INTRAMUSCULAR AND SUBCUTANEOUS INJECTIONS - CLINICAL SKILLS

This article will demonstrate the correct  technique and procedure for  administering intramuscular and  subcutaneous injections

these procedures  are commonly carried out to introduce  small volumes of a drug into the system  of a patient where oral medication  cannot be tolerated or absorbed usually  a volume of one milliliter less will be  injected subcutaneously whilst larger  volumes from two to five mil will be  injected intramuscularly also size of  needle depends slightly on patient size  but in general blue or green can be used  for I am and blue for subcutaneous  intramuscular injection sites commonly  include the following mid anterior and  mid lateral areas of the quadriceps mid  deltoids and upper outer quadrant of the  gluteal muscles the katiyal region is  used less frequently nowadays due to the  risk of damaging sciatic nerve the  equipment required for this procedure  will include the following a syringe a  drawing up

needle a correctly sized  needle for injection commonly bluer  green a cotton wool ball non sterile  gloves and a sharps container in  addition to the usual introduction and  consent process be sure to recheck  whether the patient has any allergy to  the drug euro back to deliver as well as  ensuring that the drug you have selected  matches what is written on the  prescription you should also record the  batch numbers and expiry date of the  drug in a suitable location usually a  ward register or the patient's notes now  identify a suitable site for injection  usually from one of the three previously  mentioned once identified be sure to  thoroughly wash your hands you may then  begin to prepare your injection by  drawing up the drug using the syringe  and drawing up needle ensure your Rayne 

gloves when drawing up a drug  once this has been done proceed to  removing the drawing up needle and  attaching the injection needle usually  blue or green depending on the size of  the patient being careful not to expose  the needle until you are ready to inject  stabilize the skin with your  non-dominant hand current best practice  suggests that it is not necessary to  cleanse the target skin area with an  alcohol wipe provided the patient is  clean with your dominant hand hold the  syringe as though you would hold a dart  and insert it into the skin at 90  degrees almost to the health of the  needle draw back on the plunger slightly  to ensure that you have not entered a  blood vessel when you are confident that  you are in the musculature proceed to  delivering

the drug for a large volume  wait several seconds before withdrawing  the needle  once you have withdrawn apply pressure  with the cotton wool bowl and dispose of  the sharp immediately after a few  moments of pressure check the wound to  assess bleeding it is usually minimal  check that your patient is comfortable  and dispose of your equipment after  washing your hands  ensure you document everything in the  notes correctly and on the prescription  charts correctly subcutaneous injection  sites commonly include the following  apparatus or arm lower abdomen  upper outer thigh they are generally  given for smaller volumes over a slower  release is preferred  in addition to the usual introduction  and consent

process be sure to recheck  whether the patient has any allergy to  the drug euro back to deliver as well as  ensuring that the drug you have selected  matches what is written on the  prescription you should also record the  batch numbers and expiry date of the  drug in a suitable location usually a  ward register or the patient's notes  preparation is as for intramuscular  injection with the following exceptions  volume of drug will be smaller usually  one ml or less and the injecting needle  will be shorter usually blue only after  identification of a suitable site be  sure to thoroughly wash your hands you  may then begin to prepare your injection  by drawing up the drug using the syringe  and drawing up needle whilst wearing  gloves  you  once this has been done proceed to  removing the drawing up needle and  attaching the injection needle stabilize  the skin with your non-dominant hand  current best

practice suggests that this  is not necessary to cleanse a target  skin area with an alcohol wipe provided  the patient is clean with your dominant  hand insert the needle into the skin at  45 degrees it is not necessary to  aspirate with a subcutaneous injection  once you have withdrawn apply pressure  with the cotton wheel ball and dispose  of the sharp immediately after a few  moments of pressure check the wound to  assess bleeding  it is usually minimal check that your  patient is comfortable and dispose of  your equipment after washing your hands  ensure you document everything in the  notes correctly and on the

prescription  charts correctly in summary you have  witnessed the correct technique for  intramuscular and subcutaneous  injections note that the main  differences between the troupis two  procedures are the requirement for  aspiration different volumes and needle  sizes angle of

injection and different  target sights also note that you should  be aware of using a target site that has  already been heavily used for example  the abdomen in an insulin dependent  patient repeated skin trauma can lead to  liver hypertrophy. (Do it on your own risk)