13, 22 Although muscle fibers have fewer pain receptors than subcutaneous tissue, patients often report that I.M. Explain the procedure to the patient and gain consent. Intramuscular (IM) injection: A method of administering medication directly into muscle tissue (Macqueen et al 2012). These medications are predominantly administered via injection or continuous infusion. The skin is made up of different layers. May the Z-Tracking Technique to Minimize or Avoid the Pain of Insulin Injection Be an Alternative to the 10-Second Waiting Technique? Aspiration to check whether the needle is in a blood vessel is not necessary (PHE, 2013). Inform the patient that you are going to carry out the injection. Persons administering vaccinations should follow appropriate precautions to minimize risk for disease exposure and spread. Injections are routinely administered by nurses in acute care settings and in the community. Your healthcare provider will show you how to give yourself the injection. Clipboard, Search History, and several other advanced features are temporarily unavailable. Do not massage the area, as this can lead to bruising following administration of heparin (Ogston-Tuck, 2014) and speed up absorption times with insulin (Down and Kirkland, 2012). Author: Eileen Shepherd is clinical editor at Nursing Times. Would you like email updates of new search results? subcutaneous tissue. Ensure the patient is comfortable and wash hands. Injection skill to be demonstrated in NMC OSCE can be a subcutaneous injection or an intramuscular injection. NLM This is the second article in a two-part series on injection techniques. So, administer a very small amount of medication in intradermal injection. 3. Using the correct injection technique and selecting the correct site will minimise the risk of complications. (Before administering an injection of Recommended needle size, length and angle for administering vaccines. J Hosp Med. Nurses † are on call to provide injection help and assistance to patients taking HUMIRA. This includes verbalizing of doctors order, noting of batch number and expiry date, technique of giving injection etc. Hands should be cleansed with an alcohol-based waterless antiseptic hand rub or washed with soap and water before preparing vaccines for administration and between each patient contact (1). Visit our, Injection technique 2: administering drugs via the subcutaneous route, 100 years: Centenary of the nursing register, 2020: International Year of the Nurse and Midwife, Nursing Times Workforce Summit and Awards, Diabetes Care in the UK. Insert the needle at the required angle (usually 90 degree) using a dart-like action. This is to avoid lipohypertrophy. There is debate around the use of alcohol-impregnated swabs to clean injection sites. Factors affecting blood flow to the skin, including exercise and changes in environmental temperature, can affect drug absorption. Dispose of sharps directly into the sharps bin and dispose of the syringe according to local policy. It also notes that gloves do not protect against needlestick injury. In nursing school, I learned to pinch a fold of skin before inserting the needle only if the needle is long or the patient is thin. As the amount of subcutaneous fat varies between patients, individual patient assessment is vital before carrying out the procedure. Use a needle long enough to reach deep into the muscle. This method reduces the risk of inadvertent intramuscular injection when undertaken correctly; however, releasing the skin too quickly before the injection is completed or lifting it incorrectly can increase that risk (Down and Kirkland, 2012). IM injection technique for the deltoid muscle site using the Z-track technique. Some drugs such as heparin come in a pre-loaded syringe and patients prescribed insulin may use insulin delivery devices. The patient’s condition should be individually assessed and local policies should be followed. Unlike muscle, subcutaneous tissue does not have a rich blood supply, and absorption of drugs delivered via that route is therefore slower than via the intramuscular route (see part 1) (Dougherty and Lister, 2015). Wash and dry hands to reduce the risk of infection.  |  Cellulitis; 5. Complications of poorly performed IM injection include: 1. site (shaded area) acromion process (bony prominence . SUBCUTANEOUS MEDICATION Injection technique: Ditch the pinch. After inserting the needle, always withdraw the piston make sure that it is not in a blood vessel in case of intramuscular and subcutaneous injections. doi: 10.1016/S1262-3636(10)70002-1. The nurse will show you the following steps and give you time to practice before you give a subcutaneous injection to your child. Intradermal (ID): The skin layer: used to describe the action of injecting into skin (dermis). Screen the patient to ensure privacy during the procedure. 15. Overview Purpose Some medications are given under the skin in the subcutaneous layer Improper administration can make the medication be too shallow (intradermal) or too deep (intramuscular) Nursing Points General Supplies needed Required medication vial Appropriate size syringe Insulin syringe 1 mL 3 mL Appropriate size needle Alcohol pad Gauze Injection sites Anterolateral thigh Upper […] Needles need to be long enough to inject the drug into the subcutaneous tissue. It is important to verbalize various things while demonstrating this procedure. Wait 10 seconds before withdrawing the needle (Down and Kirkland, 2012) – this will prevent backtracking of the drug (Hunter, 2008) – and then withdraw the needle. 2010 Sep;36 Suppl 2:S3-18.