MODULE 8

ADMINISTRATION OF RECTAL MEDICATION

Rectal administration is a convenient and safe method of giving certain medication, insertion of
medication into the rectum in the form of suppository is a frequent practice. Rectal suppository
is a small, solid, medicated mass, usually cone shaped with a cocoa butter or glycerin base and
melt at body temperature and are absorbed slowly. Rectal suppository commonly contains
drugs that reduce fever, induce relaxation, interact poorly with digestive enzymes and have a
taste too offensive for oral use.

Contraindication in Insertion of Rectal Suppository

a. patient with potential cardiac arrhythmias because suppository
stimulate vagus nerve
b. recent rectal surgery
c. prostate surgery – risk for rectal trauma
- discomfort

Rectal Ointment
- is a semi solid medication used to produce local effects.
-applied externally to the anus or internally to the rectum.
- commonly contain drugs that reduce inflammation or relieve pain and itching.

Advantage of Rectal Administration

a. avoid irritation of the upper gastrointestinal tract of the client.
b. when the medication has an objectionable taste or odor.
c. drugs are reduced at a slow but steady rate.
d. provide a higher blood stream level of medication because of venous
blood from the lower rectum is not transported through the liver.

Special Considerations
a. Intake of foods and fluids stimulates peristalsis, suppository for relieving
constipation should be inserted about 30 minutes before mealtime to
help soften the feces in the rectum and facilitate defecation.
Medicated retention suppository should be inserted between meals.
b. Make sure patient’s bell is within rich or signal light because client may
unable to suppress the urge to defecate
c. Inform the client that the suppository may dissolve for next bowel
movement that gives a silver gray pasty appearance.

Equipment: A tray containing the following

• rectal suppository
• disposable gloves
• tissue paper

Procedure:
a. Verify doctor’s order.
b. Wash your hands.
c. Prepare the materials needed.
d. Confirm patient’s identity
e. Explain the procedure and the purpose of the medication to the client .
f. Provide privacy.
g. Place the client on her\his left side in sim’s position. Drape with bedcover
to expose only the buttocks.
Rationale: It helps to relax the external anal sphincter, draping maintains
privacy and facilitate relaxation.
h. Put on the gloves.
i. Remove the suppository from the foil wrapper.
j. Instruct the client to take a deep breath through the mouth.
Rationale; This usually relaxes the external anal sphincter and discomfort
during insertion.
k. Retract client’s buttock with your non-dominant hand, using the index finger
of your dominant hand insert the suppository gently through the anus pass
the internal sphincter and against the rectal wall.

10 cm (4 inches) in adult
5 cm (2 inches) infant and children

l. Withdraw your finger and wipe client’s anal with toilet paper, press client’s
buttock together for several seconds.
Rationale: This helps minimize any urge to expel the suppository.
m. Remove gloves inside out, do the after care and wash your hands.
n. Ask the client to remain flat in the left lateral position for at least 5 minutes.
Rationale; The suppository should be retained at least 30 to 40 minutes.
o. If client has been given a laxative suppository, place the call light within
client reach.
p. Document all nursing assessment and intervention relative to the procedures
that includes the suppository given name of the drug, time given, time
expelled and client response.

MODULE 9

ASPIRATION OF DRUG FROM AMPULE AND VIAL

Ampoules and vials are frequently used to package sterile parenteral

medication. Ampoule is a glass container usually designed to hold a single dose of
the drug. It is made up of clear glass and has a distinctive shape with a constricted
neck. Ampoule vary in size from I to 10 ml. or more. Most ampoule necks have
colored marks around them indicating where they are pre scored for easy opening.
Vials are small glass bottles with a sealed rubber cap. Vials come in different
sizes, from single to multi-dose vials. They usually have a metal of plastic cap that
protects the rubber seal and must be removed to access the medication. To access
the medication in the vial, the vial must be pierced with a needle. In addition, air
must be injected into the vial before the medication can be withdrawn. Failure to
 inject air before withdrawing the medication leaves a vacuum within the vial that
makes withdrawal difficult.

Ampoule – is a small glass container for individual doses of liquid medication.

a. Before preparing to open the ampoule, make sure that drug content is in the
ampoule not in the stem.
Rationale: The drug tends to be trapped in the stem, which may cause
tapping the stem several times to help bring the solution down.
b. Wipe the neck of the ampoule with a cotton ball soaked in 70% alcohol.
Rationale: Wiping the ampoule with an antiseptic solution is to remove the
dust that might lodged in it.
c. Use sterile gauze or dry cotton balls to hold ampoule while braking to
protect the finger.
Rationale: Sterile material is needed because it is in direct contact with the
opening of the ampoule when the stem is removed.
d. Discard the gauze, cotton balls and stem and put the ampoule down.
e. To remove the drug, insert the needle into the ampoule and withdraw the
solution by not touching the mouth of the ampoule with the needle in order
to minimize chances of contamination.
Rationale: The fluid in the ampoule is immediately displaced by air,
therefore, there is no resistance to its withdrawal.

Vial- a medication container with a sealed rubber cap for single or multiple doses.

a. Remove a metal cap by means of a file.

Rationale: This exposes the rubber part which is the means of entrance into the vial
b. Cleanse rubber cap with cotton ball soaked in 70% alcohol and inject air
of the same amount as the solution to be withdrawn.
Rationale: This increases pressure within the vial and the drug can be withdrawn
easily since fluids move from the area of greater pressure to an area of lesser
pressure.
c. Hold the plunger firmly when withdrawing drugs from a vial especially when
the solution is in large amounts.

Syringe- is a device used for injecting, removing or infusing fluids, most common
known in health care settings for injecting medications and for use in removing
blood from the body. Syringe can differ in size and type and they can be made of
glass or plastic. The syringe consists of plunger, barrel, hub, needle and the
needle’s protective cover. It is important that all parts of a syringe coming into
contact with the body be kept free of contamination.

