COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

N205 RLE: Care of the Mother and Child at Risk or

with Health Problems (Acute and Chronic)

PARENTERAL ADMINISTRATION

https://images.app.goo.gl/A5S1WXTUFHUYygjT8

Prepared by:

RIZA MAE T. ABELLANOSA, RN, MSN

CARYL O. VILLALON, RN, MAN

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NORSU VISION-MISSION, GOALS, CORE VALUES

VISION : A dynamic, competitive, and globally responsive state university.

MISSION: The university shall provide excellent instruction, relevant and responsive research
and extension services, and quality-assured production through competent and
highly motivated human capital.

GOALS

Negros Oriental State University strives to achieve:

N- national development through effective partnership

O- opportunity-laden educational access to poor but deserving students

R- research-based and competency-driven instruction

S- scholarship and innovation

U- unity in diversity of cultures

CORE VALUES

S - spirituality

A - accountability

P - professionalism

P - patriotism

H - harmony

I - integrity

R - respect

E – excellence
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

N205: Care of the Mother and Child at Risk or with Health

Problems (Acute and Chronic)
INTRODUCTION
Administration of medication by the parenteral route or injection exposes the body to two foreign
objects: the hypodermic needle and the medication being injected. Parenteral administration requires
sterile technique, proficiency, and precautions, and therefore, specialized training. Skills presented in this
module cover the intradermal, subcutaneous and intramuscular routes. Skillful preparation, accuracy in
selection of the injection site, and precision in administration influence the effectiveness of the
medication. Faulty technique and misdirected injection can hamper the medication’s effectiveness and
may cause permanent injury to the client. Parenterally administered medications enter the bloodstream
readily, have a more rapid onset of action when compared to the oral route, and have a potential for
serious local or systemic complications (Smith, et. al., 2002).

The intradermal site is used to determine a client’s immune response to a small quantity of
injected antigen. Subcutaneous injections are administered into fatty tissue where there are few blood
vessels, slowing absorption. The abdominal site offers the quickest absorption, followed by the arm, then
the leg. Exercising an extremity will increase the rate of drug absorption. Since muscles are vascular,
intramuscular injection are absorbed more rapidly. Intravenous medications are injected directly into the
circulation, bypassing all the barriers to absorption; therefore effects are immediate (Smith, et. al., 2002).

COURSE LEARNING OUTCOMES (N205)

At the end of one week of varied teaching-learning activities, the learners shall acquire
knowledge, develop the necessary skills and manifest the right attitude in the care of the mother
and child at risk or with health problems (acute and chronic) in the healthcare setting.

CONTENTS OF THE MODULE

This module contains activities which enhances student learning to prepare nursing
students in the care of a client from pregnancy to childbirth. It includes wardclass activities which
would help students acquire knowledge on concepts related to antepartum, intrapartum,
postpartum, and nursery care.

DIRECTIONS ON HOW TO USE THE MODULE PROPERLY

In order to benefit profoundly from this module, please be guided by all the key points
presented below.
1. This module contain lessons related to antepartum, intrapartum, postpartum, and nursery
care at risk or with health problems.
2. Study the concepts presented and recall what you have learned in you previous subjects.
3. You must comply with the Learning Activities/Exercises after every lesson. This will help
develop your critical-thinking skills in order for you to prepare an appropriate plan of care
for a specific client.
4. To facilitate further learning, youtube video links are provided for certain topics. Please take
time to watch it.
5. Deadline of submission for each activity/requirement is indicated in each activity.
6. If you have any questions or clarifications, you may reach your rotation clinical instructor by
N205-A facebook messenger.
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Parenteral Administration
SPECIFIC LEARNING OUTCOMES

At the end of discussion, the student nurses will be able to:

 Differentiate among different types and routes of parenteral medications.

 Identify the 12 rights of medication administration and apply them in clinical
settings.
 Implement nursing actions to prevent medication errors.
 Describe factors to consider when choosing routes of medication
administration.
 Discuss factors to include in assessing a patient's needs for and response to
medication therapy.
 Discuss nursing roles and responsibilities in medication administration.
 Correctly and safely prepare and administer parenteral medications.
 Manifest desirable attitude in providing quality care to a client.

OVERVIEW

Syringes and needles are available in a variety of sizes; appropriate equipment is selected
depending on client factors, medication type, and the desired site of administration. Procedure for some
medications (e.g., heparin, insulin) dictates that the nurse select a specific syringe (0.5 to 1 ml capacity).
Some medications are prepared in prefilled cartridges that require the use of a special cartridge syringe
for administration (Smith, et. al., 2002).

Needles vary in diameter (gauge). The larger the number, the smaller the gauge. Smaller-gauge
needles are used for intradermal and subcutaneous injection of aqueous solutions, while larger gauges
are used for more viscous medications. Needle lengths vary as well; longer ones are used for deep
penetration to inject medication into muscle (Smith, et. al., 2002). Nurses must be mindful of potential
danger to themselves when handling and disposing of biohazardous parenteral equipment. They should
have a puncture-proof container for sharps with proper label. They should also urge their employers to
provide the safest possible equipment available such as the use of needleless syringes or retractable
needles and devices that automatically cover the tip of needles to prevent needle stick injuries.
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DISCUSSION
Principles of Surgical Asepsis

1. A sterile object remains sterile only when touched by another sterile object.
2. Only sterile objects may be placed in a sterile field.
3. A sterile object or field out of range of vision or an object held below a person’s waist is
contaminated.
4. A sterile object or field becomes contaminated by prolonged exposure to air.
5. When a sterile surface comes in contact with a wet, contaminated surface, the sterile
object or surface becomes contaminated by capillary action.
6. Fluid flows in the direction of gravity.
7. The edges of a sterile field or container are considered contaminated.
8. The skin can’t be sterilized and is unsterile.
9. Conscientiousness, alertness and honesty are essential qualities in maintaining Surgical
Asepsis.

Equipment

I. Syringe
 Discovered by Charles Gabriel Pravaz and Alexander Wood (1853)
 1670 – the use of IV injection and infusion began

Characteristics of a Syringe

1. Most health care institutions use disposable single-use plastic syringes that are
inexpensive and easy to manipulate.
2. The syringes are packed separately with or without a sterile needle in a paper wrapper
or rigid plastic.
3. Syringes come in a number of sizes, from 0.5 to 60 ml.
4. It is unusual to use a syringe larger than 5 ml for a subcutaneous or intramuscular
injection. A 2-3 ml syringe is adequate.
5. Larger syringes are used to prepare IV or intravenous drugs.

Parts of a Syringe:

https://images.app.goo.gl/Y8mbXE9Xuv4aPmak6

Fig. 1 Parts of a Syringe

 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

Common Types of Syringes:

1. Hypodermic Syringe
 Comes in 2.5 or 3 ml and often packaged with a needle attached
 Needles may be changed
 Has 2 scales on the barrel. One scale is divided into minims and the other into
tenths of an ml.
2. Tuberculin Syringe
 Designed to administer tuberculin
 Tuberculin skin testing is a method of screening for exposure to TB infection
 Has long, thin pre-attached needle.
 Calibrated in 16th of a minim and a hundredths of ml and has a capacity of 1 ml.
 Used to prepare small amounts of potent (strong, powerful) drugs
 Useful in preparing small precise doses for infants and children
3. Insulin Syringe
 Designed for insulin medication (insulin – a hormone produced in the islets of
Langerhans of the pancreas)
 Holds medications from 0.5-1 ml and is calibrated into units
4. Other Syringes
 5 ml, 10 ml, 20 ml and 60 ml
 Not used to administer drugs directly but can be useful for adding medications to
IV solutions or irrigating wounds

Classification: Tip of Syringe

1. Luer-lok
 Have tips that require needles that can be twisted and locked into place
 This design prevents the needle from accidentally sipping off the syringe
2. Non-Luerlok
 Have tips that require needles that can be pressed on to the tip of the syringe
without being twisted into place.

