NURSING PROCEDURE IM/IV/SC.

INJECTION

Injection Type and Sites

 An injection is the introduction of a drug, vaccine, liquid, and
another therapeutic agent into the body using a needle and
syringe.

A needle and syringe are used for an injection, it is a way of

administering a liquid to a patient.

Types of Injection
 

The four most frequently used types of injection are-

1. Intravenous Injection
 

The abbreviation of intravenous injection is IV. This route is the

fastest way to send medication and deliver fluids directly into a
vein.

Intravenous (IV) injection or infusion; medication sent directly into

vein using a needle or tube.

 
2.Intramuscular Injection
The abbreviation of intramuscular injection is IM. This route is
used for the Injection of a substance into muscle

3. Subcutaneous Injection
 The abbreviation for subcutaneous injection is SC.

 For SC injection, the short needle is used to give medication into

the layer between the skin and muscle.

 4. Intradermal Injection

 The abbreviation of Intradermal injection is ID. This route is used
to deliver medication into the dermis or the skin layer underneath
the epidermis.

The angle of Injection for Administration

 There are recommended degrees of angle for the administration
of the injection -
1. Intramuscular (IM) injection
 

Angle for IM injection at a 90-degree, administer into the muscle.

2. Subcutaneous (SC) injection
 Angle for SC injection at a 45-degree or 90 degree.
 3. Intravenous (IV) injection

IV route is used to send medication directly into the vein using a

needle at a 25-degree angle.

 4. Intradermal (ID) injection

Angle for ID injection at 10 to15-degree angles, inject medication

into the dermis with the needle.

 Understand Layers of Skin

 There are mainly 3 layers of skin-
 1. Epidermis

 Epidermis is the outer layer of skin, that visible to your eye.

 2. Dermis

 Dermis layer of skin lies beneath the epidermis and above

subcutaneous layer.

 3. Subcutaneous/ Hypodermis

Subcutaneous layer directly below the dermis, it is the innermost

layer of the skin, attach to skeletal muscle and bone.
Sites of Injection Administration
 1. Site for Intramuscular Injection – IM Route

 IM injection sites are –

 1. Deltoid Muscle

 The deltoid muscle is the muscle of the upper Arm, this site is
most typically used for vaccines.
To find the correct site to give the injection is two finger widths
below the acromion process.

At below of two fingers, make an upside-down triangle, make V-

shape, give the injection in the center of the triangle.

2. Vastus lateralis Muscle

 The Vastus lateralis muscle of the thigh is commonly used for

immunizations in infants.

 To find an area of injection.- divided the upper thigh into three
parts; the injection given into the outer top portion of the middle
section.

 3. Ventrogluteal Muscle

 Ventrogluteal muscle is the muscles of the hip.

To find the correct area of injection, place your hand on the hip of
the person receiving an injection, with the fingers pointing towards
it.

Spread your index and middle finger to create  V-shape,  and

inject the needle into the middle of that "V shape".

 4. Dorsal gluteal Muscle

 The dorsal gluteal muscle is a muscle of the buttock.

Note – Keep in mind, there is a risk of potential injury to

the sciatic nerve. So, administer injection correct site.
 2. Site for Subcutaneous Injection 
Subcutaneous injection sites are-

 1. Arm; back or side of the upper arm

2. Abdomen; 2-inch area away around the navel

3. Thigh; front of the thigh 

For example -  Insulin is administered via the subcutaneous

layer.

 3. Site for Intravenous Injection

IV injection sites are-

 With standard IV administration; a needle is usually inserted into

a vein in the wrist, back of the hand elbow, and the outer surface
of the foot.

Intravenous injection site most often placed in the back of the

hand, on the forearm; inside of the elbow.

  4. Sites for Intradermal Injection

 ID injection sites are-
1. Upper arm; BCG injection usually left upper ar 

2. Forearm; Tuberculin Test and allergy testing 

While administering Injection, Healthcare employees should
carefully keep in mind the routes of drug administration according
to medical prescription, to avoid medication errors.

