Battlefield Medications:Administer Injections
C168W243DEPARTMENT OF COMBAT MEDIC TRAINING
Given a patient requiring an injection and the necessary medical equipment,
administer medications by injection,
IAW the Textbook of Basic Nursing, 7thEdition, Rosdahl, Lippincott,
Chapter 63.
Terminal Learning Objective
Safety Note*Everyone wears exam gloves and goggles.
*Place ALL needles in Sharp Containers after use.
Needles do not pierce skin unless an instructor is present. If unsure, WAIT!
*Inform instructors if you suffer a needlestick Injury.
*No one gets in trouble, the concern is your safety.
*OSHA says, “Needlestick injuries are wounds caused by needles that accidentally puncture the skin.”
Whether the puncture was with a clean needle or a used needle,
if the puncture was accidental, let an instructor know right away.
Look at Your Needle in the Package
Using your student handout, circle the sterile parts of the needle.
All parts of the needle are considered sterile.
Only the protective cover should be touched.
Identify Your Needle
Hub Shaft Lumen Bevel
Identify the following parts of a needle…
Measure Your Needle
How is length and gauge determined?Length – tip of the needle to junction of shaft and hub
Gauge – diameter of the lumen
The smaller the number the larger the gauge
What is the length and gauge of this needle?
Pick the Right Needle for the Job
Four factors to considered when selecting the right needle for the job
Type of injection being givenSize of the patient (thin or not so thin) Where the injection is given (arm or butt)Thickness of the medication given
To determine needle length
To determine gauge
Identify Your Syringe
Using the picture in your student handout, identify the following parts of a syringe.
Plunger Barrel Needle Adapter Calibrated Scale
Touch Your Syringe
Sterile parts of the syringe
Plunger Needle AdapterInside of the Barrel
Measure your Syringe
The total volume of the syringe is measured in
Millimeters (ml)
Pick the Right Syringe for the Job
General Rule:
The syringe should be large enough to hold the entire dose and the calibration small enough to draw up an
accurate dose.
10.0 ml
3.0 ml
1.0 ml
Check On Your Learning
Q: What parts of the are needle sterile?
Q: What factors influence the length of the needle?
Type of injection – Size of the patient – Injection site
All parts of the needle (but not the protective cover)
Check On Your Learning
Q: Which parts of the syringe are sterile?
Q: How do you know which syringe to select?
Needle Adapter - Inside the Barrel - Plunger
The syringe should be large enough to hold the entire dose and the calibration small enough to
draw up an accurate dose.
The VERY First Time They Meet…Assembling the Needle and Syringe
Inspect all packaging
Unpack the syringe
Inspect the syringe
Unpack the needle
Assemble the needle and syringe
Inspect the needle
Recap the needle using the “scoop” method
Check On Your Learning
While preparing to administer an injection, the needle is removed from the flexible wrapper.
Ooopps, you drop the needle on the floor. The protective cap was in place when the needle
touched to floor. Can the needle still be used? Why or why not?
No, the needle should not be used. All parts of the needle are considered sterile, including the hub. If the sterile hub touches to floor, it is no longer sterile. The
contaminated hub could cause an infection.
Check On Your Learning
If the plunger of the syringe does not move smoothly, why should it be
discarded and a new syringe used?
If the syringe does not move freely, drawing the medication may be impossible.
Additionally, administering the injection may be difficult or cause additional harm to the
patient.
The Right Medication
How many times should the medication label be verified and when?
Three Times
1. When obtained from storage
2. When the medication is drawn
3. When returning the medication to storage
The Medication is Vial
You have the “right” medication, but is the medication safe to administer? How would you know?
Check the Rubber Stopper
Check the Fluid, Any Floaties?
Check the Expiration Date (Multidose Vials are Special).
Ensure the Medication was Stored Properly
Things You Should Know Before Medication is Drawn
How do you know if you have the right amount of medication in the syringe?
The forward edge of the plunger is exactly on the prescribed ml mark of the syringe.
• Verify Drug and Check the Container• Remove the Vial’s Protective Cap
• Clean the Rubber Stopper• Remove Needle’s Protective Cover
• Draw Air Into the Syringe• Insert Needle Into the Stopper
• Inject Air Into the Vial• Draw the Medication
• Withdraw the Needle from the Stopper• Expel Air Still in the Syringe• Verify the Correct Dosage
• SCOOP the Needle Into the Protective Cover• Return the Vial or Discard
Drawing Medication from a VialDemonstration
Check On Your Learning
Q: When should the medication be compared to the doctors orders and why?
Q: How do you determine the correct amount of medication has been drawn?