Aseptic Syringe Reminders

1. The tip and inside of the barrel should remain sterile.

2. The shaft of the plunger should remain sterile.

Characteristics of Hypodermic Needles

1. Needles come packaged in individual sheaths to allow flexibility in choosing the right
needle.
2. Some needles are pre-attached with standard-sized syringes.
3. Most are made of stainless steel and are disposable.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

Parts of a Needle

1. Hub – fits into the tip of a syringe

2. Shaft – connects to the hub
3. Bevel – slanted up
– 3 characteristics:
 Slant/length of the bevel
 Length of the shaft Fig. 2 Parts of a Needle

 Gauge of the shaft https://images.app.goo.gl/tNMbVMAWHd97KyUF7

Pre-filled Syringes

 Disposable, single dose.

 RN must carefully check the medication and concentration because all pre-filled syringes
are similar (e.g. Tubex Carpuject Clexane, Erythropoietin).
 RN slips the cartridge into the mechanism, secures it and checks for air bubbles in the
syringe.
 The RN advances the plunger to expel the medication as in a regular syringe.
 These systems are designed to decrease the chance or accidental needle sticks.
 Pre-filled syringes

Safety Syringes

 Passive Safety Device

 The needle retracts immediately into the barrel after use (automatic)
 Protects HW for injury/needle sticks
 Active Safety Device
 RN manipulates the safety device
 Needle-less System
 Bioejector 2000 uses no needle to deliver IM and SQ injections. It uses a
compressed CO2 cartridge to propel medication through the skin into muscle or
adipose tissue.
 Disadvantage: increased cost
 No HW should rely on technology for protection, though.

Preparing an Injection

II. Vial

Parts of a VIAL:

 Metal or Plastic Cap

 Protects the rubber seal until it is ready for use
 Rubber seal
 It is where your pierce the needle
 Characteristics of a Vial
1. A single dose or multi-dose glass medicine container.
2. Vials contain liquid (i.e. Hydrocortisone, Amikin) and/or dry forms (i.e. Ampicillin,
Cefuroxime) of medication.
3. Drugs that are unstable in solution are packaged dry.
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4. The vial label specifies the solution (solvent) used to dissolve the drug and the amount
of needle to prepare a desired drug concentration.
5. Unlike an ampule, a vial is a Closed System.
6. Failure to inject air before withdrawing the solution from a newly opened vial leaves a
vacuum within the vial that makes withdrawal difficult.

Reconstitution

 The technique of adding a diluent or solvent to a powdered drug.

 Steps:
1. Normal saline and sterile distilled water are solutions commonly used to dissolve drugs.
2. To prepare a powdered drug, the nurse draws up the amount of solvent recommended
on the vial’s label.
3. The nurse injects the solvent into the vial in the same manner as when injecting air into
the vial.
4. Most powdered drug dissolve easily, but it may be necessary to withdraw the needle to
mix the contents thoroughly.
5. Gentle shaking or rolling of the vial between the hands will dissolve the powdered drug.
6. The needle is reinserted to draw up the dissolved medication.
7. After mixing multi-dose vials, the nurse makes a label that include the date of mixing
and concentration of drug per ml.
8. Multi-dose vials may require refrigeration.

III. Ampule
a. Contains single medication in liquid form
b. Available sizes: 1-10 ml
c. Made a glass with a constricted neck that must be snapped off to allow access to the
medication.
d. A colored ring around the neck indicated where the ampule is pre-scored to break
easily.
e. Use of filter needle during aspiration may be considered.

Mixing Medications from 2 Vials

Principles:

1. Do not contaminate one medication with one another.

2. Ensure that the final dosage is accurate.
3. Maintain aseptic technique.
4. One syringe is needed to mix medications.
5. The nurse takes a syringe and aspirates the volume of air equivalent to the first drug’s
dosage.
6. The nurse injects air into vial A, making sure that the needle does not touch the
solution.
7. The nurse withdraws the needle, aspirates air equivalent to the second drug dose (vial
B) and then injects the volume of air into vial B.
8. The nurse immediately withdraws the required medication from vial B into the syringe.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

9. The nurse applies a new sterile needle to the syringe and inserts it into the vial A being
careful not to push the plunger and expel the drug within the syringe into the vial.
10. If a vial has excess positive pressure, this can cause an accidental withdrawal of too
much of the drug.

Mixing Medications from 1 Vial and 1 Ampule

1. Unnecessary to add air to withdraw the medication from an ampule.
2. The nurse prepares medication from the vial first uses the same syringe and needle,
withdraws medication from the ampule.

 This technique prevents contamination of solution from the needle.

Mixing Medications from 2 Ampules

1. Make sure all the fluid is in the bottom of the first ampule.
2. With dry 2”x 2” gauze pad, snap the neck of the ampule away from you. Repeat this
process for the second ampule.
3. Use a filter needle to draw up the required amount of both drugs.
4. Change to a regular needle to give the injection.

 i.e. Demerol and Atropine

Preventing Infection during Injection

1. To prevent contamination, draw medication from ampule quickly. Do not allow it to

stand open.
2. Avoid letting the needle touch any contaminated surfaces.
3. Avoid touching length of plunger and inner part of barrel. Keep tip of syringe covered
with cap or needle.
4. To prepare skin, wash skin with soap and water then dry. Use friction and a circular
motion while cleaning with an antiseptic swab.
5. Swab from center to inside and move outward in a 2-inch radius.

Ethyl Alcohol: Topical Antiseptic

Povidone Iodine: Antiseptic Microbicide

Administration of Injections
 Each injection route is unique with regards to the type of tissue into which the medication is
injected.
 The characteristics of the tissues influence the rate of drug absorption and the onset of drug
action.
 Before injecting the drug, the nurse should know the following:
1. The volume of drug to administer
2. Characteristic and viscosity of the drug
3. Location and anatomical structures underlying injection sites
4. Rate of absorption (e.g. muscles contain more blood vessels)
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The Nurse can attempt to minimize discomfort by observing these ways:

1. Use a sharp beveled needle in the smallest suitable length and usage.
2. Position the client comfortably as possible to reduce muscular tension.
3. Select the proper injection site, using anatomical landmarks.
4. Apply ice to the injection site to create local anesthesia before needle insertion.
5. Divert the client’s attention from injection through a conversation.
6. Insert the needle smoothly and quickly to minimize tissue pulling.
7. Hold the syringe steadily while the needle remains in the tissue.
8. Massage the injected area for several seconds unless contraindicated.

Fig. 3 Types of Parenteral Routes of Administration

https://images.app.goo.gl/LAd9BxpR3qo2HNy79

Intradermal Route

 Injection of a small amount of liquid (0.5 ml or less) into the outer layer of the client’s
skin.
 Usually for skin testing, e.g. TB testing, allergy testing, vaccines, anesthetics (These
medications are potent, thus they are injected into the dermis, where blood supply is
reduced and drug absorption occurs slowly).
 Anaphylactic reaction may occur if the medication enters the circulation rapidly.
 Skin testing is performed for clients with history of numerous allergies.
 The nurse should see the injection sites for changes in color and integrity.
 The nurse uses a tuberculin syringe with a 25G to 27G, ¼ to 5/8 inches needle.
 Angle of insertion is 10-15 degrees.
 A small bleb resembling a mosquito bite should appear on the skin’s surface.
 If a bleb does not appear or if the site bleeds after needle withdrawal, you’ve probably
injected the medication too deeply.

https://images.app.goo.gl/mP5ta97D3p8ya32C7

Fig. 4 Skin wheal caused by intradermal injection.

