Modern

approaches to
parenteral
administration
.of drugs
 Routes of Medication Administration

Parenteral medication: administration of a medication

by injection into body tissues

Subcutaneous (SC) – into tissue below dermis of skin

Intramuscular (IM) – into the body muscle

Intravenous (IV) – into a vein

Intradermal (ID)– into the dermis just under the

epidermis
What is an injection?

Injections are sterile solutions,

emulsions or suspensions.

They are prepared by dissolving,

emulsifying or suspending an active
ingredient and any other substances in
water for injection.

Injecting is the act of giving medication

by use of syringe and needle to obtain
the desired therapeutic effect taking into
account the patients safety and comfort
How are drugs for injections presented?

Single dose preparations

a pre - prepared volume of measured drug,
in a syringe for single dose use
i.e. Flu vaccines,
Pneumovax and B12.

Multidose preparations
multi-dose preparations
contain a antimicrobiacteral preservative, are
used on more than the one occasion and great
care is required for its administration but
especially it’s storage between successive
withdrawals i.e
Insulin
 Why give drugs in injection form

Injections usually allow rapid absorption

Can produce blood levels comparable to those

of intravenous bolus injections

Injections can be given from 1ml and up to 2

mils in the Deltoid and up to 3 mls in the
gluteal muscle in adults

Drugs that are altered or not absorbed by

other methods of administration
Needle length and size
For intramuscular injections e.g flu, pneumonia
and B12, the needle should be long enough to
penetrate the muscle and still allow a quarter of
the needle to remain external to the skin

When choosing the needle it is important to

assess the amount of muscle, subcutaneous fat
and weight of the patient - which in the majority
of cases will be a blue needle
Syringes

 Three main parts:

– Barrel – chamber that holds the medication
– Plunger – part within the barrel that moves back
and forth to withdraw and instill medication
– Tip – part that the needle is attached to
 Calibration:
– Syringe sizes from 1 ml to 50 ml
– Measure to a 1/10th or 1/100th depending on
calibration
Needles
 Shaft of the needle
– Length chosen depends on the depth to
which medication will be instilled
– Tip of shaft is beveled or slanted to pierce
the skin more easily

 Gauge:width of the needle (18 – 27

gauge) – a smaller number indicates a
larger diameter and larger lumen inside
the needle
Considerations when choosing a syringe and
needle

 Type of medication
 Depth of tissue penetration required
 Volume of medication
 Viscosity of medication
 Size of the client
Which is which needle?
The correct needle is the key to delivering the drug to
the correct area for the maximum effect with the least
amount of discomfort
The colour at the top of the needle reflects its size
the higher the number the smaller the lumen (bore)

Orange needles = 25 gauge = 10mm long (3/8 inch)

or 16mm long(5/8 inch) or 25mm
long (1 inch)

Blue needles = 23 gauge = 25mm long 9 (1 inch)

Green needles = 21 gauge = 38mm long (1.5 inches)

 Equipment for the administration of injections
Clean tray or receiver in which to place drug and equipment

21g needle to ease reconstitution and drawing up (23g if from a glass

ampoule

Syringe of appropriate size

Swabs saturated with isopropyl alcohol 70%

Sterile topical swab if drug is presented in ampoule form

Drug to be administered

Patients prescription to check dose, route and timing

Notes available to record administration in accordance with law

Gloves, Apron
Clinical room preparation for the administration
of injections
Protocols/procedure/standards information is
available
Hand basin for washing hands and/or alcohol
hand rub.
Area for the client to lie down if unwell
Panic button/phone to call for assistance
sharps container
Gloves
Resuscitation /anaphylaxis equipment/drugs
Oxygen and appropriate mask if available
adequate time for procedure
 Asepsis and reducing the risk of infection