Three Parts of Syringes

 • TIP – which connects with the needle
• BARREL – the outside part on which the scales are printed, usually calibrated
in tenths ( a tenth is equal to 0.1 milliliters) to make a precise measurement
of the quantity of the fluid to be given or removed. The barrel can range in
size from 0.5 to 50 ml.
- part of the syringe that contains the fluids, whether it is a
medication, blood or a solution drawn from the body.
• PLUNGER- which fits the barrel is located at the end of the syringe and can
be made of clouded or colored glass or plastic. Its purpose is to fill or empty
the barrel. The plunger is pulled back to fill the barrel and is pushed forward
for emptying.

Parts of the Needle

HUB – which fits onto the syringe
CANNULA / SHAFT – which attached to the hub
BEVEL – which is the slanted part of the tip of the needle

Different Kinds of Syringes

The three most commonly used types are:
• Hypodermic Syringe – comes in 2, 2.5, 3 and 5 ml. sizes The syringe may
have two scales marked on it; the minims and the milliliter. The milliliter scale
is the one normally used, the minim scale is used for very small dosages.
• Insulin Syringe – is similar to a hypodermic syringe, but the scale is specially
designed for insulin and should be used to administer insulin.
• Tuberculin Syringe – was originally designed to administer tuberculin solution,
a narrow syringe calibrated in tenths and hundredths of a milliliter (up to 1
ml.) in one scale. Can be used for skin testing.

MODULE 10
ADMINISTRATION OF PARENTERAL INJECTION

Medications given parenterally act more quickly than those given orally or
topically and must be prepared using sterile technique. Proper site selection is
essential for intramuscular injection to prevent tissue, bone and tissue damage. The
nurse should always palpate anatomic landmarks when selecting a site. The Z-track
method for intramuscular injection is recommended to prevent discomfort caused
by leakage of irritating and staining medication into subcutaneous tissues. Clients
receiving a series of injections have the injection sites to be rotated.

INTRADERMAL or INTRACUTANEOUS INJECTION

-an introduction of a solution by means of a syringe and needle into
the superficial layer of the skin or just below the epidermis of the
skin.
Purpose:
a.to identify allergens to which the patient may be hypersensitivity
(skin testing)
b. to diagnosis individuals who have develop antibodies against
 specific pathogens such as tubercle bacillus.
c. to vaccinate ex: BCG

Sites of Injection
a.inner surface of the forearm
b.upper chest , if not hairy
c. upper back

Equipment: Hypodermic Tray lined with sterile towel containing:

• medicine ticket
• solution prescribed
• disposable sterile tuberculin syringe
• disposable sterile 2cc syringe
• disposable sterile needle G25-26, 5/”
• disposable sterile aspirating needle
• a jar of cotton ball soaked in 70% ROH
• waste receptacle

Procedures
a. Check for the physician’s order and assemble all equipment.
Rationale: To ensure the patient receives the right medication at the right
time in the proper route.
b. Assess patient’s history of allergies and note the substances the patient is
allergic to and normal allergic reaction.
Rationale: The nurse should not administer a substance if the patient is
known to be allergic to prevent its occurrence.
c. Wash your hands and assemble all equipment.
Rationale: Hand washing deters the spread of microorganisms.
d. Follow the Ten Right in giving medications
Rationale: Promotes the patient’s safety by preventing medical error.
e. Pick up a syringe and attach the aspirating needle.
Rationale: This prevents contamination of the needle and syringe.
f. Proceed as in the procedure of preparing \withdrawing a drug from
ampoule\vial.
Rationale: Pharmaceutical products for parenteral administration are supplied
in various containers
To prepare for a skin test, withdraw 0.9cc of the diluents and 0.1cc
of the prescribed medicine.
g. Change the aspirating needle with G25 \26 needle and maintain sterility by
retaining the cap of the needle and placing it on top of the hypo towel.
h. Present preparation to C.I. for checking together with the empty ampoule or
vial of the drug prepared and pink booklet for signing.
Rationale: This guards against error in medication.
i. Carry a tray to the patient's room and identify and explain the procedure.
Rationale: This prevents error in medication, an explanation encourages the
patient cooperation and reduces apprehension.
j. Select an area on the inner aspect of the forearm (or other appropriate site)
 Rationale: The forearm is a convenient and easy location for introducing an
agent intradermal.
k. Cleanse the area with a cotton ball soaked in 70% alcohol wiping with firm
circular motion moving outward from the injection site. Discard the cotton
ball and allow the skin to dry.
Rationale: Pathogens from the skin can be forced into the tissues by the
needle, drying the skin will prevent introducing alcohol into the tissues during
injection as alcohol is irritating and makes patients uncomfortable.
l. Pick up a syringe and remove the cap, with your non-dominant hand to grasp
the dorsal forearm and gently pull the skin taut.
Rationale: Taut skin provides an easy entrance into intradermal tissue.
m. Place the needle 5-15 angle against the patient’s skin, with bevel side up,
insert the needle beneath the skin so that point of the needle can be seen
through the skin. Insert the needle only 1/8 inch.
Rationale: Intradermal tissue will be entered when the needle is held as
near parallel to the skin as possible and inserted about 1\8 inch.
n. Slowly inject the agent while watching for small wheals or bleb to appear, if
none withdraw the needle slightly.
Rationale: If a small bleb \wheal appears, the agent is in intradermal tissue.
o. Withdraw the needle quickly at the same angle that was inserted.
Rationale: Withdrawing the needle quickly at the angle at which it entered
the skin minimizes tissue damage and discomfort for the patient.
p. Do not massage the area after removing the needle, pat dry, encircle the
wheals with a blue \black pen and instruct the patient or watcher not to
disturb the wheal nor erase the mark and inform the client you will be back
with the physician after 30 minutes.
Rationale: Massaging the area where an intradermal injection is given may
interfere with the result by spreading medication to underlying subcutaneous
tissues. Do not use a red pen that may influence the reading. The physician
will interpret the result of the procedure.
q. Use the fish-hook technique to recap the used needle and place it on top of
the hypodermic towel.
Rationale: Most accidental puncture wounds occur when recapping the
needles. Leaving the needle uncapped protects the nurse from accidental
injury with the needle.
r. Write the time injected, due time and site at the back of the medicine ticket.
Rationale: The nurse considers the well-being of the client.
s. Inform the C.I. of the procedure done, patient’s name, due time, and site.
Endorse the medicine ticket to the nurse-on-duty.
Rationale: Awareness of the procedures done and give time to contact the
physician for interpretation.
t. Leave the medicine ticket and use a syringe on the hypodermic towel for
possible re-skin testing, wash your hands.
Rationale: If the result is doubtful, there may be a need for re-skin testing as
ordered. Hand washing deters the spread of microorganisms.
u. Observe the area for signs of a reaction within 30 minutes. Accompany the
attending physician or ROD to interpret the result
 Rationale; A circle identifies the site of intradermal injection and allows for
careful observation of the exact area.
v. Document in the chart the administration of the medication as to time, name
of the drug, amount and dosage, site of injection, result and the name of the
physician who interpreted the result.
Rationale: Accurate documentation is necessary to prevent a medication
error.

