Parenteral Medication Administration

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Ethical – Legal Factors

• Right to refuse

• Liability– Nerve Damage– Into a vein or artery– Infiltration / Extravasation– Tissue Damage– Unapproved site

• Dorsal Gluteal may be unacceptable at your facility

Minimize Discomfort• Position muscle for relaxed tone

• Distraction with conversation & instructions, visual imagery, relaxation techniques

• Dart-like quick entry for smooth tissue separation (it’s in the wrist action!!)

What are other ways to Minimize Discomfort

Safety Considerations

• When preparing multiple injections, always label the syringe immediately– Keep the medication container with the syringe– Do not rely on memory to determine which solution is

in which syringe

• Carefully monitor the patient for any adverse effects for at least 5 minutes after administration of any medication

• Handle multi-dose vials carefully and with aseptic technique so that medicines are not wasted or contaminated

What’s Sterile

• When can contamination occur?

• How can contamination be avoided?

What do you need to know about Injection Sites?

Injection Sites - Deltoid

Location: upper armLandmarks: Acromion Process, axillary foldMuscle mass: triangle apex at axillary line and

base of triangle 2-3 finger breadths below acromion process.

Injection area: in the middle of the triangle / into belly of the muscle mass. Avoid Brachial artery & Radial nerve (BARN)

http://www.austincc.edu/health/rnsg/skills/injectionSites.htm

Deltoid • Should not be

used in infants or children because of the muscle’s small size.

• Injection volume should not exceed 1ml in the adult

• Use a 23-28 gauge, 5/8 to 1 inch needle

• Rarely used for hospitalized patients. Primarily used for immunizations.

Injection Sites - VentroglutealLocation: lateral (ventral) side of the hipLandmarks: Iliac crest, anterosuperior illiac

spine, greater trochanter of femurMuscle mass: Gluteus medius and minimusInjection area: opposing palm of hand over

greater trochanter, middle finger pointed toward the iliac crest, index finger toward anterosuperior iliac spine. Inject into the triangle created by these fingers. No major vessels / nerves.

Ventrogluteal

Vastus LateralisLocation: anterolateral aspect of the thighLandmarks: greater trochanter, lateral femoral

condyleMuscle mass: vastus lateralis muscle Injection area: between one handbreadth

below the greater trochanter and one handbreadth above the knee. Width of area is from the midline on the anterior surface of the thigh to midline on the lateral thigh. Best to inject into outer middle third of the thigh.

No major vessels or nerves to avoid.

Vastus Lateralis• Identify the greater trochanter

and the lateral femoral condyle

• Select the site using the middle third and the anterior lateral aspect of the thigh.

Dorsal Gluteal Most Dangerous site,

Trend is away from use

• Location: Upper lateral aspect of the buttock

• Landmarks: Posterior superior iliac spine,greater trochanter

• Muscle mass: Gluteus maximus muscle

• Injection area: Draw an imaginary line between the anatomic landmarks listed above. Administer the injection lateral and slightly superior (2 inches) to the midpoint of this line.

Avoid the sciatic nerve & superior gluteal artery

Dorsal Gluteal

Z - track

• Seals the medication into the muscle tissue.

• Minimizes subcutaneous tissue irritation from tracking of the medication as the needle is withdrawn.

• Used more frequently now to decrease discomfort and pain.

• Used for irritating medications (Vistaril) and tissue staining meds (iron dextran –Imferon).

• Use in ventrogluteal or dorsogluteal sites

Z - track: An intramuscular injection technique designed to deposit medications deep into muscle tissueRelease the lateral slide of tissue ONLY after needle has been

completely withdrawn.

Subcutaneous (SC or SQ)• Common drugs given SQ:

– Anticoagulants– Insulin– Erythropoitic agents– Some Analgesics (-caine type drugs)

Injection Technique - Anticoagulants

• Heparin– Always lookup and read about med prior to

administration– Check dosage carefully: some policy req. 2nd nurse– Requires drawing up from vial; needs air lock– Abdomen SQ area only; deep into tissue– No aspiration; no massage after withdrawal due to

risk of precipitating bleeding– Rotate sites

Anticoagulant Injection Technique• Lovenox

(enoxaparin sodium)– Look up med prior to

administration– Commonly dispensed

in pre-filled syringe– Safety syringe: firmly

depress plunger AFTER removal from tissue to activate safety seal

• Lovenox Bruise – site correct??

What do you think of this site for heparin?

Intradermal• Drugs that are intradermally injected are agents

for diagnostic determinations, desensitization, or immunization.

• For this route of administration, 0.1 ml of solution is the maximum volume that can be administered.

• Document date, time, and location of ID site in med record; include projected date to be “read’

Patient education: may sting like an ant bite

ANY QUESTIONS SO FAR?