Good hand washing

Good hand drying

Aseptic technique

Good observation and questioning

of the client

Skin preparation if required

The 7 Rights of Drug Administration

 Right client
 Right medication
 Right dose
 Right route
 Right time
 Right reason
 Right documentation
INTRADERMAL INJECTIONS
INTRADERMAL INJECTIONS
Most often used for PPD
Site: the inner aspect of the forearm
Needle size is 25 - 27 gauge, 1/2 to 5/8 inch
Insert needle at 15o angle
Injection made just below the outer layer of skin
If injection does not form a wheal or if bleeding is
noted, the injection was probably too deep and
should be repeated
INTRADERMAL INJECTIONS
Review the provider’s order for accuracy
Ask the patient/parent if the patient is allergic to the
medication
Wash your hands and gather supplies, equipment
Select proper needle size, length and gauge
 INTRADERMAL INJECTIONS
6 Rights of medication administration
Check the expiration date of the medication
Check for discoloration etc., discard if questionable
INTRADERMAL INJECTIONS
Explain procedure to patient/parent
Ask for assistance with children
Position patient appropriately
Prepare injection site with alcohol - air dry
Support skin with thumb
With bevel up, completely insert bevel at a 15 o angle
INTRADERMAL INJECTIONS
Inject medication gently, place a cotton ball over the
site after needle removal
A visual wheal will be produced at the site
Dispose of needle as per policy
Wash hands
Document procedure and patient’s response
INTRADERMAL INJECTIONS
Correct
Incorrect
Technique
Technique
 Little
Tip of resistance
needle can and
be seen
a shallow bulge
 directly
Needlebeneath
insertedthe
too
surface
deep of the skin
 Resistance
- will causeshould
an induration
be felt
that ismedication
when difficult toismeasure
injected
and interpret
 Tense white wheal 5-10
mm in diameter appears at the point of the needle
Subcutaneous
injection
Insulin is the most important
drug in the subcutaneous
injections
 Insulin
Insulin
Indications
Type I diabetes mellitus, type II diabetes mellitus,
hyperkalemia,
Indications DKA/diabetic coma
Type I diabetes mellitus, type II diabetes mellitus, hyperkalemia,
DKA/diabetic coma
MOA
Stimulating
MOA peripheral glucose uptake and inhibiting
hepatic glucose
Stimulating production
peripheral glucose uptake and inhibiting hepatic
glucose production
Patient Info 
 Patient Info 
Hypoglycemia (BG < 70 mg/dL) esp with higher doses
 Hypoglycemia (BG < 70 mg/dL) esp with higher doses
– Anxiety, blurred vision, palpitations, shakiness, slurred
– Anxiety, blurred vision, palpitations, shakiness, slurred
speech,
speech, sweating
sweating
 Weight
Weightgain
gain
Where does it work?
Insulin (cont)

Administration:
 Subcutaneous injection
 Rotate site
 Check blood sugars regularly

Storage:
 Refrigerate until use
 Once vial is punctured, it is good for 28 days
and can be left at room temperature (except
for glargine which is 90 days)
Insulin (cont)

Dosing:
 Starting daily dose: 0.5-1 unit/kg/day in divided doses
 Adjust according to fasting (premeal) blood glucose of 80-130
mg/dL and peak postprandial blood glucose < 180 mg/dL
 Provide 50% as long acting insulin and 50% as prandial insulin
 1 unit of can account for 30 grams of carbohydrate (14-50)
 1 unit can lower 50 mg/dL blood glucose (10-100)

Special Population Consderations:

 Renal dysfunction
– CrCl 10-50 mL/min: 75% of normal dose
– CrCl < 10 ml/min: 25-50% of normal dose; monitor closely
 Exercise??? ---- Acute Stress???
Insulin Action
Rapid/immediate

Intermediate
Blood concentration

Fast

Slow

0 2 4 6 8 10 12 14 16 18 20 22 24

Time (hr)
Insulin Dosing

Long-acting

Long-acting &
Short-acting

Normal insulin secretion

70/30
pre-mixed
Insulin Administration
Insulin (cont)

Cautions/Severe Adverse Reactions

 Severe hypoglycemia (seizure/coma) (BG < 40
mg/dL)
 Edema
 Lipoatrophy or lipohypertropy at injection site

CONTRAINDICATIONS
 Severe hypoglycemia
 Allergy or sensitivity to any ingredient of
the product
SUBCUTANEOUS INJECTION
INTRAMUSCULAR
INJECTION
INTRAMUSCULAR INJECTION
IM INJECTION SITES

Deltoid

Dorsogluteal

Ventrogluteal

Vastus lateralis
DELTOID MUSCLE
GLUTEUS MAXIMUS
GLUTEUS MEDIUS
VASTUS LATERALIS

Institute of Nursing Theory and Practice, Prague

2007
 Intramuscular Injections and Pain

Factors that can cause pain are

The needle
The technique
The speed of the injection
The solution and composition of the drug
The volume of the drug
The approach and attitude of person
administering the injection
 :Questions
?What is an injection .1
Why give drugs in injection .2
?form
How are drugs for injections .3
?presented