Parenteral Injection (SQ,

IM)
NRG 204
Parenteral administration can be performed
by injection, that is, using a needle (usually
a hypodermic needle) and a syringe, or by the 2
insertion of an indwelling catheter.
3
Parts of a syringe &
needle

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Pre-filled syringes

FlexPen
Ampules

Vials

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 It is the introduction of a small amount of solution by
means of syringe and needle into the adipose tissue
beneath the skin.
PURPOSE:
1. To deliver medication more rapidly to the bloodstream than oral
administration.
2. To prevent slower and sustained drug administration than
intramuscular injection.
3. To prevent destruction of the drugs by the action of digestive
secretion.
4. To minimize tissue trauma and avoid the risk of hitting large
blood vessels and nerves.
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SITES:
lateral aspects of the
upper arm
anterior thigh
lower abdomen (1 inch
away from the umbilicus)
upper back (scapular area)

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medicine
medication tray
injection tray
syringe

sterile aspirating needle

sterile injection needle G25 5/8th in or G26 1in.
jar of CB with 70% ROH
waste box/receptacle
1. Check the doctor’s order on
patient chart and Medication
Administration Record (e-
MAR). Arrange medication
card on hypodermic tray.
2. Assemble complete
materials needed for the
procedure.
3. Wash hands thoroughly.
•The chart of the patient is more
reliable than the medication
ticket.
•Organization and planning
result in economy of time and
effort & minimize interruption.
•To deter the spread of
microorganisms. 10
4.Carry the tray to the patient’s
• Helps alley anxiety and respect
room. Provides client privacy.
individual confidentiality.
5. Prepares client by introducing
•Prevents error in medication.
your name, identify the patient
properly using agency protocol.

•Cooperation is easily gained when

6.Explain the procedure to the
the patient knows what is to be
patient.
performed.
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 •The site where a skin appears to
7. Locate the site of
be healthy and free from irritation
injection. Don gloves.
and inflammation reduces the
discomfort of injection.
Precautionary measure.
8.Cleanse the area to be
•Friction aides in cleaning the
injected by using firm
skin. Removes dirt in away
strokes in circular motion
direction.
from inner to outer.

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9. Prepare the syringe for Helps to ensure to avoid
injection. Removes the needle contamination. Drying the skin
cap while waiting for the prevents inactivation of the
antiseptic to dry. Pulls the cap meds/drugs being given.
straight off to avoid
contaminating the needle by the
outside edge of the cap.

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10. Hold the syringe with your
dominant thumb & fingers at an
angle of 45 degrees.
Using dominant hand
when grasping will create
a firm hold. Secure that
the entry of needle into the
subcutaneous layer.
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11. Using the nondominant
hand, pinch or spread the
skin at the site, and insert
the needle using the
dominant hand and a firm
steady push.
Pinching pulls the fatty tissue away from the
muscle and makes the injection easier.
Subcutaneous tissue is abundant in well-
nourished, hydrated person and scarce in
emaciated dehydrated ones.
Rapid injection may cause discomfort.
Pain is minimize by inserting the needle
without hesitation.
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12. When the needle is inserted, move
your nondominant hand to the end of • For support and easier injection of
the plunger. Some nurses find it easier solution. Depressing skin places
to move the nondominant hand to the countertraction & minimizes pt.’s
barrel of the syringe and the dominant discomfort when the needle is
hand to the end of the plunger. Injects withdrawn.
the medication by holding the syringe
steady and depressing the plunger with
a slow, even pressure.

13. Removes the syringe.

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14. Position the pt. and do after Comfort and convenient. To
care the equipment. protect the nurse & others from
injury & contamination.

15.Record the time & amount of

drugs on medication sheet. •Prevent medication error.

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18
19
NovoLog® FlexPen® Prefilled syringe

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1. PREPARING THE SYRINGE

A. Remove the protective tab from the disposable needle and screw the needle onto the
FlexPen. Never place a disposable needle on your FlexPen until you are ready to give
an injection. Remove the needle right after use. If the needle is not removed, some liquid
may leak from the FlexPen.
B. Pull off the outer and inner needle caps.

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2. SETTING THE DOSE
Check that the dose selector is set at 0. Dial the number of units you need to inject.
The dose can be corrected either up or down by turning the dose selector in either
direction. When dialing back be careful not to push the push button as insulin will
come out. .

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3. GIVING THE INJECTION
Deliver the dose by pressing the push button all the way in. Be careful only to push
the push button when injecting. After the injection the needle should remain under the
skin for at least 6 seconds. Keep the push button fully depressed until the needle is
withdrawn from the skin. This will ensure that the full dose has been delivered.

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Removing the cap from the needle.

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It is the introduction of medication deep into muscle
tissue where a large network of blood vessels can
absorb it readily and quickly.
Purpose:

1. To allow less painful administrations of

irritating drugs.
2. To allow more rapid absorption of the drug
compared to subcutaneous injection.
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Purpose:
3. To administer large doses (up to 5 ml in
appropriate sites) of the medication.
4. To give drugs to patients who can not take
medication orally and for drugs that are degraded
by the digestive juices.