When obtained from the place of storage, when drawn, when returned storage.
To avoid administering the wrong medication to the wrong patient.
Ensure the forward edge of the plunger is actually on the prescribed ml mark.
Check On Your Learning
Q: How are clean needles recapped?
Q: Should you recap “dirty” needles?
Place protective cover on work surface.
With the dominate hand holding the syringe, “SCOOP” the needle into the cover.
DO NOT hold the protective cover with the non-dominant hand.
No
Dr. Cooper has assessed a patient and ordered you to draw up medication for him.
Doctor’s Orders:Draw 0.1 ml of 0.9% Sodium Chloride
in a 1.0 ml syringe
with a 25 gauge needle.
Drawing Medication from a VialPractical Exercise
• Verify Drug and Check the Container• Remove the Vial’s Protective Cap
• Clean the Rubber Stopper• Remove Needle’s Protective Cover
• Draw Air Into the Syringe• Insert Needle Into the Stopper
• Inject Air Into the Vial• Draw the Medication
• Withdraw the Needle from the Stopper• Expel Air Still in the Syringe• Verify the Correct Dosage
• SCOOP the Needle Into the Protective Cover• Return the Vial or Discard
Drawing Medication from a VialPractical Exercise
Reconstituting Medication
Some medications are placed in a vial in POWDERED
form and must be reconstituted with a liquid
(diluent) before administration.
Preparing these medications is as simple as injecting the
diluent into the medication vial, mixing and drawing to
required amount.
Reconstituting MedicationDemonstration
• Verify Drug and Check the Containers
• Withdraw Correct Amount of Diluent
• Reconstitute the Medication
• Invert Reconstituted Medication Vial to Dissolve Powder
• Inspect Solution to Ensure it is Well-Mixed
• Change Needle (and Syringe)
• Withdraw Proper Amount of Medication
• Administer
Check On Your Learning
While attempting to reconstitute a powdered medication, the diluent is difficult to inject.
What should you do?If the vial with the powdered medication contains air,
some air may have to be withdrawn to allow the diluent to be injected.
How do you determine if the reconstituted medication should be inverted gently or if
vigorous mixing is required?Check the medication label or the package insert.
Dr. Mayer has assessed a patient and ordered you to draw up medication for him.
Doctor’s Orders:Drawn 0.5 ml of 0.9% Sodium Chloride
in a 3.0 or 5.0 ml syringe
with a 23 gauge needle.
Reconstituting MedicationPractical Exercise
Reconstituting MedicationPractical Exercise
• Verify Drug and Check the Containers
• Withdrawn Correct Amount of Diluent
• Reconstitute the Medication
• Invert Reconstituted Medication Vial to Dissolve Powder
• Inspect Solution to Ensure it is Well-Mixed
• Change Needle (and Syringe)
• Withdrawn Proper Amount of Medication
• Administer
Ampules
It is made entirely of glass.The medication you need is inside.
There are NO openings, caps, rubber stoppers or lids.
THIS IS AN AMPULE
Impossible Mission Made Easy
Located on the neck of every ampule is a
break line.
Once cleansed, the neck can easily be broken by hand.
But Wait…
What if glass gets in the ampule…
and then glass gets in the syringe…
and then glass gets into me?
Use a filter needle!!
Draw Medication from an Ampule Demonstration
• Tap Ampule to Force Medication out of the Neck
• Clean the Neck of the Ampule
• Break the Neck of the Ampule
• Inspect the Ampule for Glass
• Withdraw Proper Amount of Medication(Do Not inject air into the ampule – you will get a shower)
• Recap and Remove Filter Needle and Replace• Administer
Check On Your Learning
You have snapped the neck and currently inspecting an ampule.
What are you inspecting for? Small glass particles.
What do you do if you find something in the ampule?
Discard the ampule and get a new one.
When drawing medication from an ampule, should you draw air into the syringe?
Why or why not? No.
The contents of the ampule are not under pressure
Dr. Mabry has assessed a patient and ordered you to draw up medication for him.
Doctor’s Orders:Draw 0.5 ml of 0.9% Sodium Chloride
in a 3.0 or 5.0 ml syringe
with a 20 gauge needle.
Draw Medication from an Ampule Practical Exercise
Draw Medication from an Ampule Practical Exercise
• Tap Ampule to Force Medication out of the Neck
• Clean the Neck of the Ampule
• Break the Neck of the Ampule
• Inspect the Ampule for Glass
• Withdraw Proper Amount of Medication(Do Not inject air into the ampule – you will get a shower)
• Recap and Remove Filter Needle and Replace• Administer
Intradermal Injections
In preparing to become a 68W, each of you received an intradermal injection.
