down to enter the drug
- wait a few seconds before withdrawing the needle
- dispose of sharp immediately
- apply pressure over the area
- then check the site for bleeding
- check patient is okay after the administration of the medication
- dispose of waste immediately
SC injections
- don’t use alcohol wipes before injecting an SC injection as patient can develop harder skin over the site
- the needle is often a blue needle
- with the non dominant hand bunch he skin between the thumb and forefinger to lift adipose tissue from underlying muscle
- with dominant hand insertion the needle into the skin at 45 degrees
- do not draw back
- pressure the plunger down to deliver the drug
- once you have withdrawn the needle apply pressure over the site with cotton wool
- then check the site for bleeding
What are the IM injection sites
- mid anterior and mid lateral areas of the quadriceps
- mid deltoid
- upper outer quadrates of the gluteal muscles
where are the SC injection sites
- upper outer arm
- lower abdomen
- upper outer thigh