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 Give another dose at least 2 inches (5cm) away from the first site.
 The sites are:
a. the inner lower arm
b. upper chest and back
c. beneath the scapula

https://images.app.goo.gl/yxzdGphFL66EESXd9

Fig. 5 Injection sites for intradermal route.

Subcutaneous Route
 Involves injecting a small amount of liquid drug usually 0.5 to 2 ml into the
subcutaneous tissue.
 Drug is absorbed slowly into the nearby capillaries.
 A dose of concentrated drug can have a longer duration of action compared to other
injection routes.
 Absorbed completely if circulatory status is normal.
 The client may experience some discomfort because of some pain receptors.
 You may be required to give a drug SQ, such as: heparin, insulin, ovulation-stimulating
drugs and fertility drugs.
 A 25G to 27G, 3/8 to 5/8 or ½ inches needle, inserted at a 45 degree angle deposits its
medication into the SQ tissue of a normal-size client.
 A child may require a ½ inch needle.
 If a client is obese, the nurse pinches the tissue and uses a needle long enough to insert
through fatty tissue and the base of the skin fold.
 Preferred needle length is half of the skin fold.
 With this method, the angle of insertion may be 45 and 90 degrees.
 SQ injection is contraindicated in areas that are:
1. Inflamed
2. Edematous
3. Scarred or covered by a mole, birthmark, or other lesions
4. Clients with impaired coagulation
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https://images.app.goo.gl/oM71jz5U95ye28kc6

Fig. 6 Subcutaneous Injection

 Injection Sites:
1. lateral upper arms
2. upper back
3. fat pads of the abdomen
4. upper hips
5. anterior aspect of the thighs
6. scapular areas of the upper back

https://images.app.goo.gl/ATT5UkLwsuoqq6hW8

Fig. 7 Subcutaneous Injection Sites

Insulin and Heparin Injections

 Do not aspirate for blood

Unnecessary with insulin and may cause hematoma with heparin (anticoagulant, breaks
blood clot).
 Do not massage.
 Gently invert and roll insulin vial and mix the drug. Do not shake. Bubbles created could
get into the syringe or reduce the dose given.
 Position needle with bevel up.
 When injecting heparin, leave needle in place for 10 seconds then withdraw.
 Check for bleeding. If it continues, apply pressure. If bruise develops, apply ice.
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Intramuscular Route

 IM injection deposits drugs deep into muscle tissue that is richly supplied with blood.
 The injected drug moves rapidly into the systemic circulation.
 Other advantages include bypassing damaging digestive enzymes: relatively little pain
(because muscle tissue contains few sensory nerves).
 The danger of inadvertently injecting drugs directing into the blood vessels.
 Delivery of a relatively large volume of drug (usual dose is 3ml or less, but you may give
up to 5 ml into a large muscle).
 Smaller muscles can tolerate only smaller amounts of medication without severe muscle
discomfort.
 Children, older adults and thin clients tolerate less than 2 ml of medication.
 It is recommended that older infants and small children should only be given no more
than 1 ml.
 The nurse uses a 3-5 ml syringe and 19-25G needle about 1-3 inches.
 Weight influences selection of needle size.
 Angle of insertion:90 degrees
 Integrity of muscle: free from tenderness.
 Ask the client to relax, then palpate the muscle to rule out the presence of hardened
lesions.
 A muscle feels soft when relaxed and firm when tense.
 Help the client assume a position that help reduce the strain on the muscle
SITES:

1. Ventrogluteal Site
 The area contains no large nerves, or blood vessels and less fat. It is farther from
the rectal area, so it less contaminated.
 Position the client in prone or side-lying.
 When in prone position, curl the toes inward.
 When side-lying position, flex the knee and hip. These ensure relaxation of
gluteus muscles and minimize discomfort during injection.
 To locate the site, place the heel of the hand over the greater trochanter, point
the index finger toward the anterior superior iliac spine, and then abduct the
middle (third) finger. The triangle formed by the index finger, the third finger
and the crest of the ilium is the site.

https://images.app.goo.gl/yFHTCm86jGuq5Pzi6

Fig. 8 Ventrogluteal Injection Site

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2. Dorsogluteal site
 Position the client similar to the ventrogluteal site.
 The site should not be used in infant under 3 years because the gluteal muscles
are not well developed yet.
 To locate the site, the nurse draw an imaginary line from the greater trochanter
to the posterior superior to this line.
 Another method of locating this site is to imaginary divide the buttocks into four
quadrants, the upper most quadrant is the site of injection. Palpate the crest of
the ilium to ensure that the site is high enough.
 Avoid hitting the sciatic nerve, major blood vessel or bone by locating the site
properly.

https://images.app.goo.gl/eSiuRzyuUBNcdAjM9

Fig. 9 Dorsogluteal Injection Site

3. Vastus Lateralis
 Recommended site of injection for infants.
 Located at the middle third of the anterior lateral aspect of the thigh.
 Assume back lying or sitting position.

https://images.app.goo.gl/Li8XtreQRhRATdjT8
https://images.app.goo.gl/9Y4YjSZgu1eXyLD79

Fig. 10 Vastus Lateralis Injection Site

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4. Rectus femoris site-located at the middle third, anterior aspect of thigh.

https://images.app.goo.gl/d9JKH1ps9v7CzZce6

Fig. 11 Rectus Femoris Site

5. Deltoid site
 Not used often for IM injection because it is relatively small muscle and is very close
to the radial nerve and radial artery.
 To locate the site, palpate the lower edge of the acromion process and the midpoint
on the lateral aspect of the arm that is in line with the axilla.
 This is approximately 5 cm (2in) or 2 to 3 fingerbreadths below the acromion
process.

https://images.app.goo.gl/nNZjwccruA8SEDLp7

Fig. 12 Deltoid Injection Site

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Z-Track Method

 When irritating preparation (e.g. Iron) are given intramuscularly, the Z-track Method is
used.
 Minimizes tissue irritation by sealing the drug within the muscle tissues.
 The nurse selects an IM site, preferably in large, deeper muscles such as the ventrogluteal
muscle.
 A new needle must be applied to the syringe after preparing the drug so that no solution
remains on the outside needle shaft.
 Used for parenteral iron preparation: To seal the drug deep in to the muscles and prevent
permanent staining of the skin.
a. Retract the skin laterally, inject the medication slowly.
b. Hold retraction of skin until the needle is withdrawn.
c. Do not massage the site of injection to prevent leakage into the subcutaneous.

https://images.app.goo.gl/nNZjwccruA8SEDLp7

Fig. 13. Z-Track Method

Air Lock Technique

 Done by injecting a small volume of air behind a bolus of medication.