What was it and why?TB (tuberculosis) Test
Testing your exposure to the disease
Cite one more reason intradermal injections administered?Allergy Testing
Equipment
What is the standard needle length and gauge for intradermal injections?
Length - ¼ to ½ inch Gauge - 25 to 27
What is the standard syringe for intradermal injections?
Tuberculin or other 1.0 ml syringe
Read Carefully - That’s 0.1 ml NOT 1.0 ml
Intradermal Injection Sites
Inner ForearmBack of the Upper Arm
Below Shoulder Blades
What should all of these sites have in common?Free of hair, tattoos and scarsNOT over a vein or bony area
Intradermal Medication Placement
Prepare for an Intradermal Injection
What are the minimum questions a
patient should be asked before
administering any injection?
What is your name?
What are you allergic to?
What drug reactions have you experienced?
*Are you or is there a possibility you could be pregnant? *Females Only
Things to Know BEFORE it is Too Late…
Describe how the needle should be introduced into the skin?
Bevel Up at a 15-20 Degree Angle
How far should the needle be inserted into the skin?
Just until the bevel disappears.
Only This Far
Things to Know BEFORE it is Too Late…
What does “Aspirate” mean?
“To draw by suction”In this case:
Once the needle is in the tissue draw back the plunger.
Aspirating while administering injections
identifies if a needle is inadvertently placed INTO a blood vessel.
Should you aspirate intradermal injections?NO
Your Goal:RECREATE the “Wheal”
Intradermal InjectionsDemonstration
• Verify/Gather Equipment• Assure Emergency Equipment and Personnel Availability
• Select Site, Expose Site, Position Patient• Clean Site
• Remove Needle’s Protective Cover• Hold Skin
• Insert Needle• Inject Medication• Remove Needle
• Cover Site - Remember “Do Not Scratch, Rub or Wash”• Discard Needle and Syringe
• Watch the Patient for a Reaction• Where and when should the test be read?
• Record
Check On Your Learning
At what angle should the needle be inserted to deliver a intradermal injection?
15-20 degrees
If a wheal does not appear, what is your next course of action?
Withdraw the needleDispose of the needle and syringe
Re-administer the injection
Do intradermal injections require aspiration?No.
A brand new company of Soldier medics has arrived to Fort Sam Houston.
The Doctor’s Orders:Administer 0.1 ml
of 0.9% Sodium Chloride,
ID,
to PV1 Noriega,
A very thin, 24 year old female.
Intradermal InjectionsPractical Exercise
Intradermal InjectionsPractical Exercise
• Verify/Gather Equipment• Assure Emergency Equipment and Personnel Availability
• Select Site, Expose Site, Position Patient• Clean Site
• Remove Needle’s Protective Cover• Hold Skin
• Insert Needle• Inject Medication• Remove Needle
• Cover Site - Remember “Do Not Scratch, Rub or Wash”• Discard Needle and Syringe
• Watch the Patient for a Reaction• Where and when should the test be read?
• Record
Subcutaneous (SQ) Injections
What is the absorption rate for SQ injections?
15-30 Minutes
What is the duration?Hours to Weeks
What type of medication should be given SQ?
Small Amounts – Watery - Nonirritating
Subcutaneous Medication Placement
Equipment
What is the standard needle length and gauge for subcutaneous injections?
½ to 1 inch
23 to 25 Gauge
Also consider Patient’s:
amount of SQ tissue, age, size and general condition
What is the standard syringe for subcutaneous injections?
Will depend of the amount of medication given
Subcutaneous Injection Sites
1st Choice2nd Choice
3rd Choice
Not to exceed 0.5 ml
Not to exceed 2.0 ml
Per Physician’s Orders
Things to Know BEFORE it is Too Late…
Describe how the needle should be introduced into the skin?
Bevel Up at a 45 Degree Angle
How far should the needle be inserted the site?Depth depends on the condition of the patient.
Should you aspirate subcutaneous injections?Yes
Because the needle is placed deeper into the tissue, there is a better chance to hit a vessel.
Subcutaneous InjectionsDemonstration
• Identify and Screen the Patient• Verify/Gather Equipment
• Assure Emergency Equipment and Personnel Availability• Select Site, Expose Site, Position Patient
• Clean Site• Hold Skin with Non-dominate Hand
• Insert Needle• Release Skin
• Aspirate• Inject Medication
• Remove Needle and Cover Site• Massage Site
• Discard Needle and Syringe• Record
• Watch the Patient for a Reaction
Check On Your Learning
What is the purpose for subcutaneous injections?
