Procedure of injection

1. Wash your hands, explain the procedure to the patient and collect necessary equipment’s.
2. Identify your patient & select an area that is appropriate for the drug you administer. The site
should be non-tender, free of nodules or lumps and free of greater nerves and vessels.
3. And position the patient comfortably.
4. Withdraw medication from an ampoule or vial as desired.
5. If the skin is not clean don disposable glove & cleanse the area with water & soap, allow the
skin to dry. Dispose your gloves.
6. Wear clean gloves and open the medication. For ampoules use rug to cut the tip.
7. Remove the needle cap with the non-dominant hand by pulling it straight off. If dilution is
needed us another syringe with needle.
A. for intra dermal injection

7.1. Use the non-dominant hands thumb and four fingers to spread the skin taut over the
injection site.

7.2. Place the needle almost flat against the patient’s skin, bevel side up, & insert the needle
in to the skin so that the point of the needle can be seen through the skin. Insert the
needle only about 1/8″ with entire bevel under the skin.

7.3. Slowly inject the agent while watching for a small wheal or blister to appear. If none
appears, with draw the needle to ensure bevel is in intra dermal tissue.

7.4. Once the agent has been injected, withdraw the needle quickly at the same angle that it
was inserted. And dispose to proper receptacle without recapping.

7.5. Mark the edges of the blister if reaction is to be assessed.

7.6. Do not massage the area & tell patient not to rub.

7.7. Observe the area for the sign of a reaction at ordered intervals, usually at 10-15 minutes
or 24-74 hours as necessary. Inform patient this inspection
 B. For sub cutaneous injection

7.8. Grasp & bunch the area surrounding the injection site for average sized patients or
spread the skin at the site for obese patients.

7.9. Hold the syringe in the dominant hand between the thumb & for finger. Inject the needle
quickly at an angle of 45-90 degrees depending the amount & turgor of the tissue & the
length of the needle.

7.10. Aspirate three times & inject slowly if no blood comes. Do not aspirate for injecting
insulin or any form of heparin.

7.11. With draw the needle quickly at the same angle at which it was inserted.

7.12. Massage the area gently with cotton ball. Do not massage a subcutaneous heparin or
insulin injection site. Apply a small bandage if needed.

C. For intramuscular injection

7.13. Hold the syringe in your dominant hand between thumb and for finger. Encourage the
patient to relax the muscle of injection site. Bunch the site with your non-dominant
hand. And quickly dart the needle in to the tissue at a 90-degree angle.

7.14. Aspirate by slowly (for at least 5 seconds) pulling back in to the plunger to determine
whether the needle is in a blood vessel. If blood is aspirated, discard the needle,
syringe & medication, prepare anew sterile setup, & inject another site.

If no blood is aspirated, inject the solution slowly (10 seconds per ml of medication).

7.15 Remove needle slowly & steadily. Apply gentle pressure at the site with small dry
cotton.
7.16 Do not recap the needle & dispose to appropriate receptacles.
8. Assist patient to position of comfort. Encourage patient to exercise extremity used for
injection if possible.
9. Remove gloves & dispose them properly. Return materials and give them care.
10. Perform hand hygiene.
11. Chart the medication, including the site and any abnormal findings.
12. Evaluate patient’s response to medication with an appropriate time frame

intravenous injection Implementation

Equipments

- IV fluid - Tourniquet
- IV stand - Small mackintosh & draw sheet
- Cannula - Scissor
- IV set - Splint
- Plaster - Galipot
- Disposable glove - Waste receiver/kidney dish
- Alcohol 70 % swab or iodine 4 % - Safety box
- Sterile cotton balls
Procedure

1. Wash your hands, explain the procedure to the patient and collect necessary equipment’s.
2. Identify your patient, Cut adhesive stripes about 8 cm in length & attach on outside of
infusion set or on stand.
3. Assess the expiry date, appearance & no leak on the bag. Don’t use if it is turbid, cloudy
unclear or expiry date passed.
4. Squeeze the rubber cover of the bag with alcohol swab.
5. Pierce a hole on the squeezed part of bag with rigid plastic spike end of IV tube, invert &
hung the bug on the IV stand. Open the flow control & allow some fluid to drain out.
6. Make sure that the tube is free of air & hung it on IV stand to make ready for connection
with the cannula.
7. Position patient properly, select an area appropriate for use & put mackintosh & draw
sheet under the chosen site.
8. Don disposable glove & apply tourniquet above the selected site. If the patient is right
handed Endeavour to use the left arm, & vice versa. If there is an injured limb, use the
uninjured limb. Try to use a vein which is as distal as possible on the limb & avoid veins
over joints.
9. Tap the vein to encourage it to dilate.
10. Clean the skin over & around the vein with antiseptic solution or a medi- wipe, allow it to
dry.
11. Open the cannula pack. Check that the cannula is fully on the needle, and turn the needle
so the bevel is upwards.
12. Align the cannula with the vein & enter the vein through the skin with the cannula angled
at 10 to 15 degrees to the skin. Do this in a positive fashion, moving the needle forward
until the blood passes up the needle.
13. It is important to advance the needle slightly further in to the vein as the point alone may
have entered the vein at this time. Then slip the cannula off the needle until its total length
is within the vein.
14. Press on the vein just in front of the tip of cannula. This will stop further bleeding & the
tourniquet can now be released.
15. Again check the contents of the drip & that there is no air bubbles in the tubing of the
giving set. If all is well, attach the giving set to the cannula & turn on the giving set &
make sure that it is running well.
16. If the drip doesn’t run at this point, with draw the cannula slightly, as it may be impinging
on the wall of the vein. Check that there are no obstructions on the limb such as
tourniquet, which you may have forgotten to remove.
17. If the drip fails to run freely or the fluid is obviously running in to the tissues around the
cannula, then turn off the drip & with draw the cannula. Place pressure over the puncture
site & repeat the above procedure on a more proximally situated vein.
18. If the drip is running satisfactorily, clean & dry around the cannula & tape it down.
19. If the cannula is in the region of a joint, a padded splint will be required to immobilize the
joint. Ensure that you place a safety loop in the tubing of the giving set to reduce the
possibility of the cannula being pulled out.
20. Dispose waste materials, return equipment’s and give them care.
21. Wash your hands, record the procedure and patients’ reaction.