1. INJECTIONS & Medication Administration Jacquelyn Jarus-McDanel RN Online Learning Coordinator & Ambulatory Educator Wexner Medical Center at The Ohio State University

2. Injections – Learning Objectives Primary: Demonstrate the ability to independently perform basic injection technique Intradermal, SQ, IM Perform IM injection on an actual patient. Perform IM Injections on a simulator Describe How To perform injections (Intradermal, SQ, IM). List the indications, contraindications, and complications of Administering Injections Intradermal, SQ, IM

3. What are the 6 RIGHTS of medication administration? Hint: DR. TIM D Documentation Time Route/site Dose Medication Patient

4. Name the 4 CHECKS done prior to preparing an injectable medication? Hint: O-ICE O Order Is it exactly what the MD ordered? I Integrity C Concentration E Expiration Date Other checks should be considered? Lot Number & Vaccine Manufacturer

5. Vaccine Information Statements Patient care staff member Must note in each patient’s permanent medical record or permanent office log or file the following date the VIS is provided the VIS edition date (usually located at the bottom of the second page of the document) Federal Law does NOT require a signature

6. Needles & Syringes

7. Tissue & Angle of Insertion

8. Medication Preparation Ampoule & Vials

9. Washed hands, Gloves when administering injection Review chart for M.D.’s orders & patient’s allergies. Discuss any noted concerns with M.D. or R.N. Welcome patient, Name, D.O.B. Give applicable form(s) to patient and confirm understanding (VIS, TB, Screening Questionnaire) Determine patient’s comfort with procedure Review - Preparation of patient

10. Review - Preparation of Medication Select correct medication and confirm the ‘4 Checks’: a) Order, b) Integrity, c) Concentration, d) Exp. Date Clean top of medicine vial with alcohol pad. Allow to dry. Select correct needle size – confirm length and gauge. Attach needle (still in protective sleeve) to syringe.Remove needle cap & pull back plunger drawing in air equal to amount of medication to be drawn. No contamination when needle is attached to syringe noted.

11. Review With vial on flat surface insert needle into rubber stopper, inject air into vial – invert vial & syringe together. Pull back plunger to allow medication to fill syringe. When obtain correct volume, position syringe at 90 degree eye level, remove any air bubbles without loss of fluid. Remove needle from vial; replace needle cap with one- handed scoop method or engage safety device. Re- check dosage. Replace with New Needle Label syringes before leaving prep area

12. Intramuscular Injections The Deepest Layer

13. Deltoid Muscle

14. Vastus Lateralis:

15. Ventrogluteal Site

16. Administering an Intramuscular Injection

17. Intramuscular Injection Technique

18. Review - Intramuscular Injection: Hand Hygiene, gloves Cleanse site in circular motion with alcohol/antise ptic pad. Allow to air dry. Correct Site Identified. Insert needle at 90-degrees. Spread skin laterally approximately 1 inch Or grasp muscle between thumb and forefinger. Or Skin pulled taut between The thumb and forefinger Aspirate in accordance with policy. (policy: aspirate all IM medications except vaccines) Inject medication slowly, then steadily withdraw needle, release skin, and apply alcohol swab. DO NOT MASSAGE! Apply band- aid, etc. if needed. Use safety mechanism correctly and properly dispose of needle and syringe.

19. Subcutaneous Injections SQ

20. Remember Pinching with SQ

21. Review - Subcutaneous Injection Hand Hygiene, gloves Cleanse site in circular motion with alcohol/antiseptic pad. Allow to air dry. Correct Site Identified. Gently pinch up skin; Insert needle at a 45- 90 degree angle. Do not aspirate. May release skin and inject medication slowly or keep skin pinched while injecting. Withdraw needle appropriately and apply cotton ball or gauze to site. DO NOT MASSAGE! Apply Band-Aid, etc. if needed. Use safety mechanism correctly and properly dispose of needle and syringe.

22. Intradermal Injections ID

23. Review - Intradermal Injection Hand Hygiene, gloves Cleanse site in circular motion with alcohol/antiseptic pad. Allow to air dry. Select appropriate site. Avoid sites with rashes, bruises, knots, etc. With non- dominant hand, stretch skin over site with forefinger and thumb. Hold syringe between thumb and forefinger of dominant hand. Insert needle at a 5 - 15-degree angle with bevel up until resistance is felt.

24. Review Stop needle insertion when bevel is embedded but still visible. Inject solution slowly obtaining a wheal @ 6-10 mm). If medication leaked out or no wheal developed, repeat test 2” from first injection site distal from elbow or preferably on other arm. Withdraw needle at same angle of insertion. Gently dab site with gauze or cotton ball if blood appeared. Do not rub or massage. Use safety mechanism correctly. Properly dispose of needle and syringe.

25. Review - Post Procedure Washed hands Inspect injection site for excessive bleeding Observe for any (adverse) reaction(s) Report undesirable effects Document including site (s) and patient’s tolerance of procedure

27. This boy had progressive vaccinia, a massive flesh eating infection caused by vaccination. He had been immuno compromised prior to his shot and unfortunately he died as a result of his injuries. Source: [from Fenner F., Henderson DA, et al. Smallpox and its Eradication. WHO. 1988]

28. Med Administration Video A 15:21 minute video will appear shortly Click next when you’re finished viewing the video.

29. Summary  See Skills review sheets

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