SUBCUTANEOUS or HYPODERMIC INJECTION

is the introduction of a small amount of solution by means of a
syringe and needle into the adipose tissue beneath the skin.

Purpose
a. to deliver medication more rapidly to the bloodstream than oral medication.
b. to allow slower and sustained drug administration than intramuscular
injection
c. to prevent destruction of the drug by the action of digestive secretions.
d. to minimize tissue trauma and avoid the risk of hitting large blood vessels
and nerves.

SPECIAL CONSIDERATIONS
a. If 2’ (5cm) of tissue can be grasped, insert the needle at a 90-degree angle,
if only 1” of tissue can be grasped, use 45-degree angle for the injection.
b. Allergic injection sites should be rotated from one side of the body to the
other.
c. Heparin injections are given in the abdomen on both sides of and below the
umbilicus outside of the radius around the umbilicus from the costal margin to the
iliac crests. Do not aspirate before injecting the heparin.
d. The needle angle used depends on the length of the needle and the
amount of subcutaneous tissue at the site.
e. A record should be kept where each insulin injection is given. Insulin is
absorbed more quickly and uniformly when injected into the abdominal sites.

PRECAUTIONS
a. Subcutaneous injection sites should be rotated.
b. When giving medication other than insulin and heparin , aspirate after
inserting the needle to the site and before injecting the medication.
c. For heparin, the injection site should be rotated within the abdominal area
only alternating from one side to another.
d. For insulin, sites should be rotated in any site within that area.

SITES
a. upper arm
b. thigh
c. lower abdomen
d. upper back
e. upper ventrogluteal and dorsogluteal

EQUIPMENTS
• medicine tray
• injection tray
• syringe
• disposable sterile aspirating needle
• disposable sterile injection needle G255\8 or G 26
• jar with cotton ball soaked in 70% alcohol
• waste receptacle

PROCEDURES
a. Get the medicine ticket and compare with the doctor’s order
R- to ensure that the client receives the right medication at the right time.
b. Wash hands, assemble syringe and needle in the injection tray.
R- sterile items that are out of sight are in danger of being contaminated.
accidentally, prolonged exposure to the air or contact with the surface will
contaminate the needle.
c.Draw drug into the syringe and replace the aspirating needle with the
injecting needles.
d. Together with the medication ticket, present the medication to the C.I. for
checking and signing.
e. Carry a medicine tray to the patient's room and identify and carefully explain what
they are going to do.
R- cooperative is easily gained when the client knows what is to be
performed.
f. Select the site for injection, rotate the sites according to schedule.
R- selecting the site where skin appears to be healthy and free of irritation
and inflammation reduces the discomfort of injections.
g. Cleanse the area to be injected by using firm, circular motion from inside out
using a cotton ball with ROH.
R- friction aids in cleaning the skin. A clean area is contaminated when a
soiled object is rubbed over its surface.
h. Grasp the surrounding site for injection and hold in a cushion fashion.
R-cushioning the subcutaneous tissue helps to ensure having the needle
enter into the connective tissue.
i. Inject the needle quickly at an angle of 30 degrees to 60 degrees, depending on
the amount of the tissue.
R- pain is minimized by inserting the needle without hesitation.
Subcutaneous tissue is abundant in well-nourished, hydrated persons
and scarce in emaciated hydrated one’s
j. Once the needle is in the position, release the grasp of the tissue and hold
the hub of the needle.
R- injecting the solution into compressed tissue results in pressure against
nerve fibers and creates discomfort.
k. Pull back gently the plunger of syringe to determine whether the needle
is in the blood vessel or not.
 R- Blood indicates needle is placed in a blood vessel where it is
contraindicated to inject the medication.
l. If no blood appears, inject the solution slowly. If blood appears, remove the needle
and replace it with a sterile one before continuing with the procedure.
R- rapid injection may cause discomfort.
m. Rub the area gently with a cotton ball with alcohol, making the client
comfortable. Do not rub if contraindicated like heparin and insulin.
R- rubbing aids in the distribution and absorption of the solution and relieves
discomfort.
n. Turn the medicine ticket in the hypo tray.
R- this indicates the medicine has been administered.
o. Do the after care, wash your hands and record the drugs given.
R- proper disposal of sharps prevents accidental pricks.
-prevents transmission of microorganisms.
-prompt recording prevents chances of error medications.

