INTRAMUSCULAR & SUBCUTANEOUS INJECTIONWORKSHOP

LORELEI J. CABALUNA, RN, MNBotany Lecture and Laboratory Room

August 22, 201412:00 nn to 4:00 pm

Adventist Medical Center CollegeDepartment of Pharmacy

1) Drug2) Storage3) Route of Administration4) Dosage5) Preparation6) Timing7) Recording

7 POINTS TO CONSIDER BEFORE ADMINISTRATION!

Outpatient only!

The patient must have a complete prescription.

Check expiration date.

Ask for drug allergies.

1. Drug

Drug to be used have been stored properly.

Example: Vaccines (biologicals) should be stored in a

cold temperature (2 – 8 ᵒC)

2. Storage

Determine the best route of administration.

Factors:Age

Physical CharacteristicsClinical Condition

Dosage Form

3. Route of Administration

Calculate the dosage appropriately.

Double check with drug literature.

4. Dosage

Observe STERILE TECHNIQUE!

Remove remaining air inside the syringe prior to administration.

Syringe and needle must be appropriate for the amount of solution.

5. Preparation

Consider Drug-drug interaction and appropriate time interval between

administrations.

6. Timing

Observe proper documentation!

7. Recording

SUBCUTANEOUS INJECTION

SUBCUTANEOUS SITES OF INJECTION

IMPLEMENTATION• Wash hands, provide privacy• Select an injection site (no bruises, edema,

inflammation, scars), if abdomen at least 2 inches away from umbilicus, rotate injection sites

• Apply gloves, hold a dry gauze in nondominant hand

• Cleanse site with antiseptic swab (allow to dry)• Remove needle cap• Hold syringe between thumb and forefinger of

dominant hand

IMPLEMENTATION

• Pinch skin with nondominant hand• Inject firmly at appropriate angle• With needle in site, grasp lower end of syringe

with nondominant hand and inject medication with dominant hand on plunger

• Remove needle and place dry gauze over site with gently pressure (do not massage)

• Discard needle and syringe• Remove gloves and wash hands

INTRAMUSCULAR INJECTION

IM INJECTION SITES

Deltoid

Dorsogluteal

Ventrogluteal

Vastus lateralis

Note:Vastus lateralis and ventraogluteal sites used in infants

DELTOID MUSCLE

GLUTEUS MAXIMUS

GLUTEUS MEDIUS

VASTUS LATERALIS

Z-Track

• Minimizes tissue irritation by sealing the drug within the muscle tissues and decreasing pain.

• Recommended technique for all IM’s when possible.

IMPLEMENTATION• Privacy• Wash hands• Expose only required area• Select appropriate injection site & ensure client is

comfortable• Landmark site• Cleanse site with antiseptic (center and rotate outward ~

5 cm)• With nondominant hand, pull skin 2.5-3.5 cm down or

lateral (Z track), hold this position until medication is administered.

• Gauze in nondominant hand.

IMPLEMENTATION• Remove cap (pull straight off)• Hold syringe like a dart• Inject quickly at 90 degrees• Hold lower part of syringe to stabilize syringe• Pull back on plunger 5-10 sec, if no blood inject

medication slowly (1 ml/10 sec)• Wait 10 sec, slowly withdraw needle, place gauze

over site• Assess site• Observe response to medication

RETURN DEMONSTRATION

TIME!