Angles for inserting injections

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Department of General Medicine

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 intoaccount the patients safety and comfort.

Drugs for injections

Single dose preparations :

Prepared volume of measured amount drug, in a syringe for single dose use. eg:  Flu vaccines, Pneumovax and B12.

Multidose preparations :

Multi-dose preparations contains an antimicrobiacteral preservative, are used more than the one  instance and great care is needed for its administration but especially it’s storage between consecutive withdrawals.  eg :  Insulin.

Reasons for give drug in Injection form

Injected drugs are absorbed directly in to the blood stream and also produces direct results. Injections can be administered from 1ml and up to 2mls in the Deltoid and up to 3 mls in the gluteal muscle in adults. Drugs that are changed or not absorbed by other methods of administration is mainly given via Injected form.

Types of injections:

• Intravenous:  Intravenous route means "within the vein." It usually refers to giving medications or fluids via a needle or tube inserted into a vein.

• Intramuscular: This is the most common way of injecting medication directly into a patient. For rapid absorption of the medicine, this is a very convenient process because the medicine from this injection is inserted directly into the muscle. IM route are the best and the safest way of injecting medication into a patient.

• Subcutaneous: Subcutaneous injection is a useful, safe and convenient method of getting a medication into the body. “Subcutaneous” means under the skin. When perform a subcutaneous injection, use a short needle to inject a drug into the tissue layer between the skin and the muscle.

• Intradermal : It involves the injection of the fluids into the top layer of the skin, which is soft and pliable. Mainly used for treating certain health problems ,including tuberculosis and many allergies.The liquid medicine is inserted as an intradermal injection, which will lie just under the skin surface in between the layers of skin.Very tiny needle inserts the fluid properly under the surface of the skin.

1) Intramuscular (IM) Injections

Injection site:

Given the central and thickest portion of the deltoid muscle – above the level of the armpit and approximately 2–3 finger breadths below the acromion process.To avoid causing an injury, do not inject too high (near the acromion process) or too low.

Needle size:

 22–25 gauge, , 1–1½" needle

Needle insertion :

Use a needle long enough to reach deep in to the muscle.

Insert the needle at an angle of  90° to the skin with a quick thrust.

Separate the two injections given in the same deltoid muscle by a minimum of 1".

2) Subcutaneous (Subcut) Injections

Injection site : A subcutaneous injection is administered as a bolus in to the subcutis ie , the layer of skin directly below the dermis and epidermis, collectively teamed as cutis. Subcutaneous injections are highly effective in administering vaccines and medications such as insulin, diacetylmorphine, morphine,and goserelin.

Needle size  : 23–25 gauge, 5/8" needle.

Needle insertion :

Pinch up on the tissue to prevent injection in to the muscle.

Insert the needle at an angle of  45° to the skin.

Separate the two injections given in the same area of fatty tissue by a minimum of 1".

3) Intravenous Injection

Intravenous injections are taken directly in to a peripheral or central vein of the circulatory system.

Injection site:

Adult intravenous (IV) injection sites include the areas where veins lie close to the skin and are enough to withstand the pressure and volume of an intravenous injection. Usually visible and even tangible to a trained healthcare provider, the peripheral intravenous injection sites are primarily located in the upper extremities or arms. IV sites are located in the legs, but intravenous injection sites in the lower extremities are hard to reach and very painful to use. Central intravenous injection sites are  commonly difficult to reach with a standard IV cannula or a hypodermic needle and usually need placement of an indwelling central catheter such as a subclavian line or PICC line before an administration of IV medication.

Needle size  : Intravenous injectors commonly use shorter needles no larger than 25G. Intravenous injectors use either a tuberculin needle and syringe ( usually called a bluetip because of its color) or a standard insulin set (orange cap).

Needle insertion :

There are two kinds of IV medication administration. An IV “push”- is a one time, rapid injection of medication into the bloodstream and an  IV infusion - is a slow “drip” of medication into the vein over a set period of time, to deliver a constant amount of therapy. Insert the needle at an angle of 25° to the vein.

4)Intradermal

Injection site : Intradermal injection is the injection of medication  into the dermis, just below the epidermis.

Needle size  : Amount to be injected is usually 0.01 - 0.1 cc. Use a tuberculin or 1 cc syringe and 25-27 gauge, 3/8 - 5/8 inch needle.

Needle insertion : The needle has to be inserted into the skin at an angle of  5 to 15-degree.

Reference :

• Medication Administration Techniques  ; Immunization action coalltion.

• How to Administer Intramuscular and Subcutaneous Vaccine Injections to Adults ; Technical content reviewed by the Centers for Disease Control and Prevention.

• How to Administer Intramuscular (IM) Injections;http://www.nmtravelhealth.com.

• Route Of Administration; Vaccine Health Basics WHO.

• Route of administration ; From Wikipedia, the free encyclopedia.

• Intramuscular injection ; The Free Dictionary.