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

Purpose
a. to allow less painful administration of irritating drugs
b. to allow more rapid absorption of the drug compared to subcutaneous
injection.
c. to administer a large dose (up to 5 ml. in appropriate site) of the medication.
d. to give drugs to clients who cannot take medications orally and for drugs that
are degraded by the digestive juice.

Sites
a.deltoid
b. vastus lateralis
c.rectus femoris
d.dorsogluteal
e.ventrogluteal

EQUIPMENTS
• hypodermic tray lined with sterile towel
• prescribed medication
• medication ticket
• sterile needles for aspirating and for injecting G20-22
• sterile syringe
• jar CB soaked with 70% of alcohol
• waste receptacle
• sharp container
PROCEDURE
a. Get the medicine ticket and compare it with the doctor’s order.
R- to ensure the client receives the right medications at the right time.
b. Wash hands and assemble syringe and needle to be used in the medicine tray
R- sterile items that are out of sight are in danger of being contaminated
accidentally, prolonged exposure to the air and contact with a moist surface
will contaminate the needle.
c. Draw the drug into the syringe and replace the aspirating needle with the injecting
needle.
d. Together with the medication ticket, present to the C.I. for checking and signing.
e. Carry a tray to the client’s bedside and identify and explain what you are going to
do.
R- cooperation is easily gained when the client knows what is to be
performed.
f. Select the site for injection , rotate sites according to schedule.
R- selecting a site where skin appears to be healthy and free of irritation and
inflammation reduces the discomfort of injections
g. Cleanse the area to be injected by using firm, circular motion from inside out
using cotton balls with alcohol.
R- friction aids in cleaning the skin, a clean area is contaminated when a
soiled object is rubbed over its surface.

SITE FOR INJECTION

• VENTROGLUTEAL
place palm of left hand on right greater trochanter so that index
points toward anterior posterior iliac spine, spread first and middle
finger to form a “V” the injection site is the middle of the “V”.

• DORSOGLUTEAL
place hand on the iliac crest and locate the posterior superior iliac
spine, draw an imaginary line between the trochanter and the iliac
spine, the injection site is the outer quadrant.

R- toes pointing inward will relax the muscle of the buttock. Injection
into tense muscle causes pain, good visualization of the buttock aids in
correct location of the site.

Gently tap the selected site of injection with your finger several times.
R- stimulation of the peripheral nerve helps to minimize the initial
reaction when the needle is inserted.
 • DELTOID
locate the lower of the acromial process and measure 2 -3 fingers
breathes, inject just below that area.
R- this is the densest site containing no major blood vessels and
nerves.

• VASTUS LATERALIS\ RECTUS FEMORIS

locate the middle outer third of the tight by dividing the tight into 3
parts and drawing a longitudinal line from the greater trochanter of
the femur down to the knee.
R- this area contains big muscle.

Cleanse the area thoroughly using cotton ball with alcohol from the
proposed site of injection going outside in a circular motion
R- pathogens present in the skin can be forced into the tissue
by the needle.

Z-TECHNIQUE OF INTRAMUSCULAR INJECTION

Introduction of an oily viscous medication deep into the muscle tissue using
the chosen muscle site. It is used with certain drugs that irritate and discolor
subcutaneous tissues.

PROCEDURES
a. Get the medication ticket and compare it with the doctor’s order.
R- ensure the client receives the right medication at the right time.
b. Wash hands and assemble syringe and needle to be used in the injection tray.
R- sterile items that are out of sight are in danger of being contaminated
accidentally.
c. Prolonged exposure to the air or in contact with a moist surface will contaminate
the needle.
d. Draw the drug into the syringe and replace the aspirating needle with the injecting
needle.
e. Together with the medication ticket present the medication to the C.I. for
checking and signing.
f. Carry a tray to the client's bedside, identify the client and explain what you are
going to do.
R- cooperation is easily gained when the client knows what is to be
performed.
g. Select the site for injection, rotate the site according to the schedule.
R- selecting the site where the skin appears to be healthy and free of
irritation and inflammation reduces the discomfort of injection.
h. Cleanse the area to be injected by using firm, circular motion from inside out
using cotton balls with alcohol.
R- friction aids in cleaning the skin. A clean skin is contaminated when a
soiled object is rubbed over the surface.
i. Using the thumb and forefinger make a movement forming Z on the muscle. Inject
the needle slowly into the muscle at 90-degree angle. Withdraw the needle and
release the muscle gradually after the needle is withdrawn
R- Z-track method prevents leakage and tracking into the subcutaneous
tissue. Gradual release of muscle after the needle is withdrawn facilitates
drug absorption.
j. Steady the syringe and aspirate for blood, if with blood, withdraw the
needle and dispose of the syringe and needle. Have another new set of
syringe for injection.
R- Blood indicates needle is placed in a blood vessel where it is
contraindicated to inject the medication.
k. If without blood, slowly inject the medication, wait for 10 seconds before
withdrawing the needle.
R- injecting medication slowly allows the tissue to absorb the medication and
prevents untoward bruising. Waiting for 10 seconds allows time for the
medication to dispense into the tissue, helping prevent from traveling back
up the needle track.
l. Withdraw the needle while releasing the tissue. Gently wipe the site
with alcohol swab.DO NOT MASSAGE THE SITE. Use alternate site for
subsequent injections.
R- letting go of the tissue while withdrawing the needle disrupts the path of
the needle track, preventing the medication from travelling to the skin
surface.
m. Make the patient comfortable.
n. Turn the medication ticket to the hypo tray.
R- indicates the medicine has been administered.
o. Do the after care, wash hands and do the proper documentation stating name of
the drug, time, amount, site and reaction or response to treatment.
R- proper disposal of sharp objects prevents accidental pricks.
-prompt recording prevents chances of error in medication.

