INJECTION
TECHNIQUES
DR. NANDINI
Various Injection Techniques
• INTRADERMAL (ID) INJECTION
• SUBCUTANEOUS (SC) INJECTION
• INTRAMUSCULAR (IM) INJECTION
• INTRAVENOUS (IV) INJECTION
• The size of needle depends on Gauge and length
• Smaller the gauge bigger the needle
• Colors also indicate different sizes
• Adult size is 20G(pink)
• Choose the length based on habitus of the patient
• Syringe size is based on the amount of drug to be given
Intradermal
• Needle used is short and fine
• Usually a 1 ml tuberculin syringe is used
• 4 finger width below cubital fossa
• Used for
• Allergy testing
• Drug sensitivity testing
Procedure
• Inform the Patient about what you will be doing
• Wash hands and maintain aseptic precautions
• Load the drug into a 1ml syringe with 25g-27g needle
• Length of the needle is ½-5/8 inch
• Tell the patient that they will feel a small pinch
• Insert the needle at a 5- 15 degree angle and inject the drug till u see a small wheel
• Mark the raised area with a marker
• Check the site for response after 30 minutes
Subcutaneous
injection
• Subcutaneous tissue lies between the epidermis and the muscle layer
• Amount is 0.5 to 2ml
• Length of the needle is 3/8-5/8 inch
• Needle is 25-27g
• Insulin syringe is 28-31g
• Used for slow sustained absorption of drugs like:
• Heparin
• Insulin
Complications
• Severe pain
• Swelling
• Allergy
• Localized abscess formation
• Lipodystrophy – insulin injections
Intramuscular injection
• Intramuscular injections deliver the drug directly into large well perfused muscle
• Has a relatively good systemic absorption : better than subcutaneous injection
• Large quantities of the drug and irritant drugs can be given
• Upper outer quadrant of gluteal region preferred in adults – minimize injury to lumbar
plexus
•Amount 1 to 2ml for deltoid and 5ml for dorsogluteal region
•Length of the needle is 1-1 ½ inches
•23g is common
• 2/3 rd needle is inserted
Contraindications
• Active infection, cellulitis, or dermatitis at the site of administration
• Known allergy or hypersensitivity to the drug
• Acute myocardial infarction- the release of muscle enzymes may provide a confounding bias in making
the diagnosis
• Thrombocytopenia
• Coagulation defects
• Hypovolemic shock- the absorption of the drug may be hampered owing to compromised vascularity to
the muscle
• Myopathies
• Associated muscular atrophy- leads to delayed drug absorption as well as adds up the risk of
neurovascular complications
Anatomical Landmarks
• There are specific landmarks to be taken into consideration while giving IM injections so as to avoid any
neurovascular complications. The specific landmarks for the most commonly used sites are discussed below
• Dorsogluteal Region
• 5 to 7.5 cm below the iliac crest.
• Upper outer quadrant of the upper outer quadrant within the buttocks
• Ventrogluteal Region
• The heel of the opposing hand is placed in the greater trochanter, the index finger in the anterior superior iliac spine,
and the middle finger below the iliac crest. The drug is injected into the triangle formed by the index, middle finger,
and the iliac crest
• Deltoid
• 2.5 to 5 cm below the acromion process
• Vastus Lateralis
• The middle third of the line joining the greater trochanter of the femur and the lateral femoral condyle of the knee
Z track injections
• Used for irritant medications or medications that can stain the skin like :
• Iron injections
• It is done to prevent the leak of medicine onto the skin surface by creating a “Z” track to close the line of
entry of the needle
• Procedure:
• Pull the skin away laterally from injection site by 1 to 1 ½ inch
• Enter the skin at 90 degrees angle like an IM injection
• Keep the needle in place for about 10 seconds before taking it out. After you’ve removed
the needle, release your hold on the skin and tissue. This disrupts the hole that the
needle left in the tissues and prevents the medication from leaking out of the muscle.
Complications
• Muscle fibrosis and contracture
• Abscess at the injection site
• Gangrene
• Nerve injury -the sciatic nerve in gluteal injection, the femoral nerve in vastus lateralis injection, the superior gluteal
nerve in dorsogluteal injection, the femoral nerve in vastus lateralis injection, radial nerve in deltoid injection
• Skin slough
• Periostitis
• Transmission of HIV, hepatitis virus
• Persistent pain at the site of injection
Intravenous injection
• To have a fast action of the medicine as in emergency
• To give medicines those are irritating or ineffective when given by other
routes
• To have the action of medicines on the blood stream or the blood vessels
• Ventral aspect of elbow or forearm median
cubical, basilica or cephalic veins
• Doral aspect of hand – branchial, cephalic or
metacarpal veins
• In the infants the scalp vein is used
Procedure
• Wash hands
• Select appropriate syringe and needle and check whether they are in good
working order
• Recheck the order, medicine card with the label of the medicine, expiry date, etc
• Mix well and take out the required amount of solution in the syringe
• Apply a tourniquet on the upper arm
• Ask the patient to clench and unclench the hand
• Pull the skin taut and place the needle in line with vein at a 15 to 45 degree
angle
• Insert the needle, a bit below the point where the needle will pierce the vein
• When the back flow of blood occurs into the syringe release the tourniquet and
injects the medicine very slowly
• Observe the area for bleeding if bleeding occurs apply
pressure but do not massage
• Give comfortable position to the patient
• Ask the patient to take rest at least 15 to 30 minutes so that
you can observe him for any reaction
• Observe the patient for any allergic reaction
Complications
Local Systemic
• Infiltration – pain redness • Embolism:
• Extravasation – swelling , cellulitis • Pulmonary embolism
• Thrombosis • Air embolism
• thrombophlebitis • Hematoma
• Systemic infection
• Excessive fluid
administration
• Anaphylaxis
Thank
you