 The air clears the needle with medication, preventing trickling of the drug through SQ
tissues, e.g. INFERON (Wyeth’s vaccines prepared with aluminum adjuvant), Diphtheria
and Tetanus Toxoid Vaccine and Pertussis (Whooping cough) vaccine.
 After preparing the proper dose, the nurse draws up to 0.2 ml of air. The needle is injected
downward at a 90-degree angle so that the air rises to the top.
 As the nurse administers the drug with the needle at an angle less than 90 degrees, the
air collects along the barrel of the syringe and enters the muscle too soon.

https://images.app.goo.gl/nNZjwccruA8SEDLp7

Fig. 14. Air Lock Technique

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Safety in Administering Medications by Injection

 It is estimated that health workers incur over 1 million needle-stick injuries annually.
 When the nurse sticks oneself with a needle that has entered the tissue of the clients the
nurse is at risk for at least 20 potential pathogens.
 The most problematic pathogens are the HEPATITIS b Virus (HBV) and the Human
Immunodeficiency virus (HIV).
 Needles and other sharp instruments are always disposed-off into clearly marked
appropriate containers.
 Containers should be puncture and leak-proof. A needle should never be forced by anyone
into full-needle disposable receptacle.
 Used needles and syringes are never paced in any wastebaskets, in the nurse’s pockets, a
client’s meal try, or at the client’s bedside.

Miller (1994) reports that you are likely to receive needle-stick injury in one of the following ways:

1. Yu miss the needle as you are likely to recap it and stick your opposite hand.
2. You recap the needle and the needle pierces the cap
3. The cap falls off a recapped needle.
4. You injure yourself as you are getting debris for disposal that contains a sharp instrument,
5. You attempt to dispose too many sharps at one time.
6. You are stuck by a protruding sharp instrument from an overfilled sharp’s disposal
container as you are disposing a sharp instrument.
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PREPARING INJECTIONS
STEPS
PREPARING INJECTIONS
1. Review order, including name and
medication name, dose, route of
administration, and time of administration.
2. Review pertinent information related to
medication, including action, purpose, side
effects, and nursing implications.
3. Check date of expiration for medication vial
or ampule.
4. Assess client’s body fluid, muscle size, and
weight.
RATIONALE
Ensures correct administration of medication.
Allows nurse to administer medication properly
and to monitor client’s response.
Medication potency may increase or decrease
when outdated.
Determines type and size of syringe and
needles for injection.

5. Wash hands. Reduces transmission of microorganisms.

6. Prepare medication.
A. Ampule preparation.
a. Tap top of ampule lightly and quickly with Dislodges any fluid that collects above neck of
finger until fluid moves from neck of ampule. All solution moves into lower chamber.
ampule.

b. Place small gauze pad around neck of Placing pad around neck of ampule protects
ampule. nurse’s fingers from trauma as glass tip is
broken off.
c. Snap neck of ampule quickly and firmly Protects nurse’s fingers and face from
away from hands. shattering glass.

d. Draw up medication quickly. System is open to airborne contaminants.

e. Hold ampule upside down, or set it on a Broken rim of ampule is considered

flat surface. Insert syringe into center of contaminated. When ampule is inverted,
ampule opening. Do not allow needle tip solution does dribble out if needle tip or shaft
or shaft to touch rim of ampule. touches rim of ampule.

f. Aspirate medication into syringe by Withdrawal of plunger creates negative

gently pulling back n plunger. pressure with syringe barrel, which pulls fluid
into syringe.

g. Keep needle tip under surface of liquid. Prevents aspiration of air bubbles.
Tip ampule to bring all fluid within reach
of the needle.

h. If air bubbles are aspirated, do not expel Air pressure may force fluid out of ampule and
air into ampule. medication will be lost.

i. To expel excess air bubbles, remove
needle from ampule. Hold syringe with
needle pointing up. Tap side of syringe to
cause bubbles to rise toward needle.
Draw back slightly on plunger, and then
push plunger upward to eject air. Do not
eject fluid.
Withdrawing plunger too far will remove it from
barrel. Holding syringe vertically allows fluid to
settle in bottom of barrel. Pulling back on
plunger allows fluid within needle to enter
barrel so that fluid is not expelled. Air at top of
barrel and within needle is then is expelled.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

j. If syringe contains excess fluid, use sink
for disposal. Hold syringe vertically with
needle tip up and slanted slightly toward
sink. Slowly eject excess fluid into sink.
Recheck fluid into sink. Recheck fluid
level in syringe by holding it vertically.
Medication is safely dispersed into sink.
Position of needle allows medication to be
expelled without flowing down needle shaft.
Rechecking fluid level ensures proper dose.

k. Cover needle with its safety sheath or Prevents contamination of needle. New needle
cap. Change needle or syringe if you prevents tracking medication through skin and
suspect medication is on needle shaft. SQ tissues.

B. Vial containing a solution

a. Remove cap covering top of unused vial
to expose sterile rubber seal, keeping
rubber seal sterile. If a multidose vial that
has been used before is being used again,
firmly and briskly wipe the surface of
rubber seal with alcohol swab and allow
it to dry.
Vial comes packaged with cap to prevent
contamination of rubber seal. Cap cannot be
replaced after seal removal. Allowing alcohol to
dry prevents the needle from being coated with
alcohol and mixing with medication.

b. Pick up syringe and remove needle cap. Air must first be injected into vial to prevent
Pull back on plunger to draw amount of building up of negative pressure in vial while
air into syringe equivalent to volume of while aspirating medication.
medication to be aspirated from vial.

c. With vial on flat surface, insert tip of Center of seal is thinner and easier to
needle with beveled tip entering first penetrate. Injecting beveled tip first and using
through center of rubber seal. Apply firm pressure prevent coring of rubber seal,
pressure to tip of needle during insertion. which would enter vial or needle.

d. Inject air into the vial’s airspace, holding Air must be injected before aspirating fluid
on to plunger. Hold plunger with firm injecting into vial’s airspace prevents formation
pressure; plunger maybe forced of bubbles and inaccuracy in dose.
backward by air pressure within the vial.

e. Invert vial while keeping firm hold on Inverting vial allows fluid to settle in lower half
syringe ad plunger. Hold vial between of container. Position of hands prevents
thumb and middle fingers of forceful movement of plunger and permits easy
nondominant hand. Grasp end of syringe manipulation of syringe.
barrel and plunger with thumb and
forefinger of dominant hand to
counteract pressure in vial.

f. Keep tip of needle below fluid level. Prevents aspiration of air.

g. Allow air pressure from the vial to fill Positive pressure within vial forces fluid into
syringe gradually with medication. If syringe (unless vial has been used several
necessary, pull back slightly on plunger to times)
obtain correct amount of solution.

h. When desired amount has been Forcefully striking barrel while needle is
obtained, position needle into vial’s inserted in vial may bend needle.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

airspace; tap side of syringe barrel Accumulation of air, displaces medication and
carefully to dislodge any air bubbles. causes dose errors.
Effect any air remaining at top of syringe
into vial.

i. Remove needle from vial by pulling back Pulling plunger rather than barrel causes
on barrel of syringe. plunger to separate from barrel, resulting in
loss of medication.

j. Hold syringe at eye level, at 90-degree
angle, to ensure correct volume and
absence of air bubbles. Remove any
remaining air by tapping barrel to
dislodge any air bubbles. Draw back
slightly on plunger; then push plunger
upward to eject air. Do not eject fluid.
Holding syringe vertically allows fluid to settle
in bottom of barrel. Pulling back on plunger
allows fluid within needle to enter barrel so
fluid is not expelled. Air at top of barrel and
within needle is then expelled.

k. If medication is to be injected into client’s Inserting needle through a rubber stopper may
tissue, change needle into appropriate dull beveled tip. New needle is sharper.
gauge and length according to route Because no fluid is along shaft, needle will not
medication. track medication through tissues.

l. For multidose vial, make label that Ensures that future doses will be prepared
includes date of mixing, concentration of correctly. Some medications must be discarded
medication per milliliter, and nurse’s after certain number of days after mixing of
initials. vial.

