APPENDIX R

Injections Information

TypeNeedle GaugeNeedle LengthSyringeComments
Intradermal263/8 inTuberculinArea must be marked or mapped if repeated tests done.
Subcutaneous25½ inTuberculin, insulinRotate sites.
Intramuscular20---231---3 in2---3 mlRapid insertion and slowinjection help to decrease pain.
Intravenous20, 21Bag with tubing.Monitor site and needle-placement.
Blood16, 18Bag with tubing.Check equipment, needle placement, and injection site regularly.

Injection Procedures

Intradermal injection:

Inject directly below the surface of the skin. The injection should produce a wheal or fluid-filled bump that can be seen beneath the skin at the injection site. Skin on the back of the forearm is the usual site for these injections. The area should be marked or mapped for reading tests in 24---48h.

Subcutaneous injection sites.

Chart for rotating subcutaneous sites. (A) Nurse using arm and abdomen. (B) Client using abdomen and thighs.

Subcutaneous injection:

Inject into the loose connective tissue underneath the skin; do not inject more than 2 ml at a time. Areas of the body that can be “pinched up” are best suited--abdomen, upper thigh, upper arm. The needle is inserted at 45 degrees; the plunger is pulled back to assure that no blood returns and the needle is not in a vein; if no blood returns, inject solution. Subcutaneous sites should be rotated for frequent injections. Monitor sites for signs of abscess or necrotic tissue. Do not use this method for patients in shock, and monitor patients with poor perfusion or low blood pressure, as the drug may not be absorbed or may be absorbed very slowly.

Intramuscular injection sites. (A) Landmarks for the dorsogluteal injection site. (B) Landmarks for the ventrogluteal injection site.

Intramuscular injection sites (continued). (C) Landmarks for the deltoid injection site. (D) Landmarks for the vastus lateralis injection site. (continued)

Intramuscular injection:

Insert needle quickly into big muscle; pull the plunger back to assure that no blood returns and the needle is not in a vein; if no blood returns, inject slowly. Position the patient to relax the muscle, which will increase blood flow, aid absorption, and decrease pain. Vastus lateralis muscle of the thigh is site of choice for children up to 3 y; ventrogluteal muscle is the site of choice for older children and adults; deltoid muscle and gluteus maximus are other possible sites in special situations.

Intramuscular injection sites (continued). (E) Landmarks for the rectus femoris injection site.

Z-Track:

Very irritating or staining solutions may be given by Z-track technique. The skin is prepped and pulled very tightly to one side; the needle is inserted into the muscle; the drug is injected as the needle is withdrawn slowly, and the skin released. This procedure allows the various overlapping layers of tissue to slide back into position in a Z formation, sealing off the injected material.