Parenteral Route (Injection)

Requirements

Trolley

Top shelf

1. Small tray
2. Sterile syringes and needles of all sizes
3. Prescribed sterile medications in ampoules or vials
4. Patient's charts and medicine lists
5. Gallipot with swabs
6. Antiseptic solution in a gallipot
7. Sterile water for injection
8. Injection dishes
9. Tourniquet
10. Cannula of appropriate gauge
11. Strapping
12. Pair of scissors
13. Clean gloves

Bottom shelf

1. Sharps safety box
2. Receiver for used swabs
3. Receiver for used gloves
4. Small pillow for supporting the arms
5. Mackintosh and towel

Bedside

1. Screen
2. Hand washing equipment

Procedure

a) Intradermal or Intracutaneous Injection

1. Refer to general and medicine administration rules for injections.
2. A tuberculin syringe or 1 ml syringe is used with needles.
3. Identify the patient and put him or her in a comfortable position to expose the selected site.
4. Clean the skin with an antiseptic swab and allow the site to dry.
5. If BCG vaccination, clean the site with water.
6. Stretch the patient's skin, draw it tight, and introduce the needle at an angle parallel to the skin.
7. Gently and slowly inject the medicine while observing for a small wheal to appear.
8. Carefully withdraw the needle.
9. Do not massage the site after removing the needle.
10. Circle the area with a pen and record the time, requesting the patient not to wash the area until it is assessed for the intended outcome.
11. Inspect for signs of reaction when the stated duration of time has reached.
12. Report and record results.
13. Clean away the used equipment.

b) Subcutaneous Injection or Hypodermic

14. Help the patient adopt a position depending on the site selected.
15. Choose a suitable needle gauge, take a 1 ml or 2 ml syringe depending on the dosage.
16. Draw medicine into the syringe.
17. Expel the air by holding the syringe with the needle pointing up.
18. Place the syringe in the injection dish.
19. Explain the procedure to the patient, asking him or her not to move while the injection is being given.
20. Select the site and clean it with an antiseptic swab, letting the area dry first.
21. Grasp and pinch or squeeze the patient's skin gently between the finger and thumb of your left hand and insert the needle at an angle of 45 degrees.
22. Pull back the piston or plunger and inject the medicine slowly.
23. When the medicine has been injected completely, place a swab over the needle and withdraw the needle quickly and smoothly.
24. If there is any bleeding at the site, apply firm gentle pressure with a swab until it stops.
25. Make the patient comfortable and record the medicine given on the patient's treatment sheet.
26. Discard syringe, gloves, and swabs appropriately and clear away the equipment.

c) Intramuscular Injection

27. Observe the general nursing rules.
28. Read the prescription carefully and check the medicine with another nurse, including the amount to be given.
29. Assemble syringe and needle, put on gloves.
30. Break open the top of the ampoule (using a gauze swab or a file) or remove the top of the rubber cap.
31. Reconstitute powdered medicines according to the instructions on the bottle.
32. Put on gloves and draw up the prescribed dose of the medicine.
33. Expel the air and remember that with antibiotics and multi-dose vials, the air is expelled into the container.
34. Position the patient depending on the site chosen.
35. Select, locate, and clean the site and allow it to dry.
36. Inject the medication, grasp and pinch the area surrounding the injection site or spread the skin at the site as appropriate.
37. Hold the syringe between the thumb and forefinger and pierce the skin at 90 degrees, inserting the needle.
38. Aspirate by holding the barrel steady with the non-dominant hand.
39. If blood does not appear in the syringe, inject the medication slowly and steadily.
40. Withdraw the needle slowly and steadily while supporting the hub of the syringe and needle. With the non-dominant hand, support the skin surface using a cotton swab for applying counter traction at the site.
41. Apply gentle pressure at the site with a dry cotton swab but do not massage.
42. Discard the uncapped needle and syringe appropriately.
43. Clear away, remove gloves, and wash hands.
44. Record the procedure including the name of the medication, dose, site, and response of the patient.

d) Intravenous Injection

45. Prepare the injection tray and take it to the patient's bedside.
46. Identify the patient and explain the procedure to the patient.
47. Screen the bed and put on gloves.
48. Place a small pillow and a protective sheet under the patient's arm.
49. Expose the patient's forearm and anterior surface of the elbow.
50. Inspect the selected vein; if it is visible and clear, apply a tourniquet or a sphygmomanometer cuff around the patient's upper arm and inflate sufficiently about 8 to 10 cm above the site.
51. Request the patient to close and open the fist for a minute.
52. Clean the area with an antiseptic and dry with a sterile swab.
53. Expel air from the syringe.
54. Hold the patient's arm and with your left thumb exert pressure about 3 cm below the chosen site and make the skin tight.
55. Insert the needle at an angle of 15-45 degrees with its bevel up, then quickly and steadily insert into the vein. Pull back the piston slightly; if blood is aspirated, the needle is in the vein.
56. Remove the tourniquet or deflate the cuff and inject the medicine slowly.
57. When the medicine is injected, put a swab over the site and withdraw the needle.
58. Apply pressure at the site with a swab for some seconds to make sure there is no bleeding. If oozing continues, apply a swab and a piece of strapping.
59. Record the medicine given in the patient's chart.
60. Clear away and thank the patient.