C. Vial containing a powder

a. Remove cap covering vial of powdered Cap prevents contamination of rubber seal.
medication and cap covering vial of
proper diluent.

b. Pick up syringe and remove needle cap. Air must first be injected into vial to prevent
Pull back on plunger to draw amount of building up of negative pressure in vial while
air into syringe equivalent to volume of aspirating medication.
medication to be aspirated from vial.

c. With vial on flat surface, insert tip of Center of seal is thinner and easier to
needle with beveled tip entering first penetrate. Injecting beveled tip first and using
though center of rubber seal. Apply firm pressure prevent coring of rubber seal,
pressure to tip of needle during insertion. which would enter vial or needle.

d. Inject air into the vial’s airspace, holding Air must be injected before aspirating fluid.
on the plunger. Hold plunger with firm Injecting into vial’s airspace prevents formation
pressure; plunger maybe forced of bubbles and inaccuracy in dose.
backward by air pressure within the vial.

e. Invert vial while keeping firm hold on Inverting vial allows fluid to settle in lower half
syringe and plunger. Hold vial between of container. Position of hands prevents
thumb and middle fingers of forceful movement of plunger and permits easy
nondominant and. Grasp end of syringe manipulation of syringe.
barrel and plunger with thumb and
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

forefinger of dominant hand to

counteract pressure in vial.

f. Keep tip of needle below fluid level. Prevents aspiration of air.

g. Allow air pressure from the vial to fill Positive pressure within vial forces fluid into
syringe gradually with medication, if syringe (unless vial has been used several
necessary, pull back slightly on plunger to times).
obtain correct amount of solution.

h. When desired amount has been
obtained, position needle into vial’s
airspace; tap side of syringe barrel
carefully to dislodge any air bubbles.
Eject any air remaining at top of syringe
into vial.
Forcefully striking barrel while needle is
inserted in vial may bend needle. Accumulation
of air displaces medication and causes dose
errors.

i. Remove needle from vial by pulling back Pulling plunger rather than barrel causes
on barrel of syringe. plunger to separate from barrel, resulting in
loss of medication.

j. Hold ampule upside down, or set it on a
flat surface. Insert syringe into center of
ampule opening. Do not allow needle tip
or shaft to touch rim of ampule.
Holding syringe vertically allows fluid to settle
in bottom of barrel. Pulling back on plunger
allows fluid within needle to enter barrel so
fluid is expelled. Air at top of barrel and within
needle is then expelled.

k. Insert tip of needle through center of Diluent begins to dissolve and reconstitute
rubber seal of vial of powdered medication.
medication, inject diluent into vial.
Remove needle.

l. Mix medication thoroughly. Roll in palms. Ensures proper dispersal of medication

Do not shake. throughout solution. Shaking produces
bubbles.

m. Reconstituted medication in vial is ready
to be drawn into new syringe. Read label
carefully to determine dose after
reconstitution.
7. Dispose of soiled supplies. Place broken
ampule and/or used vials and used
needle in puncture-proof and leak proof
container. Clean work area and wash
hands.
Once diluent has been added, concentration of
medication (mg/ml) determines dose to be
given.
Proper disposal of glass and needle prevents
accidental injury to staff. Controls transmission
of infection.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

Name of Student: __________________________________

PREPARING INJECTIONS
Performance Checklist

Steps Able to Able to Unable to Remarks

Perform Perform with Perform
Assistance
PREPARING INJECTIONS
1. Review order, including name and
medication name, dose, route of
administration, and time of administration.
2. Review pertinent information related to
medication, including action, purpose, side
effects, and nursing implications.
3. Check date of expiration for medication vial
or ampule.
4. Assess client’s body fluid, muscle size, and
weight.
5. Wash hands.
6. Prepare medication.
A. Ampule preparation.
a. Tap top of ampule lightly and quickly with
finger until fluid moves from neck of
ampule.

b. Place small gauze pad around neck of

ampule.

c. Snap neck of ampule quickly and firmly

away from hands.

d. Draw up medication quickly.

e. Hold ampule upside down, or set it on a

flat surface. Insert syringe into center of
ampule opening. Do not allow needle tip
or shaft to touch rim of ampule.

f. Aspirate medication into syringe by

gently pulling back n plunger.

g. Keep needle tip under surface of liquid.

Tip ampule to bring all fluid within reach
of the needle.

h. If air bubbles are aspirated, do not expel

air into ampule.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

i. To expel excess air bubbles, remove

needle from ampule. Hold syringe with
needle pointing up. Tap side of syringe to
cause bubbles to rise toward needle.
Draw back slightly on plunger, and then
push plunger upward to eject air. Do not
eject fluid.

j. If syringe contains excess fluid, use sink

for disposal. Hold syringe vertically with
needle tip up and slanted slightly toward
sink. Slowly eject excess fluid into sink.
Recheck fluid into sink. Recheck fluid
level in syringe by holding it vertically.

k. Cover needle with its safety sheath or

cap. Change needle or syringe if you
suspect medication is on needle shaft.

B. Vial containing a solution

a. Remove cap covering top of unused vial
to expose sterile rubber seal, keeping
rubber seal sterile. If a multidose vial that
has been used before is being used again,
firmly and briskly wipe the surface of
rubber seal with alcohol swab and allow
it to dry.

b. Pick up syringe and remove needle cap.

Pull back on plunger to draw amount of
air into syringe equivalent to volume of
medication to be aspirated from vial.

c. With vial on flat surface, insert tip of

needle with beveled tip entering first
through center of rubber seal. Apply
pressure to tip of needle during insertion.

d. Inject air into the vial’s airspace, holding

on to plunger. Hold plunger with firm
pressure; plunger maybe forced
backward by air pressure within the vial.

e. Invert vial while keeping firm hold on

syringe ad plunger. Hold vial between
thumb and middle fingers of
nondominant hand. Grasp end of syringe
barrel and plunger with thumb and
forefinger of dominant hand to
counteract pressure in vial.

f. Keep tip of needle below fluid level.

 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

g. Allow air pressure from the vial to fill

syringe gradually with medication. If
necessary, pull back slightly on plunger to
obtain correct amount of solution.

h. When desired amount has been

obtained, position needle into vial’s
airspace; tap side of syringe barrel
carefully to dislodge any air bubbles.
Effect any air remaining at top of syringe
into vial.

i. Remove needle from vial by pulling back

on barrel of syringe.

j. Hold syringe at eye level, at 90-degree

angle, to ensure correct volume and
absence of air bubbles. Remove any
remaining air by tapping barrel to
dislodge any air bubbles. Draw back
slightly on plunger; then push plunger
upward to eject air. Do not eject fluid.

k. If medication is to be injected into client’s

tissue, change needle into appropriate
gauge and length according to route
medication.

l. For multidose vial, make label that

includes date of mixing, concentration of
medication per milliliter, and nurse’s
initials.

C. Vial containing a powder

a. Remove cap covering vial of powdered
medication and cap covering vial of
proper diluent.

b. Pick up syringe and remove needle cap.

