INJECTION
&
INFUSION
Chirathawornkhun, Parinda
Meimban, Giuzeppe Edrel Veniegas
BEFORE INJECTION
1ST WASH YOUR HANDS
7 STEP of HAND WASHING
1) PALM to PALM
2) BACKS of HAND
3) INTERLACE FINGERS
4) INTERLOCK FINGERS
5) FINGER TIPS to PALM
6) THUMBS
7) WRISTS
BEFORE INJECTION
2ND PREPARING THE SKIN
The skin is the body’s first defense against infection, it must be cleansed
thoroughly before a needle is inserted.
Cleanse the skin with a back and forth motion using an alcohol swab.
This motion moves bacteria away from the injection site. Allow the
alcohol to dry completely by air.
TYPES OF INJECTION
INTRACUTANEOUS INJECTION
(INTRADERMAL INJECTION)
SUBCUTANEUS INJECTION
(HYPODERMIC INJECTION)
INTRAMUSCULAR INJECTION
INTRAVENOUS INJECTION
SKIN LAYERS
INTRACUTANEOUS (INTRADERMAL)
INJECTION
injections are delivered into the dermis,
or the skin layer underneath the
epidermis, only a few mm thick.
injection of small amounts of material
into the corium or substance of the skin,
done in diagnostic procedures and in
administration of regional anesthetics, as
well as in treatment procedures. In
certain allergy tests, the allergen is
injected intracutaneously
Injection Procedure:
A small needle is used, usually a 26 gauge, ¼ inch needle. A 1 cc. syringe
commonly used.
Spread the skin taut, and insert the needle tip at a 10-15° angle.
Inject medication slowly. If a wheal does not appear, is was administered in
the subcutaneous tissue.
SUBCUTANEUS (HYPODERMIC) INJECTION
These injections are given because
there is little blood flow to fatty tissue,
and the injected medication is generally
absorbed more slowly, sometimes over
24 hours. Some medications that can be
injected subcutaneously are growth
hormone, insulin, epinephrine, and
other substances.
Injection
Procedure:
Raise a fold of skin between the thumb
and forefinger, and insert the needle at
a 45-90° angle.
Pull back plunger slightly. If blood
appears in syringe, remove needle,
dispose properly and prepare a new
injection.*
* It is not necessary to aspirate for blood
return when administering insulin or
heparin.
INTRAMUSCULAR INJECTION
injections are delivered into the muscle.
given when the substance is to be absorbed quickly.
given with extreme care, especially in the buttock
because the sciatic nerve may be injured or a large
blood vessel may be entered if the injection is not
made correctly into the upper, outer quadrant of the
buttock.
The gauge of the needle depends on the viscosity of the
fluid being injected.
general rule, not more than 5 ml is given in an
intramuscular injection for an adult, maximum for an
infant is 0.5 ml, and the injection is made into the
vastus lateralis muscle.
Injection
Procedure:
Spread the skin taut, (except in
vastus lateralis which requires
lifting the muscle) and insert the
needle at a 90° angle.
Pull back plunger slightly. If blood
appears, remove needle, dispose
properly and prepare a new
injection.
If no blood is present inject
medication slowly.
Z tract method
IV Infusions and IV Injections
Step 1 Gather the materials
Sterile disposable gloves
Appropriate size IV catheter (typically 14 - 25 gauge)
Bag of IV fluid
IV administration tube
tourniquet
Sterile bandage or dressing
Gauze
Alcohol wipes
Medical tape
Sharps container
Sterile pad or paper
Step 2 Introduce yourself and explain
procedure to the patient
An important part of the process of starting an IV
is introducing yourself to the patient and
explaining the procedure that's about to occur.
Talking to patients and sharing this basic
information helps put them at ease and ensures
that no part of the process surprises or shocks
them. In addition, it ensures that you have their
full consent to proceed. When you're done, have
the patient lay or recline where they'll be
receiving their IV.
Step 3 Prepare the IV Tubing
Next, prepare the IV tubing by suspending the IV
bag from an elevated stand, filling the tubing with
saline solution, and checking for any bubbles. If
necessary, clamp the tubing so that it doesn't drip
onto the floor. Be sure to remove any bubbles
from the tubing by gently tapping, squeezing, or
flushing them out of the line. Injecting air bubbles
into a patient's bloodstream can cause a serious
condition called an embolism.