 What equipment is needed for Injections? 

 Equipment needed for injection includes; needles, syringes, and
catheters.

 Choosing Syringe Types, Sizes and Uses

Types of Syringes
 Syringes and needles have an essential role as injection
devices, fluid or biopsy collection (sampling), irrigation, or
suction. Syringes consist of different types of tips. 

Syringes and needles are used to deliver medication from

different routes.

For example,

1. Intramuscular route

Know the intramuscular injection sites to inject the

medication.
 

2. Intradermal route

3. Subcutaneous route

4. Intravenous route

 Types of Syringe Tip
 

 There are 5 common types of syringe tips are-

1. Luer lock tip

2. Luer slip tip

3. Eccentric tip

4. Catheter tip

5. Permanently attached
HEMORRHAGE
 WHAT IS HEMORRHAGE ?
Table of Contents

Table of Contents 

 Causes
 Types
 Symptoms
 Risks
 Treatment
Hemorrhage is another word for bleeding. It most often refers to severe
bleeding, though not all hemorrhages are serious. A hemorrhage can be
internal, such as in the brain or abdomen, or external, from a cut or other
wound to the skin.
This article will discuss what is important to know about what the types of
hemorrhage are, when first aid is appropriate, when emergency medical
treatment is required, and what the risks of serious or fatal hemorrhage are.

Causes
Hemorrhages occur when blood escapes through damaged blood vessels.
They can happen almost anywhere in the body because the circulatory
system delivers blood to every part of it.

Hemorrhages range from slight bleeding from a shaving nick, a bruise due to
bleeding beneath the skin (bruises appear bluish because the skin affects the
way the blood looks), to hemorrhages caused by events like trauma, stroke,
or aneurysm (a bulge in an artery). Commonly, the term applies to sudden
and severe blood loss.

In Americans below the age of 40, hemorrhage that occurs due to trauma,
such as car accidents or gunshot wounds, is the leading cause of death. 1

Types of Hemorrhage
Hemorrhages can be internal or external, and are typically divided into three
types:2

 Arterial hemorrhage: This is usually severe and a medical emergency.

Blood can spurt out in a pulsing rhythm as the heart beats to pump out
blood. Arteries deliver oxygenated blood from the heart to the body. The
oxygen attached to iron-containing hemoglobin in red blood cells gives
arterial blood a bright red color.
  Venous hemorrhage: This can also be severe and life-threatening. Bleeding
is steady rather than pumping. Veins carry blood back toward the heart. The
blood is a darker red because it has less oxygen attached to its hemoglobin.
 Capillary hemorrhage: This is often less serious. Capillaries are small, thin
blood vessels that deliver nutrients through the body, like tributaries from a
river. Blood trickles out of capillaries until the body's clotting agents close
over the wound or cut.

Hemorrhagic Shock
The most serious level of hemorrhage is hemorrhagic shock, which is a
medical emergency that can quickly be fatal.3 Hemorrhagic shock is when
the body loses so much blood that the heart cannot keep up, and vital
systems begin failing.

There are four classes of hemorrhage, categorized by the percentage of

blood volume loss. Blood volume is measured as a percentage of weight, but
a typical 180-pound adult has about 1.5 gallons of blood. 4

Hemorrhagic shock can begin when you lose about 20% of blood volume.
Classes of hemorrhagic according to blood volume loss are: 5

 Class 1: Up to 15% blood loss, heart rate may increase slightly

 Class 2: 15–30% blood loss, causing rapid heartbeat and breathing
 Class 3: 30–40% blood loss, causing an increased heart rate, decreased
blood pressure, changes in mental state, difficulty returning blood to the
capillaries, and decreased urine output
 Class 4: More than 40% blood loss, with a severe drop in blood pressure,
further mental changes, a racing heart, and a possible coma


 Symptoms - External hemorrhage is usually very easy to spot, and

you can identify the source of the bleeding quite quickly. Internal
hemorrhage can be difficult to diagnose, even for medical professionals.
 If an internal injury or illness is causing hemorrhaging, the symptoms depend
on where the hemorrhage is. Some of the symptoms, which can also be
symptoms of shock, are:6