Pull back on plunger to draw amount of
air into syringe equivalent to volume of
medication to be aspirated from vial.

c. With vial on flat surface, insert tip of

needle with beveled tip entering first
though center of rubber seal. Apply
pressure to tip of needle during insertion.

d. Inject air into the vial’s airspace, holding

on the plunger. Hold plunger with firm
pressure; plunger maybe forced
backward by air pressure within the vial.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

e. Invert vial while keeping firm hold on

syringe and plunger. Hold vial between
thumb and middle fingers of
nondominant and. Grasp end of syringe
barrel and plunger with thumb and
forefinger of dominant hand to
counteract pressure in vial.

f. Keep tip of needle below fluid level.

g. Allow air pressure from the vial to fill

syringe gradually with medication, if
necessary, pull back slightly on plunger to
obtain correct amount of solution.

h. When desired amount has been

obtained, position needle into vial’s
airspace; tap side of syringe barrel
carefully to dislodge any air bubbles.
Eject any air remaining at top of syringe
into vial.

i. Remove needle from vial by pulling back

on barrel of syringe.

j. Hold ampule upside down, or set it on a

flat surface. Insert syringe into center of
ampule opening. Do not allow needle tip
or shaft to touch rim of ampule.

k. Insert tip of needle through center of

rubber seal of vial of powdered
medication, inject diluent into vial.
Remove needle.

l. Mix medication thoroughly. Roll in palms.

Do not shake.

m. Reconstituted medication in vial is ready

to be drawn into new syringe. Read label
carefully to determine dose after
reconstitution.
7. Dispose of soiled supplies. Place broken
ampule and/or used vials and used needle in
puncture-proof and leak proof container.
Clean work area and wash hands.
REMARKS:

Clinical Instructor’s Signature: ____________________________________

Date: ____________________________________
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
ADMINISTERING INTRAMUSCULAR INJECTION
DEFINITION:
 The administration of a medication into the muscle tissues.
PURPOSES:
 To promote rapid drug absorption.
 Provides alternative route when drug is irritating to subcutaneous tissue.
STEPS
1. Follow the general procedure for giving injection:
a. Check doctor’s order for client’s name,
medication name, dose, time and route of
administration. Check the medications listed
against the doctor’s order using the Rights in
Drug Administration.
b. Assess client’s history of allergies and know
substances client is allergic to and normal
allergic reaction.
c. Assess the size and built of the client.
d. Assess the status of the client.
e. Observe verbal and nonverbal responses
toward receiving injection.
2. Wash hands and prepare materials needed.
3. Withdraw the correct dosage of medicine using
the techniques described for drawing up from vial
or an ampule or for mixing medication in a
syringe.
4. Recheck your dosage calculation.
5. Identify and explain the procedure to the client.
Provide privacy.
6. Assist client into a comfortable position. Divert
client’s attention by talking about an interesting
subject.
7. Select appropriate site for injection. Don gloves.
8. Clean the site with alcohol swab/alcoholized
cotton ball using circular motion and moving from
the middle of the site outward. Allow skin to air-
dry.
9. While holding a clean dry cotton ball between
fingers of non-dominant hand, pull cap from
needle.
10. Hold syringe between thumb and forefinger of
dominant hand. Hold as dart, palm down.
RATIONALE
To identify whether any medication is to be
given to an individual client on your shift.
Ensures safe and correct administration of
medication.
Certain substances have similar compositions;
nurse should not administer any substance to
which client is known to be allergic.
To choose the correct size of needle for the
injection.
Done to determine the need for assistance to
turn or restrain the client during the
procedure.
Injections can be painful. Clients may have
anxiety, which can increase pain.
For infection control.
Facilitates proper aspiration for the ordered
medication.
To prevent medication error.
To establish correct identity and reduce level
of anxiety.
Relaxation minimizes discomfort and diverting
client’s attention reduces anxiety.
Protects yourself from potential blood spill.
Circular motion and mechanical action of swab
removes secretions containing
microorganisms.
Dry cotton ball remains accessible during
procedure. Prevents contamination of needle.
Quick, smooth injection requires manipulation
of the syringe parts.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

11. Using non-dominant hand, grasp skin, or pinch a Needle penetrates tight skin easier than loose
generous section of tissue firmly for thin or skin. Pinching ensures that medication reaches
emaciated client. muscle mass.
12. Inject skin quickly and firmly at a 90˚ angle. Quick injection minimizes discomfort.
13. Transfer non-dominant hand to the barrel of the Injection requires smooth manipulation of
syringe to steady it and position dominant hand syringe parts.
to the end of the plunger.
14. Pull back the plunger (aspirate) to ascertain if Aspiration of blood indicates intravenous
needle is in a vein. If no blood appears, slowly placement of needle. If medication is injected,
inject the medication. vein maybe injured.
15. Quickly withdraw the needle while applying a dry Some advocate the use of dry cotton ball to
cotton ball over the site. minimize client discomfort associated with
alcohol on non-intact skin.
16. Assist client to comfortable position. Gives client a sense of well-being.
17. Discard uncapped syringe in a puncture and leak Needles should not be recapped before
proof container. disposal. Safety shield containers prevent
needle-stick injuries.
18. Remove gloves and wash hands. Reduces transmission of microorganisms.
19. Stay with client 3 to 5 minutes and observe for Severe anaphylactic reaction is characterized
any allergic reactions. by dyspnea, wheezing and circulatory collapse.
20. Return to room and ask if client feels any acute Continued discomfort may indicate injury to
pain, burning, numbness, or tingling at injection underlying bones or nerves.
site.
21. Inspect site, noting bruising or induration. Bruising or induration indicates complication
associated with injection. Notify nurse in-
charge or physician. Provide warm compress
to site.
22. Return to evaluate client’s response to Nurse’s observations determine efficacy of
medication in 10 to 30 minutes. IM injections medication action.
absorb quickly; undesired effects may also
develop rapidly.
Recording and Reporting
 Chart medication dose, route, site, time, and
date given in medication record.
 Report any undesirable effects from medication
to nurse in-charge or physician.
 Record client’s response to medications in
nurses’ notes.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

Name of Student: __________________________________

ADMINISTERING INTRAMUSCULAR INJECTION

Performance Checklist

Steps Able to Able to Unable Remarks

Perform Perform to
with Perform
Assistance
1. Follow the general procedure for giving
injection:
a. Check doctor’s order for client’s name,
medication name, dose, time and route of
administration. Check the medications listed
against the doctor’s order using the Rights in
Drug Administration.
b. Assess client’s history of allergies and know
substances client is allergic to and normal
allergic reaction.
c. Assess the size and built of the client.
d. Assess the status of the client.
e. Observe verbal and nonverbal responses
toward receiving injection.
2. Wash hands and prepare materials needed.
3. Withdraw the correct dosage of medicine using
the techniques described for drawing up from
vial or an ampule or for mixing medication in a
syringe.
4. Recheck your dosage calculation.
5. Identify and explain the procedure to the client.
Provide privacy.
6. Assist client into a comfortable position. Divert
client’s attention by talking about an interesting
subject.
7. Select appropriate site for injection. Don gloves.
8. Clean the site with alcohol swab/alcoholized
cotton ball using circular motion and moving
from the middle of the site outward. Allow skin
to air-dry.
9. While holding a clean dry cotton ball between
fingers of non-dominant hand, pull cap from
needle.
10. Hold syringe between thumb and forefinger of
dominant hand. Hold as dart, palm down.
11. Using non-dominant hand, grasp skin, or pinch a
generous section of tissue firmly for thin or
emaciated client.
12. Inject skin quickly and firmly at a 90˚ angle.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

13. Transfer non-dominant hand to the barrel of the

syringe to steady it and position dominant hand
to the end of the plunger.
14. Pull back the plunger (aspirate) to ascertain if
needle is in a vein. If no blood appears, slowly
inject the medication.
15. Quickly withdraw the needle while applying a
dry cotton ball over the site.
16. Assist client to comfortable position.
17. Discard uncapped syringe in a puncture and leak
proof container.
18. Remove gloves and wash hands.
19. Stay with client 3 to 5 minutes and observe for
any allergic reactions.
20. Return to room and ask if client feels any acute
pain, burning, numbness, or tingling at injection
site.
21. Inspect site, noting bruising or induration.
22. Return to evaluate client’s response to
medication in 10 to 30 minutes. IM injections
absorb quickly; undesired effects may also
develop rapidly.
Recording and Reporting
 Chart medication dose, route, site, time, and
date given in medication record.
 Report any undesirable effects from
medication to nurse in-charge or physician.
 Record client’s response to medications in
nurses’ notes.

