Welcome to the Wonderful World of Giving Injections! You CAN do it!

What needle to use? Subcutaneous Intradermal Intramuscular 5/8 " needle 3/8 5/8" needle 1 - 1 needle 25 gauge 26 27 gauges 22 gauge (max amount: up to 1cc) (amounts: tenths of a cc) (max amount: up to 3cc)

Before You Take Your Best Shot Clean your sites with alcohol, inner to outer (cleanest to dirtiest). Aspirate to ensure that you are not in a blood vessel (if you are, back out & start again, from the beginning). Whether or not to aspirate with insulin seems to be in debate so follow your program, instructor or clinical guidelines. DO NOT aspirate with HEPARIN and do not massage heparin. You can massage other types of injections (it promotes absorption). Do not massage Z-track injections (since Z-track is used for sealing irritating preparations in the muscle). DO NOT RECAP YOUR NEEDLE after injections! (you will be tortured & shot by evil instructors!). Do remove your gloves, wash your hands, and go back to the M.A.R. to document date, time and site.

Intradermal Injections_____________________________________________________________ Give at a 15-degree angle with bevel up into the dermis. Most commonly used for allergy and TB skin tests. Amounts administered are usually in tenths of a cc. Finding the injection site: move down 3-4 finger widths from the antecubital area (inner arm side of your elbow). Clean site with alcohol but do not wipe with alcohol afterwards. Will see these injections given with a 1cc syringe. DO NOT ASPIRATE. Injection of substance should form a wheal (looks like a fluid filled blister). These tests need to be read at a certain time i.e. TB skin test. Explain to pt that they will need to return to have a TB test read. Tell them exactly when. Reading a TB skin test: you are looking for redness or induration (hardened area). A test is positive if there is an induration greater than 10mm. How to chart it: Example - Indurated area of 7mm.

Subcutaneous Injections___________________________________________________________ subcutaenous tissue is under the dermis of the skin. Choose a site free from infection, without skin lesions, do not give in a scar, and do not give into a bony prominence. Be at least 1-2 inches away from the umbilicus. Inject at a 45 90 degree angle. The maximum amount that can be injected subcutaneously is 1cc.

Sites for subcutaneous injections: 1. Outer aspect of the upper arm. 2. The abdomen below the costal margin (rib cage) to the iliac crest. 3. Anterior aspect of the thigh. 4. Scapular region (upper back). 5. Buttocks not usually used but available if you need to rotate sites.

Intramuscular Injections___________________________________________________________ The maximum amount that can be injected into a large muscle is 3cc. If you must give more than 3cc, give 2 shots in 2 different injection sites. The maximum amount that can be injected into a small muscle is to 1cc. Large muscle sites are used for irritating medications. Hold large muscles taut (tight) and pinch up small muscles for injection.

The Large Muscle Sites: 1. Ventrogluteal site Inject at a 90-degree angle (right angle). This site consists of the gluteus medius muscle lying over the gluteus minimus. This is a good muscle to work with because it is away form the sciatic nerve and blood vessels. To give this injection, position client on side with knee bent (bringing the leg up helps to relax the buttock muscles. The key to finding this site is to map it out, the nurse places her right hand on the clients left ventrogluteal (or the opposite). Landmarks to find the site place your palm on the greater trochanter of the femur, place hand perpendicular to the femur, put your thumb toward the clients groin -> point the index finger toward the iliac crest. Does this sound confusing well thats cause it is!

2. Vastus Lateralis site Inject at a 90-degree angle. Location of this site: the anterior lateral aspect of the thigh, usually well developed in adults and children, no major blood vessels or nerves near. Landmarks to fine the site: measure off a hands breaths (or width) above the knee at the patella and a hands breath below the greater trochanter. Give the injection into the middle third.

3. Dorsogluteal site Inject at a 90-degree angle. With this site there is a greater chance of giving an injection near the sciatic nerve. This area is not used in children less than 3 y/o unless they have been walking for a year (the muscle is developed by walking). Position the client in prone position with toes medial (turned inward) or position on side with upper leg flexed. Landmarks to find the site locate the posterior superior iliac spine then locate the greater trochanter. Draw an imaginary line between the two and inject into the upper outer quadrant.

Small Muscle Site: Deltoid site

Inject at a 90-degree angle. This muscle is less developed. Maximum amount injected at the site is - 1cc. Landmarks to find the site fully expose the shoulder and arm, then locate the acromion process and axillary line, form the point of a triangle between these points and inject there.

Z-Track Injections:_________________________________________________________________ Used when giving very irritating medications i.e. vistaril or a medication that would stain i.e. iron. Z-tracks are given into large muscles. How to do it: draw up medication, change needle, draw back 0.2 of air (gives you an air lock), find your site, pull skin laterally 1-1 inches (displaces skin to the side & creates a broken line, pulls subQ over), give injection, push medication in slowly, push in air, remove needle, let skin replace itself. DO NOT MASSAGE.