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PRINCIPLES OF INJECTION ADMINISTRATION -
1. For the safe administration of the injection, the knowledge of anatomy and physiology of the human body is very essential.
a. To avoid the injury of blood vessels and nerves of the underlying tissues.
• Action - Select the injection site carefully by considering the anatomical structures.
NOTE - Common Sites for the Injection Administration
* ID (Intradermal) Injection Sites -
- The inner side of the lower arm.
- The upper surface of the front chest.
- The upper surface of the posterior chest, below the scapula.
* SC (Subcutaneous) Injection Sites -
- The outer side of the upper arm.
- The upper side of the posterior chest, below the scapula.
- The anterior aspect of the abdomen, from the end of the ribs to iliac crest except for the navel area at least 2 inches away.
- Front area and lateral area of the mid-thigh.
* IM (Intramuscular) Injection Sites -
- The deltoid muscle of the upper arm.
- Upper outer quadrant area of buttocks (gluteal muscles)
- The lateral portion of the thigh (vastus lateralis)
- The front side of the thigh (rectus femoris)
* IV (Intravenous) Injection Sites -
- Any palpable and visible veins are commonly used as the intravenous site.
- The most suitable vein is the median cubital vein.
IMPORTANCE -
- Avoid administration of injection from the medial aspect of the limbs because it may lead to nerve injuries.
- Especially for the IM injections, slightly pull back the plunger to check the blood. If you found blood in the syringe, change the injection site immediately because it punctured the vein.
b. To reduce the pain.
• Action -
- Administration of Injection to the surface area is more painful comparing to the muscles. So, except any contraindications, administration of Injection in the deep muscles reduce the pain and also absorb the medications very quickly.
- The pressure of liquid medication during the injection administration produces pain to the injection site. So, administer a very small amount of medication in intradermal injection. For the subcutaneous injection up to 2 mL is safe. For the intramuscular injection up to 5 mL. For the intravenous injection, we can administer a very large amount of medications.
- Reduce the flow of medication during the injection administration because of the high flow of medications induces pain to the injection site.
- To reduce the pain of Injection administration, choose the injection sites where sensory nerves supplies are poor.
- Choose the needle which is sharp to reduce pain. Blunt or damaged needle injure the injection site's tissues.
c. To improve the absorption of medications.
• Action -
- To improve the fluid absorption, the needle of the injection must penetrate deeply if possible but carefully. The intramuscular injections have faster absorption comparing to the intradermal and subcutaneous injections because of the deeper penetration.
- Massage to the injection site improves the absorption of the medication by stimulating the circulation. But avoid massage for the intramuscular injections because the medication can back up to the subcutaneous tissues.
- Absorption is more for the water-soluble medicines and also for the medications which have the same osmotic pressure as blood. For example - isotonic solutions.
2. If avoid infection control measures, injections are functioning as a mode of infection transmission.
• Action -
- Before the injection administration check, syringe and needle must be new and properly sterilized.
- The prescribed medication must be shield properly and ensure that vials, ampules and bottles have no leakage.
- During the preparation, clean the skin area of the injection site with an alcohol swab or any other disinfectant because the skin is the common site for growing infections.
- The nurse should maintain infection control measures by washing hands properly before and after the procedure.
- The necessary for the procedure must be handle carefully by following the infection control measures and aseptic techniques.
3. Be cautious and aware of the medications which can change the blood components, it can be harmful to the patient.
• Action -
- The normal pH value of human blood is 7.4 which is slightly basic. If the normal pH level is altered such as pH level is more than 7.8 or less than 7, it can be harmful to the human. Therefore always be careful about medications and ensure that blood pH level will be in a limitation.
- Frequently check for the vital signs if prescribed medication is related to sodium and potassium salts because these types of medications can change the blood Ph level easily.
- Also, be careful about the osmotic pressure of the medication or fluid. It is safe to administer isotonic fluids because isotonic fluids have the same osmotic pressure as the blood. But for the hypotonic solutions which have less osmotic pressure comparing to the human blood, can lead to hemolysis. For the hypertonic solutions which have more osmotic pressure comparing to human blood, shrink the normal blood cells.