Absorption rate desired is slower than IM route. For small amounts of watery and nonirritating
medication.
What are possible sites for subcutaneous injections?
Upper arm, Vastus lateralis, Abdomen
At what angle should the needle be inserted for a subcutaneous injection?
45 degrees
The Doctor’s Orders:
Administer 0.5 ml
of 0.9% Sodium Chloride,
SQ,
to PFC Jefferson,
very thin 18 year old female.
Subcutaneous InjectionsPractical Exercise
Subcutaneous InjectionsPractical Exercise
• Identify and Screen the Patient• Verify/Gather Equipment
• Assure Emergency Equipment and Personnel Availability• Select Site, Expose Site, Position Patient
• Clean Site• Hold Skin with Non-dominate Hand
• Insert Needle• Release Skin
• Aspirate• Inject Medication
• Remove Needle and Cover Site• Massage Site
• Discard Needle and Syringe• Record
• Watch the Patient for a Reaction
Intramuscular (IM) Injections
What is the absorption rate for IM injections?
10-20 Minutes
What is the duration?Hours to Weeks
What type of medication should be given IM?
Viscous or Irritating – Large Volumes
Intramuscular Medication Placement
Equipment
What is the standard needle length and gauge for intramuscular (IM) injections?
Not less than 1 inch Up to 2 inches (Unless patient is extremely thin) (For obese
patients)
20-22 Gauge
What is the standard syringe for intramuscular (IM) injections?
Will depend of the amount of medication given
Intramuscular (IM) Injection Sites
1st Choice – Deltoid Muscle
Not to exceed
2.0 ml
Intramuscular (IM) Injection Sites
2nd Choice - Gluteus Maximus
Not to exceed 5.0 ml
Intramuscular (IM) Injection Sites
3rd Choice
Vastus Lateralis
Not to exceed
5.0 mlKnee
Post
eri
or
An
teri
or
Hip
Things to Know BEFORE it is Too Late…
Describe how the needle should be introduced into the skin?
Bevel Up at a 90 Degree Angle
How far should the needle be inserted?Depth depends on the condition of the patient.
Should you aspirate intramuscular injections?Yes
Because the needle is placed deeper into the tissue, there is an increased chance to hit a vessel.
Intramuscular InjectionsDemonstration
• Identify and Screen the Patient• Verify/Gather Equipment
• Assure Emergency Equipment and Personnel Availability• Select Site, Expose Site, Position Patient
• Clean Site• Hold Skin with Non-dominate Hand
• Insert Needle• Release Skin
• Aspirate• Inject Medication
• Remove Needle and Cover Site• Massage Site
• Discard Needle and Syringe• Record
• Watch the Patient for a Reaction
Q:When administering an intramuscular injection should you aspirate? Why or why not?
Q: At what angle should the needle be inserted for an intramuscular injection?
Check On Your Learning
Yes. - If you aspirate blood, the end of the needle may be in a blood vessel. Medication delivered into the blood stream, a different route of delivery, could alter the effect of the medication and possibly injure the patient.
90 degree angle
Q: What is the purpose for IM Injections?
Q: What are the preferred injection sites for an intramuscular injection?
Check On Your Learning
When rapid absorption rate & long duration is desired.
When administering viscous or irritating medications.
When large volumes of medication is needed.
Deltoid Muscle
Gluteus Maximus
Vastus Lateralis
The Doctor’s Orders:
Administer 0.5 ml
of 0.9% Sodium Chloride,
IM,
to CPT Jones,
an average sized 42 year old male.
Intramuscular InjectionsPractical Exercise
Intramuscular InjectionsPractical Exercise
• Identify and Screen the Patient• Verify/Gather Equipment
• Assure Emergency Equipment and Personnel Availability• Select Site, Expose Site, Position Patient
• Clean Site• Hold Skin with Non-dominate Hand
• Insert Needle• Release Skin
• Aspirate• Inject Medication
• Remove Needle and Cover Site• Massage Site
• Discard Needle and Syringe• Record
• Watch the Patient for a Reaction
Summary
What factor determines the gauge of the needle?Thickness of the medication administered
How are clean needles recapped?The Scoop Method
How are “dirty/used” needles disposed of?In a Sharps Container
When must filter needles be used?When drawing medication from an ampule
Of the three injections you have learned, which injections should you aspirate and why?
Intramuscular (IM) and Subcutaneous (SQ)
To ensure the end of the needle is in the desired type of tissue and NOT in a blood vessel.
Which injection has a faster rate of absorption in an “average” healthy person, IM or SQ?
IM
Summary
QUESTIONS?