 Dizziness and nausea

 Vomiting blood
 Changes in mental state, sensory capability, and motor skills
 Seizures
 Swelling
 Pale, gray, clammy, or sweaty skin
 Shortness of breath
 Extreme thirst
  Thunderclap headache: Extremely severe headache that peaks within the
first minute, usually due to bleeding next to the brain or spinal cord 7

When to Get Medical Care

Go to the emergency department or call 911 if you think there may be
internal bleeding or you see signs of shock like rapid breathing, pale
skin,confusion, or loss of consciousness. If the person is on blood thinners or
has a bleeding disorder, they also need urgent medical help.

You should get medical help for external hemorrhaging if:6

 Bleeding doesn't stop within about 10 minutes of applying steady pressure

 The wound may need stitches
 A tourniquet has been applied
 The wound contains debris that cannot be easily cleaned
 Bleeding is due to serious injury

See a healthcare provider if you see signs of infection or the injury carries a
risk of infection, including:6

 Redness
 Pain
 The wound oozes pus or fluid
 Swollen glands
 Fever
 Red streaks appear from the wound toward the heart
 Injury is from a bite, whether human or animal
 Tetanus vaccination is not up to date (within the past five to 10 years)

Risks of Hemorrhage
Other than trauma, there are health conditions that increase the risk of serious
hemorrhage. Death from hemorrhage can happen quickly if the blood loss is rapid.
They include:8

 Cancer
 High blood pressure
 Diabetes
 Peptic ulcers (erosions in the lining of the stomach or first part of the
intestine)
 Kidney damage
  Anemia (a low number of healthy red blood cells)
 Alcohol use disorder
 History of stroke (a blockage of blood flow or bleeding in the brain)
  (“blood thinners”) such as Coumadin (warfarin) or aspirin
 Liver disease
 Bleeding disorders such as hemophilia

Postpartum hemorrhage is severe bleeding after the vaginal delivery of a child. It

can be a serious complication and is the leading cause of mortality in childbirth. 9

Treatment
Treatment of a hemorrhage varies according to its severity and location. 10

First aid for minor external bleeding includes:

 Cleaning the affected area with soap and water if possible, or the cleanest
cloth available that will not stick to the wound.
 Keeping direct pressure on the wound using a clean dressing. In most cases,
the pressure will help minor bleeding stop.

In cases of severe external bleeding:11

 Apply direct pressure to the site.

 If necessary, use a tourniquet, which can be life-saving.
 Call 911 and arrange to transport the person to a hospital as quickly as
possible.

A tourniquet should be tied 2 inches above the injury but never over a joint. 11 Use
whatever material is available and tie a simple knot. Insert a stick or rod into the
knot so you can twist and tighten it and maintain pressure.
Internal bleeding cannot be helped by first aid. In hospital and emergency settings,
healthcare professionals will assess the nature and severity of the hemorrhage.
Their goal will be to supply the body with sufficient oxygen while working to control
the bleeding and limit damage to tissues.

A person with severe hemorrhaging may need intravenous (IV) fluids or a blood
transfusion. They may need surgery to stop the hemorrhage. In less severe cases
of external hemorrhage, 
stitches or surgical glue may be used to close a wound.
The “lethal triad” of hemorrhage from trauma, which can quickly result in death,
is acidosis (too much lactic acid in the blood), hypothermia (low body temperature),
and coagulopathy (blood clotting impairment).1

Summary
Hemorrhage is a term for any type of bleeding, but it's most commonly associated
with severe bleeding. External hemorrhages from a cut or wound can be minor or
serious. Minor wounds may respond to pressure and stop bleeding, but steady,
significant bleeding requires urgent medical attention.

Internal hemorrhages cannot be treated by first aid and are medical emergencies.
Significant loss of blood can lead to irreversible damage and death, but not all
hemorrhages are severe.

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