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Site:
Deltoid
Vastus Lateralis
Rectus Femoris
Dorsogluteal
Ventrogluteal

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Deltoid:.05-3cc,sitting,standing,supine or prone
Locate the lower end of the This is the densest site
acromion process and measure 2- containing no major blood
3 finger breaths. Inject below that. vessels and nerves.

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Vastus lateralis/ Rectus Femoris: 0.5-3cc,preferred for
infants children less than 7mos. & used for self injection/supine, sitting

Locate middle outer third of the This area contains big muscles.
thigh by dividing the thigh into 3
parts and drawing a longitudinal
line from the greater trochanter of
the femur down to the knee

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31
DORSOGLUTEAL( UPPER OUTER QUADRANT )
Amount: 1-5CC
Position: Side lying or sim’s position or
prone with femur internally rotated,
Location : Site is located by palpating
the posterior iliac spine & drawing
line at the midpoint. Site can also be
located by dividing by dividing the
buttocks into 4 quadrants. The
injection is given in the upper, outer
quadrant 2-3 inches below the iliac
crest.
Site is avoided in children < 2 years old
or emaciated patients. 32
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VENTROGLUTEAL
Amount: 1-5cc
Position: Side lying or sim’s position
Location: Site is located by placing the
hand with heel on the greater trochanter &
thumb toward the umbilicus. Point to the
anterior iliac spine with the index finger (
forming a “ V ”.Medication is administered
within the “ V” area.)
Site is preferred for adults & children > 7
mos. Old.
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35
 Hypodermic Tray lined with
sterile towel.
Medication
Medication Ticket
Sterile Needles for aspirating
and for injecting G20-22
Sterile Syringes
Cotton balls soaked in 70%
alcohol
Waste receptacle 36
1. Check the doctor’s order on pt’s chart • The chart of the patient is more reliable
and MAR. Checks the label on the
medication carefully against the eMAR than the medication ticket.
to make sure that the correct
medication is being prepared.

2. Follows the three checks for

administering medications. Read the • Prevent errors of medication
label on the medication (1) when it is administration.
taken from the medication cart, (2)
before withdrawing the medication, and
(3) after withdrawing the medication.

3. Assemble equipments. • Organization and planning result in

economy of time and effort & minimize
confusion.
4. Perform hand hygiene. • To deter the spread of microorganisms.
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5. Prepares the medication ampule for
drug withdrawal: Flicks the upper stem
of the ampule several times with a
fingernail. Uses an ampule opener or
place a piece of sterile gauze or alcohol
wipe between your thumb and the
ampule neck or around the ampule
neck, and break off the top by bending it
toward you.
• Ensures the solution is at the bottom
part of the ampule. Placing a sterile
gauze protects puncturing self when
breaking it and to ensure the ampule
is broken away from yourself and
away from others.

6. Withdraws the medication: Removes • To avoid unnecessary

the cap from the filter needle and insert contamination.
the needle into the center of the ampule.
Do not touch the rim of the ampule with
the needle tip or shaft.
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7. Carry tray to pts. room & identify • Avoid mistaken identity
the pt. and errors.
8. Explain the procedure to • To gain cooperation & allay
the patient. Provides privacy. anxiety.
9. Assists the client to a supine, lateral,
prone, or sitting position,
depending on the chosen site. If • To gain access to the site and for
the target muscle is the gluteus convenience.
medius (ventrogluteal site), have
the client in the supine position
flex the knee(s); in the lateral
position, flex the upper leg; and in
the prone position, toe in.
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10. Drape the patient depending on • To lessen pt’s anxiety and
the promotes cooperation.
selected site & provide privacy.
11. Locate the right site of injection.
Select a site free of skin lesions, • To avoid/lessen discomforts
tenderness, swelling, hardness, or during injection.
localized inflammation and one that
has not been used frequently.
12. Apply clean gloves. • Precaution and protection.

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13. Cleanse the area thoroughly using To prevent entry of microorganism into
cotton ball with alcohol from inner to outer the tissue.
motion.

14. Prepare the syringe for injection.

Removes the needle cap while waiting for Ensure to avoid contamination. Drying
the antiseptic to dry. Pulls the cap straight the skin prevents inactivation of the
off to avoid contaminating the needle by the meds/drugs being given.
outside edge of the cap.