MODULE 8
ADMINISTRATION OF RECTAL MEDICATION

Rectal administration is a convenient and safe method of giving certain medication, insertion of
medication into the rectum in the form of suppository is a frequent practice. Rectal suppository
is a small, solid, medicated mass, usually cone shaped with a cocoa butter or glycerin base and
melt at body temperature and are absorbed slowly. Rectal suppository commonly contains
drugs that reduce fever, induce relaxation, interact poorly with digestive enzymes and have a
taste too offensive for oral use.

Contraindication in Insertion of Rectal Suppository

d. patient with potential cardiac arrhythmias because suppository
stimulate vagus nerve
e. recent rectal surgery
f. prostate surgery – risk for rectal trauma
- discomfort
 Rectal Ointment
- is a semi solid medication used to produce local effects.
-applied externally to the anus or internally to the rectum.
- commonly contain drugs that reduce inflammation or relieve pain and itching.

Advantage of Rectal Administration

e. avoid irritation of the upper gastrointestinal tract of the client.
f. when the medication has an objectionable taste or odor.
g. drugs are reduced at a slow but steady rate.
h. provide a higher blood stream level of medication because of venous
blood from the lower rectum is not transported through the liver.

Special Considerations
d. Intake of foods and fluids stimulates peristalsis, suppository for relieving
constipation should be inserted about 30 minutes before mealtime to
help soften the feces in the rectum and facilitate defecation.
Medicated retention suppository should be inserted between meals.
e. Make sure patient’s bell is within rich or signal light because client may
unable to suppress the urge to defecate
f. Inform the client that the suppository may dissolve for next bowel
movement that gives a silver gray pasty appearance.

Equipment: A tray containing the following

• rectal suppository
• disposable gloves
• tissue paper

Procedure:
q. Verify doctor’s order.
r. Wash your hands.
s. Prepare the materials needed.
t. Confirm patient’s identity
u. Explain the procedure and the purpose of the medication to the client .
v. Provide privacy.
w. Place the client on her\his left side in sim’s position. Drape with bedcover
to expose only the buttocks.
Rationale: It helps to relax the external anal sphincter, draping maintains
privacy and facilitate relaxation.
x. Put on the gloves.
y. Remove the suppository from the foil wrapper.
z. Instruct the client to take a deep breath through the mouth.
Rationale; This usually relaxes the external anal sphincter and discomfort
during insertion.
aa. Retract client’s buttock with your non-dominant hand, using the index finger
of your dominant hand insert the suppository gently through the anus pass
the internal sphincter and against the rectal wall.

10 cm (4 inches) in adult
 5 cm (2 inches) infant and children

bb. Withdraw your finger and wipe client’s anal with toilet paper, press client’s
buttock together for several seconds.
Rationale: This helps minimize any urge to expel the suppository.
cc. Remove gloves inside out, do the after care and wash your hands.
dd. Ask the client to remain flat in the left lateral position for at least 5 minutes.
Rationale; The suppository should be retained at least 30 to 40 minutes.
ee. If client has been given a laxative suppository, place the call light within
client reach.
ff. Document all nursing assessment and intervention relative to the procedures
that includes the suppository given name of the drug, time given, time
expelled and client response.

MODULE 9

ASPIRATION OF DRUG FROM AMPULE AND VIAL

Ampoules and vials are frequently used to package sterile parenteral

medication. Ampoule is a glass container usually designed to hold a single dose of
the drug. It is made up of clear glass and has a distinctive shape with a constricted
neck. Ampoule vary in size from I to 10 ml. or more. Most ampoule necks have
colored marks around them indicating where they are pre scored for easy opening.
Vials are small glass bottles with a sealed rubber cap. Vials come in different
sizes, from single to multi-dose vials. They usually have a metal of plastic cap that
protects the rubber seal and must be removed to access the medication. To access
the medication in the vial, the vial must be pierced with a needle. In addition, air
must be injected into the vial before the medication can be withdrawn. Failure to
inject air before withdrawing the medication leaves a vacuum within the vial that
makes withdrawal difficult.

Ampoule – is a small glass container for individual doses of liquid medication.

f. Before preparing to open the ampoule, make sure that drug content is in the
ampoule not in the stem.
Rationale: The drug tends to be trapped in the stem, which may cause
tapping the stem several times to help bring the solution down.
g. Wipe the neck of the ampoule with a cotton ball soaked in 70% alcohol.
Rationale: Wiping the ampoule with an antiseptic solution is to remove the
dust that might lodged in it.
h. Use sterile gauze or dry cotton balls to hold ampoule while braking to
protect the finger.
 Rationale: Sterile material is needed because it is in direct contact with the
opening of the ampoule when the stem is removed.
i. Discard the gauze, cotton balls and stem and put the ampoule down.
j. To remove the drug, insert the needle into the ampoule and withdraw the
solution by not touching the mouth of the ampoule with the needle in order
to minimize chances of contamination.
Rationale: The fluid in the ampoule is immediately displaced by air,
therefore, there is no resistance to its withdrawal.

Vial- a medication container with a sealed rubber cap for single or multiple doses.

d. Remove a metal cap by means of a file.

Rationale: This exposes the rubber part which is the means of entrance into the vial
e. Cleanse rubber cap with cotton ball soaked in 70% alcohol and inject air
of the same amount as the solution to be withdrawn.
Rationale: This increases pressure within the vial and the drug can be withdrawn
easily since fluids move from the area of greater pressure to an area of lesser
pressure.
f. Hold the plunger firmly when withdrawing drugs from a vial especially when
the solution is in large amounts.

Syringe- is a device used for injecting, removing or infusing fluids, most common
known in health care settings for injecting medications and for use in removing
blood from the body. Syringe can differ in size and type and they can be made of
glass or plastic. The syringe consists of plunger, barrel, hub, needle and the
needle’s protective cover. It is important that all parts of a syringe coming into
contact with the body be kept free of contamination.

