Procedures

• Gloves
• Alcohol pads/cleaning sol
• Syringe 
• Needle 
• Dressing material/tape
• Med to be administered 
• Biohazard sharp container

• Standard: 
• Various sizes 3-5+ mL
• Measured in mL
• Contains some dead space
• May come prepackaged with needle

• Tuberculin: 
• Max of 1mL
• Divided into tenths
• e.g. 0.1mL, 0.2mL...

• Insulin:
• Divided into units 
• NO dead space

• Gauge  measures internal diameter of needle 
• The LARGER the gauge of the needle, the SMALLER the needle 
• THICK, CONCENTRATED meds need SMALLER Gauge (LARGE needle)

• Selection of needle gauge depends on type of injection:
• Intradermal: 25-26 G, 3/8"-5/8" long, short bevel tip
• SubQ: 23-25 G, 5/8"-1" long, short-medium bevel tip
• IM: 18-23 G, 1"-3" long, long bevel tip
• IV: 14-16 G, 1-3+" long, long bevel tip

Sheath device 

NEVER RECAP A NEEDLE with 2 HANDS -if you must recap (do NOT) use the "one-handed" recap technique

• Intradermal
• SubQ
• IM
• IV

• Skin testing -PPD test, allergy test
• Local anesthesia

• Equipment:
• Tuberculin syringe
• Needle: 25-26 G, 3/8"-5/8" long, short bevel tip
• Alcohol prep, Gauze
• +/- Bandaid 

• Tuberculin: 
• Max of 1mL
• Divided into tenthse.g. 0.1mL, 0.2mL...

• Common injection sites:
• Ventral forearm
• Dorsal upper arm 
• Scapula area 
• Upper chest 

• Procedure:
• Withdraw proper amount of medication
• Inform pt of procedure
• Select and clean site -"bull's eye" motion with alcohol prep, inside --> outside
• Apply gentle traction to stretch skin taut -pull skin wtih thumb
• Position syringe @ 15⁰ angle with needle bevel up
• Insert needle and gently lift, then inject slowly
• Form a "wheal"
• Withdraw needle, dispose in sharp container
• Gently wipe area
• Chart injection properly
• +/- Mark area of injection
• Pt. education/instructions

• Intradermal injection
• Apply gentle traction to stretch skin taut -pull skin wtih thumb
• Position syringe @ 15⁰ angle with needle bevel up
• Insert needle and gently lift, then inject slowly
• Form a "wheal"
• Withdraw needle, dispose in sharp container

• For highly soluble, potent meds -Insulin, Heparin, Epi, Antigens
• For meds that need slow, sustained release
• Limited drug doses (<1mL)
• Equipment: 
• Syringe: 1-3mL 
• Needle: 23-25 G, 5/8"-1" long, short-medium bevel tip
• Alcohol, Gauze
• +/- Bandaid

• Insulin:
• Divided into units
• NO dead space
• Common sites:
• Abdomen (good for self-injections, Insulin/fat)
• Upper back 
• Laterial thigh
• Posterior upper arm ("flabby" upper arm)

• Procedure:
• Withdraw proper amount of medication (MAX 1mL)
• Inform pt of procedure
• Select and clean appropriate site
• Pinch up 1" skin fold, lifting SQ tissue off of underlying mx
• Hold syringe like a pencil and inject @ 45⁰ angle into site 
• Release skin fold
• ASPIRATE before injecting SLOWLY 
• Withdraw needle and dispose in sharp container
• Cleanse site again if needed -blood 
• Apply dressing and bandage
• Document injection
• Monitor pt
• Pt education/instruction

SQ injection

• Pinch up 1" skin fold, lifting SQ tissue off of underlying mx
• Hold syringe like a pencil and inject @ 45⁰ angle into site Release skin fold
• ASPIRATE before injecting SLOWLY

• Rapid absorption of aqueous sol
• Prolonged absorption of oil-based sol
• Larger drug doses (3-5mL)
• Tetanus shot, PCN

• Equipment:
• Syringe: 3-5mL
• Needle: 18-23 G, 1"-3" long, long bevel tip
• Alcohol, Gauze
• Dressing/Bandage material

• Common sites:
• Posterior gluteal mx
• Ventral gluteal mx
• Deltoid mx
• Vastus lateralis mx
• Rectus femoris mx
• Dorsogluteal site: 
• Line from posterior illiac spine to greater trocanter 
• Go lateral and superior to this line --> Outer -Upper gluteal area 
• Most convenient for pt/preserves modesty (do NOT have to drop pants all the way)
• Deltoid site:
• 2-3 finger-breaths below the acromion process 
• Into the Deltoid mx (triangle)

• Procedure:
• Withdraw proper amount of medication (MAX 3mL)
• Inform pt of procedure
• Select and clean injection site
• Use NON-dominant hand to apply gentle traction to skin to "Z-track"
• Quickly insert needle at 90⁰ angle
• ASPIRATE prior to injecting medication
• Withdraw needle and release tension onskin, trapping medication in mx
• Apply pressure/bandage for any bleeding +/- massage site 
• Dispose of needle in sharp container
• Document injection
• Monitor pt
• Pt education

IM injection

• Use NON-dominant hand to apply gentle traction to skin to "Z-track"
• Quickly insert needle at 90⁰ angle
• ASPIRATE prior to injecting medication
• Withdraw needle and release tension onskin, trapping medication in mx

• Z-Track Method for IM injections
• Use to prevent backflow of medication into SQ tissue -traps medication in mx
• Displace skin to one side (laterally) before inserting needle
• Insert needle @ 90⁰ angle
• Aspirate
• Administer medication
• Withdraw needle BEFORE releasing skin 

• Needle: 14-16 G, 1-3+" long, long bevel tip 
• or 
• Buttlerfly

• Site:
• Vein in dorsal surface of hand

• Procedure:
• Tournique 6-8 inches higher to site
• Little traction to the skin
• Shallow approach to the vein 
• Flashback of blood into the needle = you are in the vein
• Move catheter forward
• Apply pressure proximal to puncture site before attaching the line
• Protect insertion site
• Sign with date and initials 

• Right patient -check pt's name (ask, read bracelet), ask about allergies
• Right medication -check medication and concentration
• Right dose -double check dose
• Right route -ensure proper route of adminitration (ID, SQ, IM, IV)
• Right time -speed of injection (rapid push, given over set time period)