1. Parenteral Administration
Equipment
Syringes
Syringe consists of a barrel, a plunger, and a tip.
Outside of the barrel is calibrated in milliliters, minims, insulin units, and heparin units.
Types
Tuberculin syringe
Insulin syringe
Three-milliliter syringe
Safety-Lok syringes
Disposable injection units

2. Figure 23-4 Parts of a syringe. Measurements located on the BARRELL
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Parts of a syringe.

3. Calibration of U100 insulin syringe.
Figure 23-6
Total syringe hold 1 ml, if full would have 100 units of insulin.
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Calibration of U100 insulin syringe.

4. Reading the calibrations of a 3-mL syringe.
Figure 23-7
Reading the calibrations of a 3-mL syringe.

5. Figure 23-9 Safety-Glide syringe.
Safety features designed to decrease needle sticks
Safety-Glide syringe.

6. Figure 23-11 Parts of a needle.
Some needles permanently attached, some removable.
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Parts of a needle.

7. Parenteral Administration
Equipment (continued)
Needles
Parts are the hub, shaft, and beveled tip.
Opening at the needle’s beveled tip is the lumen.
Size of the diameter of the inside of the needle’s shaft determines the gauge of the needle; the smaller the gauge, the larger is the diameter.
Needle gauge selection is based on the viscosity of the medication.
Needle gauges-which has a larger diameter a 20 gauge or a 25 gauge? Answer-a 20 gauge
Thicker meds need larger diameter needle, such as a 20, 18 or 16.

8. Parenteral Administration
Equipment (continued)
Needle Length
Selected based on the depth of the tissue into which the medication is to be injected
Intradermal: 3/8 to 5/8 inch
Subcutaneous: 5/8 to 1/2 inch
Intramuscular: 1 to 1 1/2 inch

9. Needle length and gauge.
Figure 23-12
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Needle length and gauge.

10. Intramuscular injections
Gauge-20-22
Length-1-1 ½ inches
Angle-90 degrees
Darting motion
ASPIRATE

11. Parenteral Administration
Intramuscular Injections
Involves inserting a needle into the muscle tissue to administer medication
Site Selection
Gluteal sites
Vastus lateralis muscle
Rectus femoris muscle
Deltoid muscle
Z-track Method
Used to inject medications that are irritating to the tissues
Deltoid-0.5 ml.
Adults other sites-maximum 2 ml.

12. Locating IM injection for ventrogluteal site.
Figure 23-15, C
Ventrogluteal site-pt needs to be in prone, supine or side lying position. Landmarks are-greater trochanter, anterior superior iliac spine and iliac crest.
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Locating IM injection for ventrogluteal site.

13. Figure 23-16, C & D
Dorso gluteal-tic tac toe board on one cheek.
(C, D, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Locating right dorsogluteal site. Giving IM injection in left dorsogluteal site.

14. Giving IM injection in vastus lateralis site on adult.
Figure 23-17, C
Always use vastus lateralis on infants.
Hands at side=where longest finger hits
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Giving IM injection in vastus lateralis site on adult.

15. Rectus femoris muscle. A, Child/infant. B, Adult.
Figure 23-18
Play patty cake. Where palms hit thigh.
(From Clayton, B.D., Stock, Y.N. [2004]. Basic pharmacology for nurses. [13th ed.]. St. Louis: Mosby.)
Rectus femoris muscle. A, Child/infant. B, Adult.

16. Giving IM injection in deltoid site.
Figure 23-19, C
Can only hold 0.5 ml.
(C, from Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Giving IM injection in deltoid site.

17. Figure 23-20
Example of Z track method. Used if irritating or staining.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

18. Intradermal Injections
Gauge-25-29
Length-1/4 to ½ inch
Amount- 0.1 ml
Angle-15 degrees
DO NOT ASPIRATE

19. ParenteralAdministration
Intradermal Injections
Introduction of a hypodermic needle into the dermis for the purpose of instilling a substance such as a serum, vaccine, or skin test agent
Not aspirated
Small volumes (0.1 ml) injected to form a small bubblelike wheal just under the skin
Used for allergy sensitivity tests, TB screening, and local anesthetics
A tuberculin syringe used with a 25-gauge, 3/8- to 5/8-inch needle
BEVEL UP!!!

20. Figure 23-21
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Angles of insertion for intramuscular (90°), subcutaneous (45°), and intradermal (15°).

21. Subcutaneous injections
Gauge-25-29
Length-3/8, ½ and 5/8 inches
Angle-45 degrees
DO NOT ASPIRATE

22. Parenteral Administration
Subcutaneous Injections
Injections made into the loose connective tissue between the dermis and the muscle layer
Drug absorption slower than with IM injections
Given at a 45-degree angle if the patient is thin or at a 90-degree angle if the patient has ample subcutaneous tissue
Usual needle length is 1/2 to 5/8 inch and 25 gauge
Used to administer insulin and heparin

23. Figure 23-22
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Subcutaneous injection. Angle and needle length depend on the thickness of skinfold.

24. Nursing Process Nursing Diagnoses Anxiety Health-seeking behaviors
Injury, risk for
Knowledge deficient
Mobility, impaired
Noncompliance: drug regimen
Sensory/perception, disturbed
Assessment- had a shot before? Muscle mass, weight, hydration status. Mobility issues for getting to site. Allergies and reaction/