Three Parts of Syringes

• TIP – which connects with the needle
• BARREL – the outside part on which the scales are printed, usually calibrated
in tenths ( a tenth is equal to 0.1 milliliters) to make a precise measurement
of the quantity of the fluid to be given or removed. The barrel can range in
size from 0.5 to 50 ml.
- part of the syringe that contains the fluids, whether it is a
medication, blood or a solution drawn from the body.
• PLUNGER- which fits the barrel is located at the end of the syringe and can
be made of clouded or colored glass or plastic. Its purpose is to fill or empty
the barrel. The plunger is pulled back to fill the barrel and is pushed forward
for emptying.

Parts of the Needle

HUB – which fits onto the syringe
CANNULA / SHAFT – which attached to the hub
BEVEL – which is the slanted part of the tip of the needle

Different Kinds of Syringes

The three most commonly used types are:
• Hypodermic Syringe – comes in 2, 2.5, 3 and 5 ml. sizes The syringe may
have two scales marked on it; the minims and the milliliter. The milliliter scale
is the one normally used, the minim scale is used for very small dosages.
• Insulin Syringe – is similar to a hypodermic syringe, but the scale is specially
designed for insulin and should be used to administer insulin.
• Tuberculin Syringe – was originally designed to administer tuberculin solution,
a narrow syringe calibrated in tenths and hundredths of a milliliter (up to 1
ml.) in one scale. Can be used for skin testing.

MODULE 10
ADMINISTRATION OF PARENTERAL INJECTION

Medications given parenterally act more quickly than those given orally or
topically and must be prepared using sterile technique. Proper site selection is
essential for intramuscular injection to prevent tissue, bone and tissue damage. The
nurse should always palpate anatomic landmarks when selecting a site. The Z-track
method for intramuscular injection is recommended to prevent discomfort caused
by leakage of irritating and staining medication into subcutaneous tissues. Clients
receiving a series of injections have the injection sites to be rotated.

INTRADERMAL or INTRACUTANEOUS INJECTION

-an introduction of a solution by means of a syringe and needle into
the superficial layer of the skin or just below the epidermis of the
skin.
Purpose:
a.to identify allergens to which the patient may be hypersensitivity
(skin testing)
b. to diagnosis individuals who have develop antibodies against
specific pathogens such as tubercle bacillus.
c. to vaccinate ex: BCG

Sites of Injection
a.inner surface of the forearm
b.upper chest , if not hairy
c. upper back

Equipment: Hypodermic Tray lined with sterile towel containing:

• medicine ticket
• solution prescribed
• disposable sterile tuberculin syringe
• disposable sterile 2cc syringe
• disposable sterile needle G25-26, 5/”
• disposable sterile aspirating needle
• a jar of cotton ball soaked in 70% ROH
• waste receptacle
 Procedures
w. Check for the physician’s order and assemble all equipment.
Rationale: To ensure the patient receives the right medication at the right
time in the proper route.
x. Assess patient’s history of allergies and note the substances the patient is
allergic to and normal allergic reaction.
Rationale: The nurse should not administer a substance if the patient is
known to be allergic to prevent its occurrence.
y. Wash your hands and assemble all equipment.
Rationale: Hand washing deters the spread of microorganisms.
z. Follow the Ten Right in giving medications
Rationale: Promotes the patient’s safety by preventing medical error.
aa. Pick up a syringe and attach the aspirating needle.
Rationale: This prevents contamination of the needle and syringe.
bb. Proceed as in the procedure of preparing \withdrawing a drug from
ampoule\vial.
Rationale: Pharmaceutical products for parenteral administration are supplied
in various containers
To prepare for a skin test, withdraw 0.9cc of the diluents and 0.1cc
of the prescribed medicine.
cc. Change the aspirating needle with G25 \26 needle and maintain sterility by
retaining the cap of the needle and placing it on top of the hypo towel.
dd. Present preparation to C.I. for checking together with the empty ampoule or
vial of the drug prepared and pink booklet for signing.
Rationale: This guards against error in medication.
ee. Carry a tray to the patient's room and identify and explain the procedure.
Rationale: This prevents error in medication, an explanation encourages the
patient cooperation and reduces apprehension.
ff. Select an area on the inner aspect of the forearm (or other appropriate site)
Rationale: The forearm is a convenient and easy location for introducing an
agent intradermal.
gg. Cleanse the area with a cotton ball soaked in 70% alcohol wiping with firm
circular motion moving outward from the injection site. Discard the cotton
ball and allow the skin to dry.
Rationale: Pathogens from the skin can be forced into the tissues by the
needle, drying the skin will prevent introducing alcohol into the tissues during
injection as alcohol is irritating and makes patients uncomfortable.
hh. Pick up a syringe and remove the cap, with your non-dominant hand to grasp
the dorsal forearm and gently pull the skin taut.
Rationale: Taut skin provides an easy entrance into intradermal tissue.
ii. Place the needle 5-15 angle against the patient’s skin, with bevel side up,
insert the needle beneath the skin so that point of the needle can be seen
through the skin. Insert the needle only 1/8 inch.
Rationale: Intradermal tissue will be entered when the needle is held as
near parallel to the skin as possible and inserted about 1\8 inch.
jj. Slowly inject the agent while watching for small wheals or bleb to appear, if
none withdraw the needle slightly.
Rationale: If a small bleb \wheal appears, the agent is in intradermal tissue.
 kk. Withdraw the needle quickly at the same angle that was inserted.
Rationale: Withdrawing the needle quickly at the angle at which it entered
the skin minimizes tissue damage and discomfort for the patient.
ll. Do not massage the area after removing the needle, pat dry, encircle the
wheals with a blue \black pen and instruct the patient or watcher not to
disturb the wheal nor erase the mark and inform the client you will be back
with the physician after 30 minutes.
Rationale: Massaging the area where an intradermal injection is given may
interfere with the result by spreading medication to underlying subcutaneous
tissues. Do not use a red pen that may influence the reading. The physician
will interpret the result of the procedure.
mm. Use the fish-hook technique to recap the used needle and place it on
top of the hypodermic towel.
Rationale: Most accidental puncture wounds occur when recapping the
needles. Leaving the needle uncapped protects the nurse from accidental
injury with the needle.
nn. Write the time injected, due time and site at the back of the medicine ticket.
Rationale: The nurse considers the well-being of the client.
oo. Inform the C.I. of the procedure done, patient’s name, due time, and site.
Endorse the medicine ticket to the nurse-on-duty.
Rationale: Awareness of the procedures done and give time to contact the
physician for interpretation.
pp. Leave the medicine ticket and use a syringe on the hypodermic towel for
possible re-skin testing, wash your hands.
Rationale: If the result is doubtful, there may be a need for re-skin testing as
ordered. Hand washing deters the spread of microorganisms.
qq. Observe the area for signs of a reaction within 30 minutes. Accompany the
attending physician or ROD to interpret the result
Rationale; A circle identifies the site of intradermal injection and allows for
careful observation of the exact area.
rr. Document in the chart the administration of the medication as to time, name
of the drug, amount and dosage, site of injection, result and the name of the
physician who interpreted the result.
Rationale: Accurate documentation is necessary to prevent a medication
error.