Step 4 Choose a suitable gauge and
length of catheter for the situation
Gauge Diameter Length mm
mm
14G 2.1 45
16G 1.8 45
18G 1.3 32/45
20G 1.1 32
22G 0.9 25
24G 0.7 19
26G 0.6 19
Step 5 Put on Sterile Gloves
Inserting an IV pierces the skin and
introduces foreign equipment directly into
the bloodstream. To avoid the risk of a
dangerous infection, it's important to wash
your hands and dry them with a clean paper
towel before beginning, then put on sterile
gloves before you handle your equipment
and touch the patient. If at any point your
gloves' sterility becomes compromised,
take them off and put on a new pair — it's
better to be safe than sorry.
Step 6 Look for prominent veins
Commonly used
infusion sites.
A) Ventral and dorsal aspects of
arm and hand.
B) Scalp veins (usually only used
for infants.
Step 7 Apply a tourniquet
Step 8 Palpate the vein if necessary
Step 9 Disinfect the IV site
Step 10 Prepare the Catheter for
insertion
Step 11 Insert The needle
Procedure:
Stabilize the vein by pulling the skin taut
in the longitudinal direction of the vein.
Do this with the hand you are not going to
use for inserting the needle. Insert the
needle at an angle of around 35 degrees.
Puncture the skin and move the needle
slightly into the vein (3-5 mm).
Hold the cannula and needle steady, then
aspirate. If blood back flows, you are in
the vein. If it does not come, try again.
Step 12 If you miss the vein, explain and
try again
Step 13 Remove and discard the needle
Step 14 Remove the needle and insert
the tubing
Step 15 Secure the IV
Check the flow of fluid into the IV
Open the IV roller clamp and look for
drips forming in the drip chamber.
Check that the IV is infusing into the
vein by occluding the vein (pressing
down on it to block its flow) distal to
the site of the IV (away from the
torso). The flow of drips should slow
and stop, then restart flowing when
you stop occluding the vein.
Change the Dressing as needed
IVs left in for an extended period of time are at a greater
risk of infection than IVs used only for a single operation
or procedure. To reduce the risk of infection, it's
important to carefully remove the dressing, clean the site
of the IV, and put a new dressing in place. In general,
transparent dressings should be changed roughly weekly,
while gauze dressings should be changed more frequently
because they don't allow observation of the IV site. Don't
forget to wash your hands and wear a fresh pair of gloves
every time you touch a patient's IV site. This is especially
important for when you're changing dressings, as the use
of long-term IV connections is associated with an
increased rate of infection.
Removing the IV safely
To remove an IV, first, close the roller clamp to stop the
flow of fluid. Gently remove the tape and dressing to
expose the catheter hub and IV site. Place a clean piece
of gauze over the IV site and apply delicate pressure as
you pull the catheter out. Instruct the patient to hold the
gauze in place to stop the flow of blood. You may want to
secure the gauze over the puncture site with tape or a
bandage. However, with gentle pressure, for most
patients, bleeding will stop quickly enough that this isn't
absolutely necessary
Dispose of all needles properly
The needles used to start an IV
qualify as medical sharps and need to
placed in a well-marked sharps
container immediately after use.
Because needles can transfer
infectious agents and even blood-
borne illnesses from person to person
if handled improperly, it's extremely
important to ensure that these
needles aren't disposed with ordinary
trash, even if you're sure that the
patient is perfectly healthy.
IV related complications
Hematoma: Occurs when blood
leaks from the vein into the
surrounding tissue, usually after
more than one vein wall is
accidentally punctured. Often
accompanied by pain, bruising, and
irritation. Will usually resolve
within several weeks light
pressure.
IV related complications
Infiltration:Occurs when fluid is injected
outside of the vein into surrounding soft
tissue. Will cause swelling and smooth, pale
skin in the affected area. Can be a minor or
serious issue depending on the medicine
being administered.
IV related complications
Embolism: Occurs after injecting air into the vein. Often
caused by air bubbles in the IV tubing. Children are
especially at risk. In serious cases, causes trouble
breathing, chest pain, blue skin, low blood pressure, and
even stroke.
Thrombosis and endarteritis: Life-threatening conditions
that can result from injecting into an artery, rather than a
vein. Can lead to severe pain, compartment syndrome
(high pressure on a muscle leading to a very painful "tight"
or "full" feeling) gangrene, motor dysfunction, and even
the eventual loss of the limb.