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15. Hold the syringe in a dart position
or 90 degree-angle.
16. Uses the ulnar side of the
nondominant hand to pull the skin
approximately 2.5 cm (1 in.) to the
side. Under some circumstances,
such as for an emaciated client or
an infant, the muscle may be
pinched.
• To ensure insertion of needle into the
muscles.
• Helps group the muscle and
makes the injection easier.
• Abundant in well-nourished,
hydrated person and scarce in
emaciated dehydrated ones.
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17. Holding the syringe between the thumb and
forefinger (as if holding a pen), pierce the skin
quickly and smoothly at a 90° angle.
18. Holds the barrel of the syringe steady with
your nondominant hand and aspirate by
pulling back on the plunger with your
dominant hand. Aspirate for 5 to 10
seconds.
19. Inject the solution slowly. Then withdraws
the needle smoothly at the same angle of
insertion.
• Pain is minimize by inserting the needle
without hesitation.
To stabilize the needle. Aspirate the plunger
to determine whether the needle is in correct
site if you have hit a blood vessel. If blood is
present, withdraw the needle and restart
with a new needle.
Rapid injection may lead to a sudden
distension of muscle tissue, which itself
could be painful.
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20. Applies gentle pressure at the site with a dry
sponge. It is not necessary to massage the
area at the site of injection. If bleeding occurs,
apply pressure with a dry sterile gauze until it
stops.
21. Activates the needle safety device or
discard the uncapped needle and attached
syringe into the proper receptacle.
22. Removes and discard gloves and perform
hand hygiene. Documents all relevant
information. The time of administration,
drug name, dose, route, and the client’s
reactions.
• Rubbing or massaging the injection site
area should be avoided through the time
the drug is expected to reach peak levels
to avoid intended absorption patterns.
Proper disposal of infectious material.
Precautionary measures.
To deter spread of microorganisms.
Recording of procedure done, and to
assess the patients reaction to treatment.
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Inserting needle in the 45
ventrogluteal site
Aspirating Applying pressure at the injection site. 46
 Z-track IM
Administration
 Method used with irritating
medications
– Vistaril
– Iron

 Used to “trap” medication in

muscle and prevent “tracking” of
solution through tissues.
(leakage)
• The Z-track method is a type of IM
injection technique used to prevent
tracking (leakage) of the medication into
the subcutaneous tissue (underneath the
skin). During the procedure, skin and
tissue are pulled and held firmly while a
long needle is inserted into the muscle.

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 INTRAVENOUS INJECTION
• a needle is inserted directly into a vein.
• A solution containing the drug may be given in a single dose or by continuous infusion.
• Intravenous administration is the best way to deliver a precise dose quickly and in a well-
controlled manner throughout the body.
• It is also used for irritating solutions, which would cause pain and damage tissues if
given by subcutaneous or intramuscular injection.
• An intravenous injection can be more difficult to administer than a subcutaneous or
intramuscular injection because inserting a needle or catheter into a vein may be
difficult, especially if the person is obese.
IV Injection
Heparin Lock IV
 Automation of Medication
Administration
• Client records are all in the computer
• No longer requires the use of medicine
tickets
• Uses Automated Dispensing System
(ADS) wherein Medication
Administration Record (MAR) of
the patient is encoded. The system uses
scanner or a Automated Dispensing
Cabinet (ADC) with a scanner.

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53
54
RM.# DATE
Based on DDH:
NAME
COLOR ROUTE
MEDICINE TOPICAL/OTHER TREATMENT/NSG
PINK PROCEDURES
DOSAGE ROUTE
WHITE ORAL
FREQUENCY
BLUE PARENTERAL
TIMING

SIGNATURE frequency : timing

Q 4°/RTC- 8am-12nn-4pm-
OD-8AM 8pm-12am-4am(depends on
BID-8AM-6PM the time of 1st dose)
TID-8AM-2PM-8AM Q 8°, Q 12°- Depends upon
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the time the 1st dose was
QID-8AM-12NN-4PM-8PM given
RM.#: DATE:
2202 JUNE 14, 2015
NAME:
CHIU,KIM
MEDICINE
AMBROXOL 1 TAB.
DOSAGE ROUTE
75 MG P.O
FREQUENCY
BID
TIMING
8AM-6PM
SIGNATURE

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 DAVAO DOCTORS HOSPITAL
118 E. Quirino Ave. Davao City
MEDICATION SHEET
DATES
MEDS DATE & TIME
DATE/TIME MEDICINES ( DOSAGES & 6/14 6/16
ORDERED FREQ) & TREATMENTS
TIME RECEIVED 6/15 DISCONTINUED

6/14/15 8:02AM
AMBROXOL 75MG 3 TABS
8AM
6AM
6PM
D/C 6/14/15
BID P.O 6PM

6/14/15 8:15AM
LANOXIN 0.25MG 8AM 2 TABS
7:30AM
1 TAB P.O. OD

6/14/15 8:10AM 6/14/15 CHANGED TO BID

CIPROBAY 500MG 1 TAB P.O 2 TABS
8AM OD 8AM

6/14/15 CIPROBAY 500MG 6AM

9AM
1 TAB BID P.O,AC 6PM
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 SINGLE/STAT ORDER NURSE’S SIGNATURE
Captopril 25 mg. 1 9:15AM
6/14/15 tab SL now

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Thank you for listening

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