REMARKS:

Clinical Instructor’s Signature: ____________________________________

Date: ____________________________________
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

ADMINISTERING SUBCUTANEOUS INJECTION

DEFINITION:
 The administration of drug/medication into the subcutaneous tissue.

PURPOSE:
 Used in the administration of medications such as insulin and heparin, because these
drugs are absorbed slowly to produce sustained effects.

STEPS RATIONALE
1. Follow the general procedure for giving injection: To identify whether any medication is to be
given to an individual client on your shift.
a. Check doctor’s order for client’s name, Ensures safe and correct administration of
medication name, dose, time and route of medication.
administration. Check the medications listed
against the doctor’s order using the Rights in
Drug Administration.
b. Assess client’s history of allergies and know Certain substances have similar compositions;
substances client is allergic to and normal allergic nurse should not administer any substance to
reaction. which client is known to be allergic.
c. Assess the size and built of the client. To choose the correct size of needle for the
injection.
d. Assess the status of the client. Done to determine the need for assistance to
turn or restrain the client during the
procedure.
e. Observe verbal and nonverbal responses toward Injections can be painful. Clients may have
receiving injection. anxiety, which can increase pain.
f. Assess for factors such as muscle atrophy, Atrophied muscle absorbs medication poorly.
reduced blood flow, or circulatory shock. Factors interfering with blood flow to muscles
impair medication absorption.
2. Wash hands and prepare materials needed. For infection control.
3. Withdraw the correct dosage of medicine using the Facilitates proper aspiration for the ordered
techniques described for drawing up from vial or an medication.
ampule or for mixing medication in a syringe.
4. Recheck your dosage calculation. To prevent medication error.
5. Identify and explain the procedure to the client. To establish correct identity and reduce level
Provide privacy. of anxiety.
6. Assist client into a comfortable position. Divert Relaxation minimizes discomfort and diverting
client’s attention by talking about an interesting client’s attention reduces anxiety.
subject.
7. Select appropriate site for injection. Don gloves. Protects yourself from potential blood spill.
8. Clean the site with alcohol swab/alcoholized cotton Circular motion and mechanical action of swab
ball using circular motion and moving from the removes secretions containing
middle of the site outward. Allow skin to air-dry. microorganisms.
9. While holding a clean dry cotton ball between Dry cotton ball remains accessible during
fingers of non-dominant hand, pull cap from needle. procedure. Prevents contamination of needle.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

10. Hold syringe between thumb and forefinger of
dominant hand. Hold as dart, palm down.
11. Using non-dominant hand, grasp skin, or pinch a
generous section of tissue firmly for thin or
emaciated client.
12. Inject needle quickly and firmly at a 45˚ angle. Then
release skin, if pinched.
13. For obese client, pinch skin at site and inject needle
at 90˚ angle below tissue fold.
14. After needle enters site, grasp lower end syringe
barrel with nondominant hand. Move dominant
hand to end of plunger. Avoid moving syringe while
slowly pulling back on plunger to aspirate drug. If
blood appears in syringe, remove needle, discard
medication and syringe, and repeat procedure.
Quick, smooth injection requires manipulation
of the syringe parts.
Needle penetrates tight skin easier than loose
skin. Pinching ensures that medication reaches
muscle mass.
Quick, firm insertion minimizes discomfort.
Injecting medication into compressed tissue
irritates nerve fibers.
Obese clients have fatty layer of tissue above
SQ layer.
Properly performed injection requires smooth
manipulation of syringe parts. Movement of
syringe may displace the needle, causing
discomfort. Aspiration of blood into syringe
indicates IV placement of needle, SQ and IM
injections are not for IV use.

Exception: Do not aspirate when giving Heparin.

Aspiration of heparin injection may cause the
needle to move, creating tissue damage and
bleeding.
15. Slowly inject the medication. Slow injection reduces pain and tissue trauma.
16. Quickly withdraw the needle while applying a dry Some advocate the use of dry cotton ball to
cotton ball over the site. minimize client discomfort associated with
alcohol on non-intact skin.
17. Assist client to comfortable position. Gives client a sense of well-being.
18. Discard uncapped syringe in a puncture and leak Needles should not be recapped before
proof container. disposal. Safety shield containers prevent
needle-stick injuries.
19. Remove gloves and wash hands. Reduces transmission of microorganisms.
20. Stay with client 3 to 5 minutes and observe for any Severe anaphylactic reaction is characterized
allergic reactions. by dyspnea, wheezing and circulatory collapse.
21. Return to room and ask if client feels any acute pain, Continued discomfort may indicate injury to
burning, numbness, or tingling at injection site. underlying bones or nerves.
22. Inspect site, noting bruising or induration. Bruising or induration indicates complication
associated with injection. Notify nurse in-
charge or physician. Provide warm compress
to site.
23. Return to evaluate client’s response to medication Nurse’s observations determine efficacy of
in 10 to 30 minutes. medication action.
Recording and Reporting
 Chart medication dose, route, site, time, and date given in medication record.
 Report any undesirable effects from medication to nurse in-charge or physician.
 Record client’s response to medications in nurses’ notes.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

Name of Student: __________________________________

ADMINISTERING SUBCUTANEOUS INJECTION

Performance Checklist

Steps Able to Able to Unable Remarks

Perform Perform to
with Perform
Assistance
1. Follow the general procedure for giving injection:
a. Check doctor’s order for client’s name,
medication name, dose, time and route of
administration. Check the medications listed
against the doctor’s order using the Rights in
Drug Administration.
b. Assess client’s history of allergies and know
substances client is allergic to and normal
allergic reaction.
c. Assess the size and built of the client.
d. Assess the status of the client.
e. Observe verbal and nonverbal responses
toward receiving injection.
f. Assess for factors such as muscle atrophy,
reduced blood flow, or circulatory shock.
2. Wash hands and prepare materials needed.
3. Withdraw the correct dosage of medicine using
the techniques described for drawing up from
vial or an ampule or for mixing medication in a
syringe.
4. Recheck your dosage calculation.
5. Identify and explain the procedure to the client.
Provide privacy.
6. Assist client into a comfortable position. Divert
client’s attention by talking about an interesting
subject.
7. Select appropriate site for injection. Don gloves.
8. Clean the site with alcohol swab/alcoholized
cotton ball using circular motion and moving
from the middle of the site outward. Allow skin
to air-dry.
9. While holding a clean dry cotton ball between
fingers of non-dominant hand, pull cap from
needle.
10. Hold syringe between thumb and forefinger of
dominant hand. Hold as dart, palm down.
11. Using non-dominant hand, grasp skin, or pinch
a generous section of tissue firmly for thin or
emaciated client.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

12. Inject needle quickly and firmly at a 45˚ angle.

Then release skin, if pinched.
13. For obese client, pinch skin at site and inject
needle at 90˚ angle below tissue fold.
14. After needle enters site, grasp lower end syringe
barrel with non-dominant hand. Move dominant
hand to end of plunger. Avoid moving syringe
while slowly pulling back on plunger to aspirate
drug. If blood appears in syringe, remove
needle, discard medication and syringe, and
repeat procedure.
Exception: Do not aspirate when giving
Heparin.
15. Slowly inject the medication.
16. Quickly withdraw the needle while applying a
dry cotton ball over the site.
17. Assist client to comfortable position.
18. Discard uncapped syringe in a puncture and leak
proof container.
19. Remove gloves and wash hands.
20. Stay with client 3 to 5 minutes and observe for
any allergic reactions.
21. Return to room and ask if client feels any acute
pain, burning, numbness, or tingling at injection
site.
22. Inspect site, noting bruising or induration.
23. Return to evaluate client’s response to
medication in 10 to 30 minutes.
RECORDING AND REPORTING
1. Chart medication dose, route, site, time, and
date given in medication record.
2. Report any undesirable effects from medication
to nurse in-charge or physician.
3. Record client’s response to medications in
nurses’ notes.

