Injections ID SubQ IM

• Needle Length = 1/4 to 1/2 inch
• Needle Guage = 26 or 27
• (See Pg. 180)

• 10 to 15 degrees
• (see pg. 182)

• tuberculin syringe calibrated in tenths and hundredths of a milliliter
• (p. 179)

only about 1/8 inch with bevel side up, and entire bevel under skin (p. 182)

• longest absorption time of all parenteral routes
• (p. 179)

• usually less than 0.5 mL
• (pg. 179)

• Needle Length = 3/8 to 1 inch can be used, 3/8 to 5/8 inch needles are most commonly used. (p.184)
• Needle Guage = 25-30 (p. 184)

• 45 to 90 degrees
• Choose the needle length based on the amount of Subcutaneous tissue present, generally insert 3/8 inch needle at 90 degrees, and 5/8 inch needle at 45 degrees.
• (p. 184)

• 1. Outer aspect of upper arm.
• 2. Abdomen (below costal margin to iliac crest)
• 3. Anterior aspect of thigh.
• 4. Upper Back
• 5. Upper ventral gluteal area.
• (see. p. 184)

(Heparin is also administered subQ.  The most common site is the abdomen.  For heparin injections, avoid the area two inches around the umbilicus and the belt line.) p. 189

• Adipose tissue has few blood vessels, so drugs administered here have a slow, sustained rate of absorption into capillaries. The sites for subcutaneous injections listed in order from most rapid absorption to slowest absorption are abdomen, arms, thighs, upper ventral gluteal area.
• (p. 184)

Usually, no more than 1 mL of solution is given Subcutaneously. Giving larger amounts adds to discomfort, and may predispose to poor absorption (p. 185)

• Pinching is advised for thinner patients and when a longer needle is used, to lift the adipose tissue away from underlying muscle and tissue. If pinching is used, once the needle is inserted, release the skin to avoid injecting into compressed tissue.
• (p. 184)

• Needle Length:
• Vastus Lateralis = 5/8 to 1 inch.
• Deltoid = 1 to 1.5 inch.
• Ventrogluteal - 1.5 inch.
• Child Deltoid = 5/8 to 1.25 inch
• (p. 192)

• Guage:
• 20-25 for biologic agents and meds in aqueous solutions
• 18-25 for meds in oil-based solutions
• (p. 191)

Prependicular to patient's body. This insures an angle between 72 & 90 degrees. (p. 196)

• Ventrogluteal
• Vastus Lateralis
• Deltoid
• (p. 191)

• Faster than with SubQ injections due to larger blood vessels and greater number of blood vessels within the muscle.
• (190)

• 1-4 mL in general
• 1-2 mL in deltoid
• 1-2 mL in children and elderly
• (p. 193)

To locate the ventrogluteal site, place the palm of your hand over the greater trochanter, with your fingers facing the patient's head. (left hand for right hip or right hand for left hip) Place the index finger on the anterosuperior iliac spine and extend the middle finger dorsally, palpating the iliac crest. A triangle is formed, and the injection is given in the center of the triangle. (p. 752 - 753)

To locate the vastus lateralis site, divide the thigh into thirds horizontally and vertically, and administer the injection in the outer middle third. (This site is particularly desirable for infants and children.)

• Locate the deltoid muscle by palpating the lower edge of the acromion process. A triangle is formed at the midpoint in line with the axilla on the lateral aspect of the upper arm, with the base of the triangle at the acromion process.
• (p. 753)

• 1. Put on clean gloves.
• 2. Cleanse the site with an antimicrobial swab.
• 3. Remove the needle cap.
• 4. Perform the injection.

For an intradermal injection, slowly inject the agent while watching for a small wheal or blister to appear.  (p. 182)

For a subcutaneous injection, inject the medication slowly (at a rate of 10 sec/mL).  (p. 187)

For an intramuscular injection, inject the solutioin slowly (10 sec/mL).  Once the medication has been instilled, wait 10 seconds before withdrawing the needle.  (p. 196)

For an intradermal injection, do not massage the area, apply pressure, or rub the site after removing the needle.  If necessary, gently blot the site with a dry gauze square.  (p. 182)

For a subcutaneous injection, use a gauze square to apply gentle pressure to the site after the needle is withdrawn.  (p. 188)

For an intramuscular injection, apply gentle pressure at the site with a dry gauze.  Do not massage the site.  (p. 196)

Heparin injections are administered subcutaneously.  

The most common site is the abdomen.  When administering a heparin injection, avoid the area two inches around the umbilicus and the belt line.  (p. 189)

The Z-track technique can be used for intramuscular injections. 

• To perform the Z-track technique:
• 1. Move the skin to one side (about an inch).
• 2. Insert the needle at 90 degrees.  
• 3. Aspirate for blood, then inject at the appropriate rate.
• 4. Leave the needle in for an additional 10 seconds.
• 5. Withdraw the needle and then allow the displaced tissue to return to its normal position, preventing the solution from escaping from the muscle tissue.

For an intradermal injection, use the non-dominant hand to spread the skin taught over the injection site.

For a subcutaneous injection, grasp and bunch the area surrounding the injection site or spread the skin taut at the site.

For an intramuscular injection, displace the skin in a Z-track manner by pulling the skin down or to one side about 1 inch with your non-dominant hand.