Why is aspiration not necessary for a sc injection

If the gluteal muscle must be used, care should be taken to define the anatomic landmarks. For toddlers, the anterolateral thigh muscle is preferred, and when this site is used, the needle should be at least 1 inch long.

The deltoid muscle can be used if the muscle mass is adequate. If 2 vaccines are to be administered in a single limb, they should be spaced an inch apart 4 , The anterolateral thigh can also be used In this case the needle length should be 1 inch to 1.

Knowledge of body mass can be useful for estimating the appropriate needle length The deltoid muscle is preferred for adolescents years of age. The anterolateral thigh can also be used.

For injection into the anterolateral thigh, most adolescents will require a For adults, the deltoid muscle is recommended for routine intramuscular vaccinations 23 Figure 3. The anterolateral thigh also can be used.

For men and women who weigh lbs kg , a 1-inch needle is sufficient. For women who weigh lbs kg and men who weigh lbs kg , a 1- to 1. For injection into the anterolateral thigh muscle, a 1.

Subcutaneous injections may be administered into the upper-outer triceps area of an infant if necessary. Rotavirus, adenovirus, cholera vaccine, and oral typhoid vaccines are the only vaccines administered orally in the United States.

Oral typhoid capsules should be administered as directed by the manufacturer. The capsules should not be opened or mixed with any other substance. Rotavirus vaccines are licensed for infants. There are 2 brands of rotavirus vaccine, and they have different types of applicators. Providers should consult package inserts for details. Live attenuated influenza vaccine is approved for healthy nonpregnant persons aged years and is the only vaccine administered by the intranasal route.

The administration device is a nasal sprayer with a dose-divider clip that allows introduction of one 0. The tip should be inserted slightly into the naris before administration. Even if the person coughs or sneezes immediately after administration or the dose is expelled any other way, the vaccine dose need not be repeated 5. Severely immunosuppressed persons i. It would be uncommon for persons with these conditions to be in a role administering vaccines.

Other persons at increased risk for influenza complications can administer LAIV. If multiple vaccines are administered at a single visit, administer each preparation at a different anatomic site Health-care practices should consider using a vaccination site map so that all persons administering vaccines routinely use a particular anatomic site for each particular vaccine.

For infants and younger children, if more than 2 vaccines are injected in a single limb, the thigh is the preferred site because of the greater muscle mass; the injections should be sufficiently separated separate anatomic sites [i. For older children and adults, the deltoid muscle can be used for more than one intramuscular injection. If a vaccine and an immune globulin preparation are administered simultaneously e. Jet injectors are needle-free devices that pressurize liquid medication, forcing it through a nozzle orifice into a narrow stream capable of penetrating skin to deliver a drug or vaccine into intradermal, subcutaneous, or intramuscular tissues Immune responses generated by jet injectors against both attenuated and inactivated viral and bacterial antigens are usually equivalent to, and occasionally greater than, immune responses induced by needle injection.

However, local reactions or injuries e. Multiple use jet injectors using the same nozzle for consecutive injections without intervening sterilization were used in mass vaccination campaigns from the s through the s 33 ; however, these were found to be unsafe because of the possibility of bloodborne pathogen transmission and should not be used. A new generation of jet injectors with disposable cartridges and syringes has been developed since the s.

With a new, sterile dose chamber and nozzle for each patient and correct use, these devices do not have the same safety concerns as multiple-use nozzle jet injectors. Several of the newer devices have been approved by FDA for use with specific vaccines To minimize bruising and pain associated with heparin injections, they can be given in the abdominal area, at least 5 cm away from the belly button.

There are many risks associated with the administration of heparin, including bleeding, hematuria, hematemesis, bleeding gums, and melena. Many agencies use prepackaged heparin syringes. Always follow the standards for safe medication administration when using prefilled syringes.

Low molecular weight heparin LMWH is more effective in some patients. Assess patient conditions prior to administration. Some conditions increase the risk for hemorrhage bleeding , such as recent childbirth, severe diabetes, severe kidney and liver disease, severe traumas, cerebral or aortic aneurysm, cerebral vascular accidents CVA , blood dyscrasias, and severe hypotension.

