Administering Injections

Healthcare professionals that provide patient care are expected to be clinically competent to perform administration of injections if the need arises for you or your loved one.  Medications given by injection generally work more quickly than if given by mouth, but they are more uncomfortable for those receiving them.  Most patients will frown upon having to get a shot, but the benefits most always outweigh the few seconds of discomfort that will be experienced.

Injections can be administered in different ways into the body, depending upon where in the body the most desirable effects of the specific medication will occur.  Injections can be given intramuscularly (IM), subcutaneously (SQ), or intradermally (ID).  The type of medication that is being administered and the body type of the patient are key factors that will determine the way the injection is given for each route.

The following are general nursing implications that the Total Home Health professional should always take into consideration when administering medications via injection:

·      Vastus lateralis site is the recommended site for infants and children younger than 2 years of age.

·      Injection sites should always be rotated to enhance absorption of the medication; staff should always note which site was used so that the next injection can be given into a different site.

·      Do not use injection sites that are swollen, inflamed, or have moles, birthmarks, or scars.

·      Always discard all sharps (needles) in the designated containers to prevent accidental needle sticks.

The intramuscular (IM) route is the most appropriate for medications that could be irritating otherwise.  Common sites for IM administration include ventrogluteal, deltoid, and the vastus lateralis if caring for the pediatric population.  The dorsogluteal site is no longer recommended due to its proximity to the sciatic nerve and the damage it could cause.  Needle size should range between 18 to 27 gauge, generally a 25 to 27 gauge needle is used.  Needle should be 1 to 1.5 inches long.  The volume of medication that is injected is usually 1 to 3 milliliters, and needle is to be inserted at a 90 degree angle.  If the physician order requires that more than 3 milliliters is to be administered, medication must be divided into two syringes, and given in two different sites.  IM injections may be more inconvenient for patients due to the need to remove clothing to expose the appropriate sites.  Also, they may be more difficult for a family member to administer, this is where the professionals at Total Home Health will be there to assist you. 

The Z-track method may also be used when giving medication via the IM route.  This type of injection will prevent the medication from leaking back into the surrounding subcutaneous tissue.  For example, the Z-track method is used for iron preparation because the medication will possibly cause visible, and possibly permanent, skin stains.  To perform Z-track, the skin and tissue at the site is displaced by pulling and holding it firmly to the side while the needle is inserted.  After the medication is injected, the skin and tissue are released.  The displacement and replacement of the skin causes the needle track to take the shape of the letter “Z,” which causes the medication to track in a way as to prevent leakage into the surrounding tissues.  Z-track injection is usually less painful than the traditional IM injection.

The subcutaneous (SQ) route is the most appropriate for small doses of nonirritating, water-soluble medication.  The common medications administered SQ include insulin and heparin.  Sites are determined related to body type of patient.  They usually say if you can “pinch an inch,” you can give an SQ injection there.  Most common sites include the abdomen, upper hips, lateral upper arms, and thighs.  A 3/8 to 5/8 inch, 25 to 27 gauge needle, or an insulin syringe of 28 to 31 gauge is generally used.  No more than 1.5 milliliters of solution should be given per this route.  For an average-sized client nurse should pinch up the skin, and inject at a 45 to 90 degree angle.  If client is obese, nurse should always inject at a 90 degree angle for adequate absorption.

The intradermal (ID) route may also be utilized if the situation warrants.  This is usually used for tuberculin testing or checking a patient for allergies.  Only small amounts of solution should be used, 0.01 to 0.1 milliliters, for an ID injection.  A tuberculin syringe with a fine 26 to 27 gauge needle is used.  The injection should be given in a thin-skinned, hairless site at a 5 to 15 degree angle, making sure that the bevel of the needle is facing upwards.  The sites most generally used are the inner surface of the mid-forearm or the scapular area of the back.

Injections should always be administered per physician orders.  An increased risk of infection exists with any of the injection routes, due to it being an invasive procedure.  Hand washing prior to injections and preparing the injection site by cleansing it with an anti-microbial agent, or alcohol swab, will greatly decrease chance of infection.   Total Home Health professionals will be there to assist you with all your needs when it comes to administering your medications by injection.  Knowing that it is a rather unpleasant experience, their compassionate care will help to make you feel more at ease during these times.