REMARKS:

Clinical Instructor’s Signature: ____________________________________

Date: ____________________________________
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

ADMINISTERING INTRADERMAL INJECTION

DEFINITION:
 The administration of a small amount of medication/fluid into the dermal layer of the
skin just beneath the epidermis.

PURPOSE:
 Indicated for diagnosing allergies and tuberculin testing.
 Used to administer vaccinations (BCG) and local anesthesia.

STEPS RATIONALE
1. Follow the general procedure for giving injection: To identify whether any medication is to be
given to an individual client on your shift.
a. Check doctor’s order for client’s name, Ensures safe and correct administration of
medication name, dose, time and route of medication.
administration. Check the medications listed
against the doctor’s order using the Rights in
Drug Administration.
b. Assess client’s history of allergies and know Certain substances have similar
substances client is allergic to and normal compositions; nurse should not administer
allergic reaction. any substance to which client is known to be
allergic.
c. Assess the size and built of the client. To choose the correct size of needle for the
injection.
d. Assess the status of the client. Done to determine the need for assistance
to turn or restrain the client during the
procedure.
e. Observe verbal and nonverbal responses toward Injections can be painful. Clients may have
receiving injection. anxiety, which can increase pain.
f. Assess for factors such as muscle atrophy, Atrophied muscle absorbs medication
reduced blood flow, or circulatory shock. poorly. Factors interfering with blood flow
to muscles impair medication absorption.
2. Wash hands and prepare materials needed. For infection control.
3. Withdraw the correct dosage of medicine using the Facilitates proper aspiration for the ordered
techniques described for drawing up from vial or an medication.
ampule or for mixing medication in a syringe.
4. Recheck your dosage calculation. To prevent medication error.
5. Identify and explain the procedure to the client. To establish correct identity and reduce level
Provide privacy. of anxiety.
6. Assist client into a comfortable position. Divert Relaxation minimizes discomfort and
client’s attention by talking about an interesting diverting client’s attention reduces anxiety.
subject.
7. Select appropriate site for injection. Don gloves. Protects yourself from potential blood spill.
8. Clean the site with alcohol swab/alcoholized cotton Circular motion and mechanical action of
ball using circular motion and moving from the swab removes secretions containing
middle of the site outward. Allow skin to air-dry. microorganisms.
9. With nondominant hand, stretch skin over site with Needle pierces skin more easily.
forefinger or thumb.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
10. Hold the 1ml/tuberculin syringe with gauge 25-27
needle at a 10-15˚ angle, with bevel of the needle
facing up.
11. Insert the needle just until the bevel is no longer
visible. Do not aspirate.
12. Inject the medication slowly while watching for a
small wheal/bleb to appear.
13. Withdraw the needle. Do not massage the site.
14. Encircle the wheal/bleb with a pen if the site must
be assessed for reaction or sensitivity.
15. Discard uncapped syringe in a puncture and leak
proof container.
16. Remove gloves and wash hands.
17. Return to evaluate client’s response to medication
in 10 to 30 minutes.
18. Recording and Reporting
 Chart medication dose, route, site, time, and
date given in medication record.
 Report any undesirable effects from medication
to nurse in-charge or physician.
 Record client’s response to medications in
nurses’ notes.
Intradermal tissues will be penetrated when
the needle is held as near parallel to the skin
as possible.
Facilitate proper introduction of the
medicine.
Small wheal/bleb indicates the medication
was deposited in the dermis.
Massage can disperse medication into the
tissue and altering test result.
Encircling part of the wheal/bleb serves as
basis for reading.
Needles should not be recapped before
disposal. Safety shield containers prevent
needle-stick injuries.
Reduces transmission of microorganisms.
If ID is done for sensitivity test (ANST), check
for redness and itchiness that goes outside
the marked wheal/bleb. Refer to physician.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

Name of Student: __________________________________

ADMINISTERING INTRADERMAL INJECTION

Performance Checklist

Steps Able to Able to Unable Remarks

Perform Perform to
with Perform
Assistance
1. Follow the general procedure for giving injection:
a. Check doctor’s order for client’s name,
medication name, dose, time and route of
administration. Check the medications listed
against the doctor’s order using the Rights in
Drug Administration.
b. Assess client’s history of allergies and know
substances client is allergic to and normal
allergic reaction.
c. Assess the size and built of the client.
d. Assess the status of the client.
e. Observe verbal and nonverbal responses
toward receiving injection.
f. Assess for factors such as muscle atrophy,
reduced blood flow, or circulatory shock.
2. Wash hands and prepare materials needed.
3. Withdraw the correct dosage of medicine using
the techniques described for drawing up from vial
or an ampule or for mixing medication in a
syringe.
4. Recheck your dosage calculation.
5. Identify and explain the procedure to the client.
Provide privacy.
6. Assist client into a comfortable position. Divert
client’s attention by talking about an interesting
subject.
7. Select appropriate site for injection. Don gloves.
8. Clean the site with alcohol swab/alcoholized
cotton ball using circular motion and moving
from the middle of the site outward. Allow skin to
air-dry.
9. With nondominant hand, stretch skin over site
with forefinger or thumb.
10. Hold the 1ml/tuberculin syringe with gauge 25-
27 needle at a 10-15˚ angle, with bevel of the
needle facing up.
11. Insert the needle just until the bevel is no longer
visible. Do not aspirate.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

12. Inject the medication slowly while watching for

a small wheal/bleb to appear.
13. Withdraw the needle. Do not massage the site.
14. Encircle the wheal/bleb with a pen if the site
must be assessed for reaction or sensitivity.
15. Discard uncapped syringe in a puncture and leak
proof container.
16. Remove gloves and wash hands.
17. Return to evaluate client’s response to
medication in 10 to 30 minutes.
RECORDING AND REPORTING
18. Chart medication dose, route, site, time, and date
given in medication record.
19. Report any undesirable effects from medication
to nurse in-charge or physician.
20. Record client’s response to medications in
nurses’ notes.

REMARKS:

Clinical Instructor’s Signature: ____________________________________

Date: ____________________________________

Reference:

Berman, A. Snyder, S. & Frandsen, G. (2016). Kozier and Erb’s Fundamentals of Nursing:
Concepts, Process and Practice. (10th ed.). New Jersey: Pearson Education Inc.

Potter, P. et.al., (2017). Fundamentals of Nursing. (9th ed.). St. Louis, Missouri: Elsevier, Inc.

Smith, S., Duell, D. & Martin, B. (2002). Photo Guide of Nursing Skills. New Jersey: Pearson
Education Inc.