Over-the-counter OTC herbal medications, such as garlic, ginger, and horse chestnut, may interact with heparin. Data source: Clayton et al. Safety Considerations: Do not aspirate pull back on the plunger after injection. Review lab values and assessment data prior to injection. Avoid sites that are bruised, tender, hard, or swollen. Be vigilant when preparing and administering high-alert medications. Always compare the physician orders with the MAR.

Prepare medication. Perform hand hygiene ; gather supplies. You will need medication syringe, non-sterile gloves, alcohol swab and sterile gauze, Band-Aid. Enter room and introduce yourself. Identify patient using two acceptable identifiers, explain procedure and the medication, and allow patient time to ask questions. Assess patient for any contraindications for the medications. Assessment is a prerequisite to the administration of medications.

Choosing the correct site allows for accurate reading of the test site at the appropriate time. SC site for injection back of upper arm. Clean site with alcohol swab. Remove the needle cap with the non-dominant hand, pulling it straight off. This technique lessens the risk of an accidental needle-stick injury. Grasp or pinch the area surrounding the injection site, or spread the skin taut at the site.

Pinching is advised for thinner patients. Select SC site back of upper arm. Hold the syringe in the dominant hand between the thumb and forefinger. Insert the needle quickly at a to degree angle. Inserting quickly causes less pain to the patient. Subcutaneous tissue is abundant in well-nourished, well-hydrated people. For patients with little subcutaneous tissue, it is best to insert the needle at a degree angle. After the needle is in place, release the tissue.

Move your non-dominant hand to steady and lower the end of the needle. With your dominant hand, inject the medication at a rate of 10 seconds per ml. Avoid moving the syringe.

Keeping the needle steady helps keep the needle in place. SC injection Inject medication. Withdraw the needle quickly at the same angle at which it was inserted, while supporting the surrounding tissue with your non-dominant hand. Withdrawing at the same angle prevents tissue damage and increased pain at the injection site. Using a sterile gauze, apply gentle pressure at the site after the needle is withdrawn. Do not massage the site. Massage is not necessary and can damage underlying tissue. Massaging after a heparin injection can contribute to the formation of a hematoma.

Do not recap the needle. Apply the safety shield or needle guard on needle and dispose in a sharps container. Safety shields and needle guards help prevent accidental needle-stick injuries. SC needle with safety shield Discard syringe in sharps container. Dispose of supplies; remove gloves and perform hand hygiene.

This reduces the risk of infection and the spread of microorganisms. Document procedure and findings according to agency policy.

Timely documentation ensures patient safety. Evaluate patient response to medication. It is important to evaluate the therapeutic effect of the medication and assess for adverse effects. Needles need to be long enough to ensure the drug is injected into the muscle; length depends on:.

Women have more subcutaneous fat than men Zaybak et al, and consideration needs to be given to using longer needles for patients who are obese. PHE recommends that a 25mm or 38mm needle is used in adults. Traditionally nurses have been taught to leave a few millimetres between the skin and the hub of the needle in case the needle breaks off during the injection.

This practice is not evidence based, may cause medication to be delivered into the subcutaneous fat layer and, with modern single-use needles, is no longer necessary Greenway, There is some debate about using alcohol-impregnated swabs to clean injection sites.

PHE suggests that, if a patient is physically clean and generally in good health, swabbing the skin is not required. Follow local policy. It is common practice to draw back on a syringe after the needle is inserted to check whether it is in a blood vessel.

While it is important to aspirate if the DG muscle site is used — because of proximity to the gluteal artery — it is not required for other IM injection sites PHE, ; Malkin, It also notes that gloves do not protect against needle-stick injury.

Nurses need to risk assess individual patients Royal College of Nursing, and be aware of local policies for glove use. Tagged with: Coronavirus zone: medicines management Newly qualified nurses: practical procedures. Sign in or Register a new account to join the discussion. Unfortunately in nursing, we often practice a certain way because that is the way it has always been done. I applaud the work of the researchers who did this study; they are truly moving nursing practice forward based on evidence.

Translating evidence into practice is a series of steps and the researchers have taken the first steps to appraise the evidence and recommend practice changes based on the evidence.

It is up to each of us to take the evidence presented and integrate it into practice.