DEFINITIONS

Parenteral Injections

The term parenteral in medical terminology means beyond

the intestine (par = beyond, enteral = intestines)

An injection is a shot, or a dose of medicine given by way of

a syringe and a needle.
WHY PARENTERAL ROUTE?
Rapid
Produces a direct result
Drugs are absorbed directly into the
bloodstream
Types of injections
Intravenous fastest effects
Intramuscular next fastest result
Subcutaneous slower than other two
ADVANTAGES OF PARENTERAL INJECTIONS

• Effective route for drug delivery when the

patients physical or mental state would make
other routes difficult
• Do not irritate the digestive system
• Can deliver a precise dose to a targeted area of
the body (i.e. into a joint or within the spinal
canal)
DISADVANTAGES OF PARENTERAL INJECTIONS

• Patient may have allergic reaction

• Introduction of microorganisms
• Injections can cause injury to tissue, nerves, veins, and
other vessels
• Needle can strike a bone
• Injections can traumatize a vein and cause a possible
hematoma
PARTS
“The SMALLER the
NUMBER, the
LARGER the
GAUGE (inside
diameter)
 TYPES OF PARENTERAL INJECTIONS

1. INTRADERMAL (ID)
2. SUBCUTANEOUS (SC or SQ)
3. INTRAMUSCULAR (IM)
4. INTRAVENOUS (IV)
INTRADERMAL (ID) INJECTIONS

Intradermal injection (also intracutaneous or

intradermic, abbreviated as ID) is a shallow or
superficial injection of a substance into the
dermis, which is located between the epidermis
and the hypodermis.
INDICATIONS
It is commonly used for
tuberculin skin testing (Mantoux Test)
allergy testing
local anesthetics
BCG vaccine
The ID injection route has the longest
absorption time of all parenteral routes
SITES FOR ID INJECTIONS
The dosage of an ID injection is usually
under 0.5 ml. The angle of administration
for an ID injection is 5 to 15 degrees.
SUBCUTANEOUS (SC OR SQ) INJECTIONS

Subcutaneous (SQ or Sub-Q) injection means the

injection is given in the fatty tissue, just under
the skin.
In this type of injection, a short needle is used to
inject a drug into the tissue layer between the
skin and the muscle.
INDICATIONS
small volumes of drugs that require slow absorption and
long duration of action
for medications that must be absorbed into the
bloodstream slowly and steadily
i.e. heparin growth hormones
insulin Live, attenuated injectable vaccines (MMR, varicella)

These injections are given because there is little blood flow to fatty tissue, and
the injected medication is generally absorbed more slowly, sometimes over 24
hours.
SITES FOR SC OR SQ INJECTIONS
Subcutaneous injections
are usually given at a 45-
to 90-degree angle. The
angle is based on the
amount of subcutaneous
tissue present. Generally,
give shorter needles at a
90-degree angle and
longer needles at a 45-
degree angle (Lynn,
2011).
INTRAMUSCULAR (IM) INJECTIONS

The intramuscular (IM) injection route deposits

medication into deep muscle tissue, which has a
rich blood supply, allowing medication to absorb
faster than by the subcutaneous route

An intramuscular injection usually takes 5 to 10 minutes or 1-

2 hours for the muscle to fully absorb the medicine or
vaccine.
INDICATIONS
less painful administration of irritating drugs
rapid absorption of the drug compared to subcutaneous injection
administer large doses (up to 5 ml in appropriate sites) of the
medication
Alternative route for clients cannot take medications orally and
for drugs that are degraded by the digestive juices

The most common medications given by IM route include:

Antibiotics- penicillin G benzathine penicillin, streptomycin.
Biologicals- immunoglobins, vaccines, and toxoids.
Hormonal agents- testosterone, medroxyprogesterone[2]
Ventrogluteal Site
To locate, place the palm of your
hand over the greater trochanter,
with your fingers facing the client’s
head. The right hand is used for the
client’s left hip, or the left hand for
the right hip, to identify landmarks.
Place the index finger on the
anterosuperior iliac spine and
extend the middle finger dorsally,
palpating the iliac crest. A triangle is
formed, and the injection is given in
the center of the triangle.
The ventrogluteal site is located by placing the
palm on the greater trochanter and the index
finger toward the anterosuperior iliac spine.
Vastus lateralis
To locate the site, divide the thigh
into thirds horizontally and vertically
and administer the injection in the
outer middle third. This space
provides a large number of injection
sites. The vastus lateralis site is
particularly desirable for infants and
children, whose gluteal muscles are
developed poorly. Restrain infants
between the nurse’s arm and body
to safely administer an injection
here.
The vastus lateralis site is identified by dividing
the thigh into thirds, horizontally and vertically.
Deltoid Muscle
Locate the deltoid muscle by
palpating the lower edge of the
acromion process. A triangle is
formed at the midpoint in line with
the axilla on the lateral aspect of the
upper arm, with the base of the
triangle at the acromion process.

The deltoid muscle site is located by

palpating the lower edge of the
acromion process.
The dorsogluteal is not the preferred
site due to its proximity to the sciatic
nerve and major blood vessels. If
landmarked correctly however, it is
safe to use. Up to 4mls can be
injected into this site. The patient can
be positioned lying on their stomach
or standing up.
Insert needle at a 90° angle to the skin
with a quick thrust. Retain pressure on
skin around injection site with thumb
and index finger while needle is inserted.
 Z – Technique of Intramuscular Injection

Z – technique intramuscular injection

is the introduction of oily or viscous medication deep into the
muscle tissue.
The technique seals the medication in the chosen muscle site.

Indication:
It is used for certain drugs that irritate and discolor the
subcutaneous tissues. It provides less discomfort
and decrease the occurrence of lesions at the injection site (Potter
p.890)
INTRAVENOUS (IV) INJECTIONS

Some medications must be given by an

intravenous (IV) injection or infusion. This
means they’re sent directly into your vein using a
needle or tube. In fact, the term “intravenous”
means “into the vein.”
Drugs administered via intravenous (IV) injection or
infusion do not need to be absorbed, as they are delivered
directly into the bloodstream.
INDICATIONS
Hydration
Emergency medications
Electrolyte replacement
Nutrition (PPN or TPN)
Medication administration
Blood Products Transfusion
Radiological contrast agents
Chemotherapy
About standard IV lines
used for short-term needs
they may be used during a short hospital stay to administer medication
during surgery or to give pain medications, nausea medications, or
antibiotics
used for up to 4 days

Types:
IV push
An IV “push” or “bolus” is a rapid injection of medication. A syringe is
inserted into your catheter to quickly send a one-time dose of a drug into your
bloodstream.

IV infusion
controlled administration of medication into your bloodstream over time.
Pump infusion. The pump is attached to your IV line and
sends medication and a solution, such as sterile saline, into
your catheter in a slow, steady manner.

Drip infusion. This method uses gravity to deliver a

constant amount of medication over a set period of time.
With a drip, the medication and solution drip from a bag
through a tube and into your catheter.
PERIPHERAL LINES
CENTRAL LINE
ARTERIAL LINE
INTRAVENOUS LINE
IV CANNULA
CENTRAL VENOUS CATHETER
CENTRAL LINE
PERIPHERALLY INSERTED CENTRAL
CATHETER (PICC)
ARTERIAL LINE