Subcutaneous Injection

Subcutaneous injection is an effective method of drug delivery that is used quite frequently in nursing.Objective is to deposit medication into the subcutaneous tissue layers safely, avoiding injury to the patient, while ensuring proper drug absorption after injection.

Sites of Subcutaneous Injection

Subcutaneous Injection Syringe Angles

“Rules of thumb”, for the nurse using this method.

• First, a well-lighted area should be used to assess the site of injection.
• Second, when giving repeated doses on a regular basis, the use of a site rotation chart should be instituted and kept on the Medication

Administration Record (MAR).

• Third, avoiding exposing the needle in the patient’s line of vision decreases level of anxiety.

Additionally, keep in mind the anatomy of the patients receiving the medication:

Obesity requires the use of a longer needle, and elderly people have less subcutaneous tissue stores and less skin elasticity.

Example of Subcutaneous Injection

Insulin is routinely delivered by the subcutaneous injection route.

• Reference should be made to the section on insulin for added information.

• Efficient teaching to diabetic patients is beneficial because most of these patients will be self-administering these medications at home.

Heparin is another medication that is commonly administered by subcutaneous injection.

Some special considerations for heparin, owing to its anticoagulant effects, are

• Site of choice is the abdomen, because the layer of subcutaneous tissue here does not lie over any major muscles, leading to decreased chance of hematoma formation and movement.
• Syringe of Choice is 1/2-inch, 25- to 27-gauge.
• Changing the needle once the medication is drawn up to prevent heparin from remaining in needle, which could lead to inadvertent delivering of the medication into the intradermal tissue.
• Controversial views on aspirating prior to injection (review agency policy on this issue).
• Do not Massage after heparin injection. Massaging the site after injection can increase incidence of bruising.
• Rotation of sites around abdomen to decrease irritation to tissue.

Crah Cart

Crash Cart

A crash cart is a wheeled cabinet or chest of drawers which contains all of the equipment necessary for emergency resuscitation, from latex gloves to a defibrillator. Crash carts are conveniently positioned throughout hospitals and some other medical facilities so that they can be quickly accessed in an emergency.

Parts of Crash Cart

The drawers of a crash cart are clearly organized and labeled, so that medical personnel can grab what they need in a hurry.

Division of Drawers

The drawers are usually divided into adult and child sections, as tools and medical supplies come in different sizes for larger and smaller bodies. Commonly, drawers are divided into cardiac and respiratory sections, and a separate drawer may be used for the storage of drugs used in resuscitation.

Top: For Defibrillator and Cardiac monitor

Drawer1: Medication

Drawer2: Breathing and Airway

Drawer3: Solutions and Tubings

Drawer4: Cardiac and Chest procedure supplies

Note: May change according to hospital policy.

Medication Guide for Nurses

Medication Administration

Guide for Nurses

The ground rules of medication order; for infant, adult or elderly, are same regardless of its route of administration. The nurse must follow these ground rules to ensure the safe medication administration.

General Considerations

1. A medication order must include the patient's full name, the date, and time the order was written, the name of the medicine, the dose, the route, frequency, and signature of the person writing the order.
2. Medications must be checked for the five rights with each administration: right patient, right medication, right dose, right route, and right time.
3. Allergies should be checked prior to each medication administration.
4. Some medications have special administration instructions, such as the patient must remain upright after administration.
5. Many medications are made by more than one company, and may have similar names. if an order is unclear, check with the prescriber before administration.

Special condiderations must be taken for certain age group to ensure safe medication administration.

Special considerations for Paediatric patients

1. Do not refer to medications as candy.
2. For infants, a syringes of droper is the best.
3. Place syringe alongside the tongue to prevent gagging and expulsion of medication.
4. Postion the infant in a semi-reclining posion and administer in small amounts, to prevent chocking.
5. If using a spoon, collect and re-feed expelled medication.
6. Play techniques may help elicit the child's coopoeration.
7. For children taking sweerened medicaitons, especially on a long term basis, follow mendication with oral hygiene to assist in decreasing dental caries.

Special considerations for Elderly patients

The elderly are often on multiple medications from various physicians. Look for possibe drug interactions as well ad prescriptions for more than one drug from the same class (such as bta-blockers).

Routes of Medication Administration

An Overview

Tropical Medication:

Such as lotions, powders, aerosol sprays, patches, pasted, and ointments

1. To create systemic and/or local effects.
2. Maintain skin hydration.
3. Protect skin surfaces.
4. Reduce local skin irritation.
5. Create local anesthesia.
6. Treat local infections.

Special Consideration:
Tropical medications should not be administered if skin integrity is altered, unless otherwise indicated. Skin must be cleaned before application to ensure beneficial therapeutic outcomes.

Rectal Suppository:

Various medications are delivered via rectum and absorbed through mucous membranes of rectum.

1. To produce systemic effects or a local effect on gastrointestinal mucosa.
2. Approach is convenient and safe.
   

Contraindication

Should never be administered to patient with rectal surgery or active rectal bleeding.

Special Consideration:

Should never be forced into a mass of fecal matter.

Subcutaneous Injections:

Deposits medication into the subcutaneous tissue layers.

1. To prevent irritation to the gastrointestinal tract.
2. To prevent destruction of medication by first-pass hepatic effect of gastric juices.
3. To achieve a rapid effect.
   

Contraindication

In circulatory shock, in reduced local tissue perfusion.

Special Consideration:
Check for five rights of medication administration. Review patient's allergies.

Intramuscular Injections
Administer medication into Muscle.

1. This method provides rapid drug absorption because muscle tissue is highly vascular.
2. Muscle is less sensitive to irritating and viscous medications.

Special Consideration:

• If volume of medication exceeds 5ml in adult of 3ml in a child, tow separate injection should b given at different sites.
• If medication is irritating to the tissue, use Z-tract method.

Z-Track Intramuscular Injections:

To administer irritating medication in muscle and prevent seepage to surrounding tissues.

Special Consideration:

• Needle length should be 2" to prevent medication delivery to subcutaneous tissue.
• Viscosity of solution should be considered when selecting gauge of needle.
  

Intra-dermal Injections:

Administers medication into dermal layer of skin.

1. For diagnostic testing for exposure to specific diseases or method of diagnostic testing for allergens
2. For test dose of antibiotics

Special Considerations:

• Patient is related to allergen sensitivity.
• The reaction could be fatal, know the location of resuscitation equipments
• Have appropriate antidotal medications (usually epinephrine hydrochloride, bronchodilator, and antihistamine) available.

Caution:

Avoid use of new products on skin ( i.e., soap or perfumes) or covering injection site with a bandage as these actions may produce false-positive test results.

Intravenous Injections:

Administered directly into the systemic circulation, thus bypassing the absorption phase.

1. Used during emergencies, with critically unstable patients, and as a route when rapid and predictable responses are required.
2. Antibiotic administration.
3. For Blood Transfusion.
4. This route is suitable for Fluids administration.

Special Considerations:

• Check five rights of medication administration.
• Verify allergies of patient.
• Be aware of information about drug before administration; Action, purpose, side effects, normal dosage, nursing implications.

Caution:

Always use medication after verifying expiry date.