Chapter 8

Calculating Injectable
Dosages
Medications given by injection are called parenteral
medications. Great care must be taken with injectable
medications to assure the correct dosage, method of
administration, and site for injection. Injected medications work
faster than non-parenteral (oral, topical, inhalation, etc) drugs;
therefore care and caution must be exercised to prevent
untoward effects.

7.1 Injection Routes

Medications given by injection may be given by these methods:
Intradermal (ID): given just under the skin; often used for skin
tests such as the Mantoux TB test. Short needles are used
for these injections and tiny amount of fluid are injected.
Subcutaneous (SubQ): given into the fatty, subcutaneous
layer of skin; usually given with a shorter needle (ex: 1/2
inch). Small amounts of fluid (ex: 1 ml or less) are injected
via this route.
Intramuscular (IM): given into the muscle; this is a deeper
injection and requires a longer needle, usually at least 1
inch long. As much as 3 ml can be injected into one site.
7.2. PACKAGING OF INJECTABLE MEDICATIONS 3
4

7.2 Packaging of Injectable Medications

Medications for injection are packaged in a variety of ways:
Vial: glass bottle with rubber top; may contain a single dose or
multiple doses. Medication in vials may be supplied as a
liquid or as a powder which will need to be mixed
(reconstituted) with the appropriate fluid. Medication is
removed from the vial by puncturing the rubber top with a
needle or plastic tip attached to a syringe and withdrawing
the medication into the syringe.
Ampule: glass bottle with pointed top and breakable neck
containing liquid medication. To remove medication, the
ampule is broken at the neck and a needle attached to a
syringe is used to withdraw medication into the syringe.
Pre-filled Cartridges: some medications are supplied in
cartridges which must be placed in a holder for injection.
Since the supplied dosage of pre-filled medication is often
different from the amount ordered, care must be taken to
expel the unneeded medication from the cartridge. Some
cartridges are designed so that medication can be
withdrawn from them, much like a vial.
Pre-filled Syringes: medication for injection may also come
packaged in a pre-filled syringe. Again, since the supplied
medication is often differ- ent from the ordered dose, care
must be taken to expel the unneeded medication before
injecting into the patient.

7.3 Types of Syringes

Syringes are available in a variety of sizes. Almost all syringes
used in health- care settings are plastic, intended for single use,
and disposable. Syringes may be packaged with a needle; or
they may be packaged without a needle and you will need to
choose an appropriate needle to attach.
Most healthcare settings also have ‘needleless’ systems in
which a plastic tip replaces the needle and can be use for
withdrawing medication from the containers. Needleless
systems reduce the risk of accidental needle sticks and the risk
of exposure to pathogens.
7.3. TYPES OF SYRINGES 3
5

Common syringes used in healthcare settings include:

Tuberculin (TB) syringe: a slender, 1 ml syringe used when
the amount of solution to be give is less than 1 ml. This
syringe is calibrated in tenths (0.1 ml) and hundredths
(0.01 ml).

Insulin syringe: a slender syringe designed to be used with

insulin admin- istration only. This syringe is calibrated in
units; insulin dosages are ordered in units. No other type of
syringe should be used for insulin administration.

3 ml syringe: a popular syringe for many types of medication

administra- tion. This syringe is calibrated in tenths (0.1
ml).

5 ml syringe: this syringe is usually used when fluid amounts

greater than 2 1/2 ml are to be given. This syringe is
calibrated in two-tenths (0.2 ml).
7.4. TYPES OF NEEDLES 3
6

7.4 Types of Needles

Just as syringes come in a variety of sizes, so do needles.
Needle size includes the length of the needle and the gauge
(diameter of the opening in the needle). Note: as the gauge of
the needle increases, the number of the gauge decreases.
Example: an 18 gauge needle has a large opening; a 25 gauge
needle has a smaller opening.
The choice of what needle to use depends on the type of
injection being given, the viscosity of the fluid, body size, and
type of medication. The following table notes examples of
needle size and length for 3 types of injec- tions.

Type of Needle Needle Length

Injection Gauge (inches)
Intradermal 25, 26 3/8, 1/2, 5/8
Subcutaneous 23, 25, 26 3/8, 1/2, 5/8
Intramuscular 18, 20, 21, 22 1, 1 1/2, 2
(adapted from Kee, J. and Marshall, S. (2004) Clinical Calculations St. Louis: Saunders)

7.5 Calculations for Injectables

Injectable dosages can be calculated using the same formulas
you used with oral dosages. Medications for injection will be
liquid, so your dosages will be expressed in milliliters (ml).
Example: You have an order for Demerol 35 mg IM every 4
hours prn for pain. The medication is supplied as Demerol 50
mg/ml in a pre-filled car- tridge. How many milliliters will you
give?

Basic Formula Method

First convert 0.5 Gm to mg by moving the decimal point 3
places to the right. (0.5 Gm = 500mg) Then
D
×V −→ 35 0.7
H × 1 ml =ml
mg
50
mg
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Ratio-Proportion Method
First convert 0.5 Gm to mg by moving the decimal point 3
places to the right. (0.5 Gm = 500mg) Then

Dose on
hand Quantity = Dose desired
X
on hand
50 35
1 = X tablets
−→ 50X = 35

−→ X = 0.7
ml

Dimensional Analysis Method

V C(H)
×
DH = amount to administer
×
C(D) 1

(Note: you may choose to omit the conversion part of the

formula since the supplied and desired units are both
milligrams)
1 ml 1 mg 35
× × =
0.7
50 1 mg 1 ml

7.6 Giving Insulin Injections

Some points to remember when preparing insulin for injection:

• Insulin is ordered in units.

• Always use an insulin syringe for administering insulin.

Insulin sy- ringes are calibrated in units, therefore no
calculation is necessary.

• Fill the syringe to the desired unit marking. Example: you

are to give 20 units of NPH insulin. You would draw up
enough medication to reach the 20 unit marking on the
insulin syringe.

• Insulin syringes are to be used for insulin administration ONLY.

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Mixing 2 insulins in 1 syringe

Frequently, you will be mixing two types of insulin (Regular and
NPH) in one syringe. By mixing the insulins in one syringe, the
patient avoids getting 2 injections. Some points to remember
about mixing insulins:

• Avoid contaminating one vial with the contents of the other.

• Regular Insulin is fast acting.

• NPH Insulin has a delayed onset of action because a

retardant has been added to the solution.

• Always draw up Regular insulin first. (If NPH Insulin is

drawn up first, traces of the retardant could enter the
Regular Insulin vial and delay the onset of action.)

• Add air to the NPH vial first, then add air to the Regular vial.

• Draw up the Regular Insulin, then add the NPH.

• Be very careful when withdrawing the NPH! You cannot

inject med- ication back into the vial or correct the NPH
dosage without altering the Regular dosage.
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