1. Administering Injections and Immunizations
Chapter 54
Administering Injections and Immunizations
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2. Parenteral Injectable Medication
Indications for parenteral routes
Patient is unable to tolerate medication by mouth
Other routes do not provide the desired effect quickly enough
Oral medications would be destroyed by the GI tract
Continuous delivery is required
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Injection Types
Medical assistants typically administer injections by the following routes:
Intradermal
Subcutaneous
Intramuscular
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IV Medications
Medical assistants are not permitted by provide direct IV injections or start an IV
It is important to be able to recognize a problem and report it to the provider immediately
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Needles
Parts of a Needle
Needle Gauges and Sizes
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Needles
Different needles used for various routes of administration
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Syringes
The parts of a syringe
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Syringes
Sizes of syringes
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9. Medication Containers
Ampules and vials
Cartridge units
Single-dose, prefilled disposable syringe and cartridge unit
Powdered medication to be reconstituted
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Needle Safety
Handling and disposing needles safely
Use needle safety devices
What to do in the event of a needlestick
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Preparing the Patient
Explain the procedure and ensure patient comfort
Special considerations for children
Ensure immunization forms are signed
Prepare the skin
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Angles of Injection
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13. Intradermal Injections
Needle size:
26G or 27G, ⅜ - ⅝ inch long
Angle of injection:
10-15 degrees
Medication amount given:
0.01 to 0.05 mL
Medications given:
Tuberculin skin tests, allergy testing
Common sites of injection:
Anterior forearm, mid-back areas
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14. Intradermal Injections
A small wheal should develop at the site of the injection
Record: speed of the reaction, size of the wheal
Observe the patient about 20 minutes (or longer) for any reaction
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15. Subcutaneous Injections
Needle size:
25G to 27G, ½ to ⅝ inch
Angle of injection:
45 degrees
Medication amount given:
Less than 2 mL
Medications given:
Insulins
Common sites of injection:
Upper outer part of the arm, abdominal area, or upper thigh
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16. Intramuscular Injections
Needle size:
18G to 23G, 1 to 3 inches
Angle of injection:
90 degrees
Medication amount given:
0.5 to 3.0 mL
Medications given:
Narcotic pain medications, loading dose of antibiotics
Common sites of injection:
Deltoid, gluteus medius, ventrogluteal, and vastus lateralis
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Z-Track IM Method
This technique prevents the medication from following the path of the needle and leaking out into the tissues
Used for injecting substances that may be irritating or cause discoloration of the subcutaneous tissues
Do not massage the injection site after administration
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18. Injections and Children
Considerations
Needle length: The size of the child’s arm or leg will help to decide the size of the underlying muscle, which determines the needle length appropriate for the muscle thickness.
Needle gauge: Determined by the viscosity of the medication.
Injection site: The vastus lateralis is the preferred injection site for infants and young children
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Immunizations
Natural immunity: After recovery from exposure to certain illnesses, antibodies are generated
Artificial immunity: Produced by administering immunizations or vaccines that trigger an immune response in the body, which in turn stimulates the production of antibodies
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Types of Vaccines
Live attenuated (changed) pathogens
Examples: varicella and measles
Pathogenic toxin
Examples: diphtheria and tetanus
Killed pathogen
Examples: pertussis (whooping cough), rabies, and poliomyelitis
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Vaccine Schedules
The CDC publishes annual immunization schedules for children and adults
The most current schedules can be downloaded from
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22. Preparing for Immunization
Every patient or parent of a minor patient must be made aware of the benefits and risks of all vaccines
A signed copy of the VIS is put in the patient’s permanent record
Authorization forms should be in order before immunizations are administered
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23. Illnesses Reduced by Immunization
Influenza
Pneumonia
Haemophilus influenza type B (Hib, HIB)
Measles, mumps, and rubella (MMR)
Diphtheria
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24. Illnesses Reduced by Immunization
Pertussis (whooping cough)
Rabies
Tetanus
Rotavirus
Varicella zoster (chicken pox)
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25. Illnesses Reduced by Immunization
Hepatitis A
Hepatitis B
Human papillomavirus (HPV)
Meningitis
Polio
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