4. Unknown and fearful situations can produce anxiety for the client.
• Action -
- Before starting the procedure, explain the whole procedure to the client, so that the client gets confidence and become familiar with the procedure.
- Keep in mind that fear and anxiety increases muscle tension which leads to painful injection administration. Therefore, explain the procedure, advice the client to become relax and maintain a comfortable position.
- Hide needle and syringe from the client before giving injection because the sight of the needle and syringe can to fear and panic to the client.
- Distract the client by starting a conversation with the client during the introduction of the needle to reduce the pain.
- To avoid anxiousness of the client provides needed privacy, if necessary.
5. Injected medication can not be retrieved. Be aware before injection administration and ensure the availability of antidote.
• Action -
- During the preparation, make sure that the medications are prescribed by the physician.
- Follow the five rights of medication administration during the procedure.
- Always be sure that the ward or procedure room has enough lighting facilities.
• Some common mistakes must be avoided -
- Check for the test dose results to prevent allergic reactions.
- Follow aseptic techniques to prevent infection transmission.
- To avoid circulatory overload, regulate the flow of intravenous fluids.
- Push back the plunger of the syringe and check for the blood. If there is a presence of blood, immediately change the injection site.
- Follow the prescription and administer the correct dosage to the client to avoid overdosage of medication.
- Always remove the air bubbles from the syringe to avoid air embolism.
- To avoid nerve injuries, choose an appropriate site before the injection administration.
6. Proper planning and arrangements save time, equipment and workloads.
• Action -
- The nurse should have procedure knowledge, skills, past experiences and enough confidence.
- Always be attentive and aware to avoid mistakes during the procedure.
- Before and during the procedure, the nurse must provide psychological support.
- Collect all the necessary equipment and arrange to avoid loss of time and interruption of the procedure.
GENERAL INSTRUCTIONS FOR THE INJECTION ADMINISTRATION -
1. Administer Injection if there is a written order of a doctor.
2. During the injection administration procedure, the transmission of infection is common. Therefore carefully handle equipment, medicine and administer injection by following the aseptic techniques.
3. Syringes and needles have variation based on the purposes. You should not mix it. Always use the appropriate one.
For example - Intradermal injection syringe and aspiration syringe cannot be the same.
4. Before selecting needles and syringes, you must check for its condition. Needles must be sharp and syringes must be airtight with any leakage.
5. If you are withdrawing medicine from a vial, change the needle after it because rubber cap of a vial may become blunt the needle.
6. Must follow the five rights of medication administration.
7. Always check the expiry date of medicine and don't use any medicine if outdated or expired.
8. Check for test dose result if a medicine has chances for allergic reaction.
9. Before injection administration, remove all the air bubbles from the syringe to prevent air embolism.
10. Don't administer more than one injection at the same site especially for the insulin injections because it may lead to Lipodystrophy (break down of fat).
11. During injection administration, insert the needle quickly and smoothly, inject the medicine slowly and withdraw needle smoothly and quickly to reduce pain.
12. Other than intravenous, always push back the plunger after inserting the needle and check for the blood. If blood is present, immediately withdraw the needle and change the site.
NURSE'S RESPONSIBILITIES DURING INJECTION ADMINISTRATION -
(Pre-procedure assessment)
1. Check the patient's history such as age, allergic sensitivity, medical diagnosis and purpose of the injection.
2. Check for the doctor's order for injection, medication, dosage, frequency and routes of administration.
3. For verification of patient, ask name, check bed number and other data.
4. Must check for the nurse's records and confirm the last injection administration timing.
5. If medication has a chance for an allergic reaction, the nurse should provide a test dose before the injection administration.
6. Check the injection site properly. If the site has discolouration, pain, itching, swelling, redness, lesions and abscess formation, the nurse should change the site.
7. Check for the client's previous experience, nervousness, fear and anxiety. If the client is anxious, provide psychological support.
8. Check for contraindications.
9. Check for the client's knowledge and explain the procedure before starting the procedure to avoid nervousness and irritation.
