1. Injectable Medications
Subcutaneous – Intramuscular - Intradermal

2. Why Give Injectable Meds??
Patient cannot swallow
Decreased LOC
Drug inactivated by gastric juices
Desire to increase drug effectiveness

3. Injectable Medications
Parenteral drugs must be prepared, packaged, administered in ways to maintain sterility
Vials, ampules
pre-filled syringes
Powder form
Check dates for possible expiration
Assess fluid for clarity & color
Wear gloves to administer
Engage safety device or needle guard after use
Never re-cap
a used needle!

4. Ampule, Vial & Pre-filled Syringe

5. Parts of a Needle & Syringe

6. Injectable Medications
Vials
Glass or plastic with needle-accessible rubber stopper
Ready solution or powder for reconstitution
Single use vial
No preservative, discard after one use
Multiple dose vial
May contain a preservative, used for several doses IF asepsis maintained
Must be labeled with date/time opened & initials of person opening
If drug expires, this date & time must be labeled also

7. Check expiration date of drug and note when opened (drugs can be kept for varying length of time after a multidose vial is opened – contact pharmacy if unsure)
Swab rubber top with alcohol wipe
Add air to vial (same amount as med to be given – prevents vacuum from forming in the vial)
Invert the vial – pull back on syringe plunger and draw up med (keep at eye level)
After removing needle from vial, tap barrel of the syringe to remove excess air
If this is a newly opened vial, label the vial with date and time opened and your initials
TOUCH ONLY THE BARREL AND PLUNGER OF THE SYRINGE!!

8. Injectable Medications
Ampules (Ampoules)
Sealed glass containers
Tops must be broken to allow insertion of needle and withdrawal of the medication
Safety!!!!!!!!
Use filter needle to prevent glass in solution
Discard unused portion
Discard broken ampule in sharps container

10. Injectable Meds Pre-filled syringes Single dose / single use
Most have needle attached
Several forms of these
Some called “Tubexes”
May require adapter to administer

11. Syringes
The larger the gauge number, the smaller the diameter of the lumen
The smaller the gauge number, the larger the diameter of the lumen
Intradermal (ie: TB skin test)
Needle gauge
Needle length ½ - 5/8”
Subcutaneous (ie: Insulin, heparin)
Needle gauge 26-30
Needle length 3/8, - ½”
Intramuscular (IM)
Needle gauge 18, 20, 21, 22, 23, 25
Needle length 1, 1 ½, 2”
ASSESS THE CLIENT FOR APPROPRIATE SIZE OF NEEDLE LENGTH (LONGER FOR PATIENTS WHO ARE OBESE, ETC)

12. Subcutaneous Drugs Use appropriate type of syringe
Insulin or Tuberculin
Small gauge, shorter needle
Never more than 1 mL at a site
Use angle of needle that insures infusion into SC and not muscle
Do NOT aspirate
Choose subcutaneous sites
Rotate sites, avoid overuse and tissue damage
***Insulin is ONLY drawn up in Insulin syringes***
ABSORBED MORE SLOWLY THAN IM – FEWER BLOOD VESSELS IN FATTY TISSUE

13. Injectable Medication Sites

14. SubQ Injection Sites

15. THIS IS AN EXAMPLE OF A SC INJECTION INTO THE FATTY TISSUE AT THE BACK OF THE UPPER ARM

16. Intramuscular Medications
Use appropriate sized syringe
Use appropriate needle size
Consider depth of site & type of solution
Choose appropriate muscular site
Ventrogluteal, deltoid & vastus lateralis
Select by identifying anatomic landmarks
Avoid use of same site repeatedly
IM Adult: Z-Track method
SMALLER GAUGE (LARGER LUMEN) THAN SC
DELTOID – UPPER ARM
VASTUS LATERALIS – OUTER MIDDLE THIRD OF THIGH

17. Ventrogluteal
Vastus Lateralis
Deltoid

18. Z-TRACK INJECTION Indications: Adult IM injections
Technique: Move skin to one side, administer medication & withdraw needle. Once needle is withdrawn, displaced tissue is allowed to return to its normal position, preventing the solution from escaping from the muscle tissue

19. Ventrogluteal Site

22. Deltoid Site

24. Vastus Lateralis Site

26. Dorsogluteal Site
Not a recommended site.

27. Intradermal Drugs Used for administration of diagnostic agents
Preferred site: inner aspect of forearm
Hairless, thinly keratinized
Upper chest or back also used
1 mL tuberculin syringe, 26 gauge needle
Position needle with bevel up
Insert through epidermis so point of needle is almost visible under skin; advance needle 1/8 inch under skin
Inject (0.1 mL) until wheal appears; withdraw needle
15 DEGREE ANGLE OF NEEDLE

28. Technique: Remember, bevel up, 5-10 degree angle, advance ~ 1/8 inch, create a wheal (bleb) & mark location

29. Intradermal Sites

30. Reconstitution of Medication
Used when meds would lose potency as a liquid
Drug label will identify diluent needed
Diluents commonly used are sterile water, or sterile NS for injections
If not found, call pharmacy for direction!!
Displacement Factor (possible)
The powder and solution add volume to the solution and  total volume of the mixture (i.e. Directions: add 5.6mL of sterile water, total volume of solution is 6mL after reconstitution).
DILUENT IS THE LIQUID USED TO RECONSTITUTE A POWDERED DRUG INTO A LIQUID FORM (STERILE WATER, NS, BACTERIOSTATIC WATER)
AFTER ADDING DILUENT, THE AMOUNT OF DRUG IS INCREASED BECAUSE THE POWDERED DRUG OCCUPIES SPACE, SO YOU MAY ADD 2.6 ML OF DILUENT BUT HAVE A DRUG YIELD OF 3 ML IN LIQUID FORM

31. Reconstituting (Cont)
Note the length of time the medication is good for once it’s reconstituted
Directions for storing once mixed
Date, time and initial the vial
The medication will only be able to be used for a specified time
Make sure to put the expiration date and time on the label also!

32. Lets practice. 1. How much diluent do you add. 2
Lets practice! 1. How much diluent do you add? 2. What is the meds final concentration? ___mg/___mL 3. Order: Ceclor 500mg p.o. q12hr How much will you give?

33. More Practice. 1. How much diluent do you add. 2
More Practice! 1. How much diluent do you add? 2. What is the meds final concentration? ___mg/___mL 3. Order: Kefzol 300 mg IV bid How much will you give?

34. Last Practice. Order Tazicef 300mg IM q 12 hr 1
Last Practice! Order Tazicef 300mg IM q 12 hr 1. How much diluent do you add? 2. What is the final concentration for the IM reconstituted medication? ___mg/___mL 3. How much will you give?