SUBCUTANEOUS or HYPODERMIC INJECTION

is the introduction of a small amount of solution by means of a
syringe and needle into the adipose tissue beneath the skin.

Purpose
e. to deliver medication more rapidly to the bloodstream than oral medication.
f. to allow slower and sustained drug administration than intramuscular
injection
g. to prevent destruction of the drug by the action of digestive secretions.
h. to minimize tissue trauma and avoid the risk of hitting large blood vessels
and nerves.
SPECIAL CONSIDERATIONS
f. If 2’ (5cm) of tissue can be grasped, insert the needle at a 90-degree angle,
if only 1” of tissue can be grasped, use 45-degree angle for the injection.
g. Allergic injection sites should be rotated from one side of the body to the
other.
h. Heparin injections are given in the abdomen on both sides of and below the
umbilicus outside of the radius around the umbilicus from the costal margin to the
iliac crests. Do not aspirate before injecting the heparin.
i. The needle angle used depends on the length of the needle and the
amount of subcutaneous tissue at the site.
j. A record should be kept where each insulin injection is given. Insulin is
absorbed more quickly and uniformly when injected into the abdominal sites.

PRECAUTIONS
e. Subcutaneous injection sites should be rotated.
f. When giving medication other than insulin and heparin , aspirate after
inserting the needle to the site and before injecting the medication.
g. For heparin, the injection site should be rotated within the abdominal area
only alternating from one side to another.
h. For insulin, sites should be rotated in any site within that area.

SITES
a. upper arm
b. thigh
c. lower abdomen
d. upper back
e. upper ventrogluteal and dorsogluteal

EQUIPMENTS
• medicine tray
• injection tray
• syringe
• disposable sterile aspirating needle
• disposable sterile injection needle G255\8 or G 26
• jar with cotton ball soaked in 70% alcohol
• waste receptacle

PROCEDURES
a. Get the medicine ticket and compare with the doctor’s order
R- to ensure that the client receives the right medication at the right time.
b. Wash hands, assemble syringe and needle in the injection tray.
R- sterile items that are out of sight are in danger of being contaminated.
accidentally, prolonged exposure to the air or contact with the surface will
contaminate the needle.
c.Draw drug into the syringe and replace the aspirating needle with the
injecting needles.
d. Together with the medication ticket, present the medication to the C.I. for
checking and signing.
e. Carry a medicine tray to the patient's room and identify and carefully explain what
they are going to do.
R- cooperative is easily gained when the client knows what is to be
performed.
f. Select the site for injection, rotate the sites according to schedule.
R- selecting the site where skin appears to be healthy and free of irritation
and inflammation reduces the discomfort of injections.
g. Cleanse the area to be injected by using firm, circular motion from inside out
using a cotton ball with ROH.
R- friction aids in cleaning the skin. A clean area is contaminated when a
soiled object is rubbed over its surface.
h. Grasp the surrounding site for injection and hold in a cushion fashion.
R-cushioning the subcutaneous tissue helps to ensure having the needle
enter into the connective tissue.
i. Inject the needle quickly at an angle of 30 degrees to 60 degrees, depending on
the amount of the tissue.
R- pain is minimized by inserting the needle without hesitation.
Subcutaneous tissue is abundant in well-nourished, hydrated persons
and scarce in emaciated hydrated one’s
j. Once the needle is in the position, release the grasp of the tissue and hold
the hub of the needle.
R- injecting the solution into compressed tissue results in pressure against
nerve fibers and creates discomfort.
k. Pull back gently the plunger of syringe to determine whether the needle
is in the blood vessel or not.
R- Blood indicates needle is placed in a blood vessel where it is
contraindicated to inject the medication.
l. If no blood appears, inject the solution slowly. If blood appears, remove the needle
and replace it with a sterile one before continuing with the procedure.
R- rapid injection may cause discomfort.
m. Rub the area gently with a cotton ball with alcohol, making the client
comfortable. Do not rub if contraindicated like heparin and insulin.
R- rubbing aids in the distribution and absorption of the solution and relieves
discomfort.
n. Turn the medicine ticket in the hypo tray.
R- this indicates the medicine has been administered.
o. Do the after care, wash your hands and record the drugs given.
R- proper disposal of sharps prevents accidental pricks.
-prevents transmission of microorganisms.
-prompt recording prevents chances of error medications.

