Routes of injections
IM
Periorbital
IV
Subconjunctival
Fastes absoprtion to slowest absorption
Intravenous > Inhalation > Intraperitoneal > Intramuscular > Subcutaneous > Oral > Topical
6 rights of medication administration
- The right patient
-always confirm ID with full name and DOB - The right DRUG
– Always confirm correct drug, confirm name when you receive order, prep it, and before
you administer it - The right ROUTE
– Always confirm the route in which you are to give the medicine - The right TIME
– Always confirm when the patient is to get the medicine (usually immediately in office) - The right DOSE
– Always confirm the dose matches what was ordered or if it is correct - The right DOCUMENTATION
– Always immediately and completely document all details in the medical record,
including how the drug was tolerated
Steps to administer injections
• Wear gloves and prep skin
• Choose the appropriate needle
– Deeper the injection = Larger the gauge & longer the needle
• IM: 1-1½ inch 20-23 gauge
• SQ & Subconj: 1/2 ȯ 5/8 inch 25-27 gauge
• Aspirate
– Pull back on plunger prior to injection
– Ensure the needle is in the proper structure (i.e. muscle, vein, tissue)
Complications of injections
– Severe pain – Tingling or numbness – Redness, warmth, swelling, or drainage – Prolonged bleeding – Allergic reaction
Uses of IM injections
deliver a medication deep into the muscle,
allowing it to absorb quickly into the bloodstream
When to use IM instead of IV
when some drugs irritate the veins, when veins cannot
be located, when oral medication can destroy the GI system, or when a faster
absorption rate is required
Administration of IM injections
Deltoid, vastus lateralis, ventrogluteal, dorsogluteal
Quantity of IM injection
– Deltoid & Thigh: <2mL
– Gluteal muscles: <5mL
– Infants: <0.5mL; Children <5: 1mL; Children >5: <2mL
Administration of IM injection into the deltoid
- Feel for the acromion process (top of upper arm)
- Two finger widths below the acromion process
- Squeeze or pull down to create tension on the triangle (decrease pain upon injection
- Give the injection within the triangle
Anaphylaxis and vaccines
Administration of vastus lateralis muscle of the thigh
- Divide the upper thigh into three parts - locate the middle of the sections
- Injection goes within the outer top portion
Anaphylaxis and medication
Administration of injection into the ventrogluteal muscle of the hip
• Safest for adults and children >7 months old (deep & far from major structures)
• Place heel of hand on the hip
– Fingers pointing upwards toward their head
• Thumb towards groin
• Pelvis under the pinky finger
• spread index and middle finger into a V
• Inject into the middle of the
Dorsogluteal muscle of the buttocks injection
- Historically most common, though dangerous due to major structures
- Do NOT use this for infants or children <3 years old (underdeveloped muscles)
- Expose one side of the buttocks
- Draw an imaginary line from the coccyx to the side of the body
- Find the middle of the line and go up 3 inches • Draw another line down across the first (halfway down the buttock)
- The upper-outer square has a curved bone
- The injection goes below the curved bone
Optometric use of IM injections
Infections
-gonococcal=IM Rocephin
Muscular disturbances and migraines
-blepharospasm, hemifacial sopams, EOM disturbances
Periorbital injection
Injections into the periorbital area skin can be either intradermal (creates a wheal)
or subcutaneous (deeper into the dermis)
– Eyelid = ALWAYS intradermal
• The eyelid has little dermis
• The eyelid is the thinnest skin in the body
Eyelid injection is always
Intradermal
Anatomy of eyelid and periorbital injection
– Tissue is very thin (4-5 cell layers thick)
– Uniform depth
– Takes 5-7 days to replicate
– Very little fat
• Less atrophy and resultant dimples – Potential space between epidermis and dermis
• Small amount of anesthetic for large space – Try to stay 2mm from the margin and 2mm from the brow if possible
Malar mound s
AKA festoons
Droopy lower lids
Supraorbital nerve block
• Palpate to find supraorbital foramen
– 2-3cm lateral to midline of face at inferior edge of supraorbital ridge
• Insert the needle laterally right above the eyebrow
– Bevel up***
– Aspirate to ensure location
– Inject ~1mL of anesthetic
• Place a finger below the superior orbital rim
– Prevents ballooning of anesthetic
• Gently massage
• Uses:
– Upper eyelid lacerations
Infraorbital nerve block
Unconventional method
• Palpate to find infraorbital foramen
– 2-3cm lateral to midline of face at inferior edge of infraorbital ridge
• Place a finger over the foramen to ensure the needle
does not go into the canal
• Insert the needle laterally to the side of your finger
– Bevel up*** – Aspirate to ensure location – Inject ~1mL of anesthetic
• Gently massage
• Uses:
– Lower eyelid lacerations
Lesion removal periorbital
– Intradermal injection • Mark lesion before injection to ensure original borders • Insert the needle laterally at 5-10* – Bevel up*** – Aspirate to ensure location – Inject ~1mL of anesthetic • Gently massage • Uses: – Individual lesion removal
Injecting while advancing the needle
IV injection with systemic side effects can happen
-inject only while withdrawing the needle
Failure to wait for anesthetic or hemostatic effect
Inadequte anesthesia or hemostasis
Wait 4-5m after injection for medication to work
Injecting directly into an infected areas
Inadequate anesthesia and potential spread of infection
Inject around the area and do NOT use epinephrine
