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Inst.: Dr. Ashraf El - Jedi
The needle gauge (diameter) refers to its width. For most injections, 18- to 27-gauge needles are used; the smaller the number, the larger the diameter. For example, an 18-gauge needle is wider than a 27-gauge needle. A wider diameter provides a larger lumen, or opening, through which drugs are administered into the tissue.
4 . Fig.Injection Routes There are four injection routes for parenteral administration: intradermal injections (between the layers of the skin). and intravenous injections (instilled into veins. intramuscular injections (in muscle tissue). subcutaneous injections (beneath the skin but above the muscle). 34-8).
)and intravenous( D .Injection routes: intradermal( A .)subcutaneous( B .)intramuscular and subcutaneous in other than thin persons( C .) 5 .
Small volumes. 6 . Examples include tuberculin tests and allergy testing.01 to 0. are injected because of the small tissue space.05 mL.Intradermal Injections Intradermal injections are commonly used for diagnostic purposes. usually 0.
7 .Injection Sites A common site for an intradermal injection is the inner aspect of the forearm. Other areas that may be used are the back and upper chest.
A 25. It is used to administer intradermal injections.to 27-gauge needle measuring a half-inch in length commonly is used when administering an intradermal injection.Injection Equipment A tuberculin syringe holds 1 mL of fluid and is calibrated in 0. 349).01-mL increments (Fig. 8 .
9 .Figure 34-9 • A tuberculin syringe.
the nurse instills the medication shallowly at a 10to 15-degree angle of entry 10 .Injection Technique When giving an intradermal injection.
The volume of a subcutaneous injection is usually up to 1 mL. 11 . Medication is instilled between the skin and muscle and absorbed fairly rapidly: the medication usually begins acting within 15 to 30 minutes of administration.Subcutaneous Injections A subcutaneous injection is administered more deeply than an intradermal injection. The subcutaneous route commonly is used to administer insulin and heparin.
and outer areas of the thigh and upper buttocks 12 . Additional or alternative injection sites for insulin are the outer back area of the upper arm. where it is fleshier.Injection Sites The preferred site for giving a subcutaneous injection of insulin and heparin is the abdomen.
is recommended rather than rotating to a different area with each injection The rate of drug absorption at various subcutaneous sites from fastest to slowest is abdomen. thighs. and buttocks. preferably the abdomen. arms.Injection Sites Rotating within one injection site. 13 .
Injection Equipment Insulin is prepared in an insulin syringe A 25gauge needle is used most often 14 .
15 . the nurse inserts the needle at a 90-degree angle.Injection Technique To reach subcutaneous tissue in a normal-sized or obese person who has a 2-inch tissue fold when it is bunched. The tissue usually is bunched between the thumb and fingers before administering the injection to avoid instilling insulin within the muscle.
16 .Figure 34-11 • Angles and needle lengths for subcutaneous injections.
Intramuscular Injections An intramuscular injection is the administration of up to 3 mL of medication into one muscle or muscle group. 17 . Because deep muscles have few nerve endings. irritating medications commonly are given intramuscularly.
rectus femoris. ventrogluteal. 18 .Injection Sites The five common intramuscular injection sites are named for the muscles into which the medications are injected: dorsogluteal. vastus lateralis. and deltoid.
19 . The primary muscle in this site is the gluteus maximus. which is large and therefore can hold a fair amount of injected medication with minimal postinjection discomfort.Dorsogluteal Site The dorsogluteal site is the upper outer quadrant of the buttocks and is a common location for intramuscular injections. This site is avoided in clients younger than 3 years because their muscle is not sufficiently developed.
To locate the appropriate landmarks 20 . If the dorsogluteal site is not identified correctly. damage to the sciatic nerve with subsequent paralysis of the leg can result.
Palpate the posterior iliac spine and the greater trochanter. Draw an imaginary diagonal line between the two landmarks. Divide the buttock into four imaginary quadrants. 21 . nsert the needle superiorly and laterally to the midpoint of the diagonal line.
The ventrogluteal site is also safe for use in children.Ventrogluteal Site The ventrogluteal site uses the gluteus medius and gluteus minimus muscles in the hip for injection. 22 . This site has several advantages over the dorsogluteal site: it has no large nerves or blood vessels. and it is usually less fatty and cleaner because fecal contamination is rare at this site.
Inject into the center of the triangle formed by the index finger. middle finger. 23 . To locate the ventrogluteal site: Place the palm of the hand on the greater trochanter and the index finger on the anteriorsuperior iliac spine (Fig. 34-15). Move the middle finger away from the index finger as far as possible along the iliac crest. and iliac crest.
Figure 34-14 • Dorsogluteal site. 24 .
Figure 34-15 • Ventrogluteal site . 25 .
Vastus Lateralis Site The vastus lateralis site uses the vastus lateralis muscle. Large nerves and blood vessels usually are absent in this area. one of the muscles in the quadriceps group of the outer thigh. 26 .
The nurse locates the vastus lateralis site by placing one hand above the knee and one hand just below the greater trochanter at the top of the thigh (Fig. 34-17). 34-16). He or she then inserts the needle into the lateral area of the thigh (Fig. 27 .
Figure 34-16 • Locating the vastus lateralis muscle . 28 .
Figure 34-17 • Spreading the skin at the vastus lateralis site and darting the tissue 29 .
30 . The nurse places an injection in this site in the middle third of the thigh. with the client sitting or supine (Fig. This site may be used for infants. 34-18).Rectus Femoris Site The rectus femoris site is in the anterior aspect of the thigh.
Figure 34-18 • Location of rectus femoris injection site . 31 .
It is used only for adults because the muscle is not sufficiently developed in infants and children. 32 .Deltoid Site The deltoid site in the lateral aspect of the upper arm (Fig. 34-19) is the least-used intramuscular injection site because it is a smaller muscle than the others. intramuscular injections into this site are limited to 1 mL of solution. Because of its small capacity.
Figure 34-19 • Deltoid site. 33 .
Inject in the area between these two landmarks. 34 . sit. or stand with the shoulder well exposed. To use this site safely: Have the client lie down. Draw an imaginary line at the axilla. Palpate the lower edge of the acromion process. There is a risk for damaging the radial nerve and artery if the deltoid site is not well identified.
Injection Technique When administering intramuscular injections. nurses use a 90-degree angle for piercing the skin (Skill 34-3). 35 .
Numb the skin with an ice pack before the injection. Use the Z-track method for intramuscular injections. Rotate injection sites. if appropriate. Apply pressure to the site during needle withdrawal. 36 .Reducing Injection Discomfort Use the smallest-gauge needle that is appropriate. Change the needle before administering a drug that is irritating to tissue. Massage the site afterward. Instill the medication slowly and steadily. Select a site that is free of irritation. Insert and withdraw the needle without hesitation.
Nursing Implications Acute Pain Anxiety Fear Risk for Trauma Deficient Knowledge Ineffective Therapeutic Regimen Management 37 .