INTRAMUSCULAR INJECTION
is the introduction of medication deep into the muscle tissue
where a large network of blood vessels can absorb it readily and
quickly.
Purpose
e. to allow less painful administration of irritating drugs
f. to allow more rapid absorption of the drug compared to subcutaneous
injection.
g. to administer a large dose (up to 5 ml. in appropriate site) of the medication.
h. to give drugs to clients who cannot take medications orally and for drugs that
are degraded by the digestive juice.

Sites
a.deltoid
b. vastus lateralis
c.rectus femoris
d.dorsogluteal
e.ventrogluteal

EQUIPMENTS
• hypodermic tray lined with sterile towel
• prescribed medication
• medication ticket
• sterile needles for aspirating and for injecting G20-22
• sterile syringe
• jar CB soaked with 70% of alcohol
• waste receptacle
• sharp container

PROCEDURE
a. Get the medicine ticket and compare it with the doctor’s order.
R- to ensure the client receives the right medications at the right time.
b. Wash hands and assemble syringe and needle to be used in the medicine tray
R- sterile items that are out of sight are in danger of being contaminated
accidentally, prolonged exposure to the air and contact with a moist surface
will contaminate the needle.
c. Draw the drug into the syringe and replace the aspirating needle with the injecting
needle.
d. Together with the medication ticket, present to the C.I. for checking and signing.
e. Carry a tray to the client’s bedside and identify and explain what you are going to
do.
R- cooperation is easily gained when the client knows what is to be
performed.
f. Select the site for injection , rotate sites according to schedule.
R- selecting a site where skin appears to be healthy and free of irritation and
inflammation reduces the discomfort of injections
g. Cleanse the area to be injected by using firm, circular motion from inside out
using cotton balls with alcohol.
 R- friction aids in cleaning the skin, a clean area is contaminated when a
soiled object is rubbed over its surface.

SITE FOR INJECTION

• VENTROGLUTEAL
place palm of left hand on right greater trochanter so that index
points toward anterior posterior iliac spine, spread first and middle
finger to form a “V” the injection site is the middle of the “V”.

• DORSOGLUTEAL
place hand on the iliac crest and locate the posterior superior iliac
spine, draw an imaginary line between the trochanter and the iliac
spine, the injection site is the outer quadrant.

R- toes pointing inward will relax the muscle of the buttock. Injection
into tense muscle causes pain, good visualization of the buttock aids in
correct location of the site.

Gently tap the selected site of injection with your finger several times.
R- stimulation of the peripheral nerve helps to minimize the initial
reaction when the needle is inserted.

• DELTOID
locate the lower of the acromial process and measure 2 -3 fingers
breathes, inject just below that area.
R- this is the densest site containing no major blood vessels and
nerves.

• VASTUS LATERALIS\ RECTUS FEMORIS

locate the middle outer third of the tight by dividing the tight into 3
parts and drawing a longitudinal line from the greater trochanter of
the femur down to the knee.
R- this area contains big muscle.

Cleanse the area thoroughly using cotton ball with alcohol from the
proposed site of injection going outside in a circular motion
R- pathogens present in the skin can be forced into the tissue
by the needle.

Z-TECHNIQUE OF INTRAMUSCULAR INJECTION

 Introduction of an oily viscous medication deep into the muscle tissue using
the chosen muscle site. It is used with certain drugs that irritate and discolor
subcutaneous tissues.

PROCEDURES
a. Get the medication ticket and compare it with the doctor’s order.
R- ensure the client receives the right medication at the right time.
b. Wash hands and assemble syringe and needle to be used in the injection tray.
R- sterile items that are out of sight are in danger of being contaminated
accidentally.
c. Prolonged exposure to the air or in contact with a moist surface will contaminate
the needle.
d. Draw the drug into the syringe and replace the aspirating needle with the injecting
needle.
e. Together with the medication ticket present the medication to the C.I. for
checking and signing.
f. Carry a tray to the client's bedside, identify the client and explain what you are
going to do.
R- cooperation is easily gained when the client knows what is to be
performed.
g. Select the site for injection, rotate the site according to the schedule.
R- selecting the site where the skin appears to be healthy and free of
irritation and inflammation reduces the discomfort of injection.
h. Cleanse the area to be injected by using firm, circular motion from inside out
using cotton balls with alcohol.
R- friction aids in cleaning the skin. A clean skin is contaminated when a
soiled object is rubbed over the surface.
i. Using the thumb and forefinger make a movement forming Z on the muscle. Inject
the needle slowly into the muscle at 90-degree angle. Withdraw the needle and
release the muscle gradually after the needle is withdrawn
R- Z-track method prevents leakage and tracking into the subcutaneous
tissue. Gradual release of muscle after the needle is withdrawn facilitates
drug absorption.
j. Steady the syringe and aspirate for blood, if with blood, withdraw the
needle and dispose of the syringe and needle. Have another new set of
syringe for injection.
R- Blood indicates needle is placed in a blood vessel where it is
contraindicated to inject the medication.
k. If without blood, slowly inject the medication, wait for 10 seconds before
withdrawing the needle.
R- injecting medication slowly allows the tissue to absorb the medication and
prevents untoward bruising. Waiting for 10 seconds allows time for the
medication to dispense into the tissue, helping prevent from traveling back
up the needle track.
l. Withdraw the needle while releasing the tissue. Gently wipe the site
with alcohol swab.DO NOT MASSAGE THE SITE. Use alternate site for
subsequent injections.
 R- letting go of the tissue while withdrawing the needle disrupts the path of
the needle track, preventing the medication from travelling to the skin
surface.
m. Make the patient comfortable.
n. Turn the medication ticket to the hypo tray.
R- indicates the medicine has been administered.
o. Do the after care, wash hands and do the proper documentation stating name of
the drug, time, amount, site and reaction or response to treatment.
R- proper disposal of sharp objects prevents accidental pricks.
-prompt recording prevents chances of error in medication.