Injection Techniques

1
Injection Techniques

• Aim
• To gain the knowledge and skills required to
  safely prepare and administer intramuscular and
  subcutaneous injections to children

2
Learning outcomes

• The student will be able to
• Explain the rationale for selecting sites and
  methods for injection
• Demonstrate safe and evidence based techniques in
  SC and IM injection
• Discuss the care and support of the child and
  family

3
Children and injections

• Injections are given only when there is no
  alternative route
• Receiving an injection is one of the most
  traumatic events that children can experience
• Vaccination is by far the most common reason to
  give a child an injection

4
Route of injection

• Intramuscular

• Subcutaneous

• Means in the muscle
• Well perfused so rapid absorption
• Larger area
• Can absorb larger doses

• Means under the skin this is the fatty layer
  of adipose tissue
• Less well perfused so slower, sustained
  absorption

5
SC Method(s)
6
IM Method
7
Z Track technique
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9
Injection sites

• Type of medication and manufacturers instructions
• Size and age of child
• Safe positioning
• Size and condition of muscle
• Frequency or number of injections

10
SC Injection sites
11
IM injection sites

• Adults/adolescents deltoid or antero-lateral
  aspect of the thigh
• Infants antero-lateral aspect of the thigh NEVER
  THE DORSOGLUTEAL SITE
• Infants deltoid?
• gt12 months
• gt15 months (WHO 2005)

12
Positioning
13
Needle size?

• Sometimes come as integral to syringe so no
  option to change
• If drawing up through a rubber bung, replace with
  new needle
• Needle length is important it needs to be long
  enough to reach either subcutaneous tissue or
  muscle
• Remember, needles differ in length and gauge and
  the colour denotes the gauge

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Cleansing of injection site?

• Only if visibly dirty soap and water
• Not necessary to use steri-wipe, but if used it
  must dry

16
Do you need to aspirate?

• No not necessary
• Subject of debate for some time

17
Post injection site care

• Gentle pressure of required
• Do not rub site
• Plasters?

18
Preparation and distraction

• Prepare child and parent where possible
• Must be age appropriate
• Distraction may be used before during and after
  procedure
• For infants and young children, positioning and
  comfort can be helpful
• Toys with noises!

19
Preparation and distraction

• Older children behavioural contracting
  (informal)
• Reward based!
• Visual distraction
• Parental comfort

20
Remember..

• Sometimes preparation does not mean that a child
  (and parent) will not get upset
• Distraction does not work for all children
• Continue to provide comfort and reward

21
References

• Hockenberry, M.J. Wilson, D. (2009) Wongs
  Essentials of Pediatric Nursing 8th Edition. St
  Louis Mosby
• Perry, A., Potter, P. Ostendorf. (2014)
  Clinical Nursing Skills and Techniques 8th
  Edition. St Louis Mosby
• RCPCH (2002) Position Statement on Injection
  Technique. London RCPCH
• Cocoman, A. Murray, J.(2006) IM Injections
  Hows your technique? online http//www.inmo.ie/
  MagazineArticle/PrintArticle/5676 accessed
  30/7/2013
• HPA (2013) Correct Administration of vaccines
  online http//www.hpa.org.uk/EventsProfessionalT
  raining/HealthProtectionAcademy/AdditionalOpportun
  itiesAndInformation/ImmunisationTrainingResources/
  hpacadvacc05SlideSetsforCoreCurriculumTeaching/
  accessed 30/07/2013
• Paediatric Nursing practice guide (year)
  Intramuscular injection technique. Paediatric
  Nursing. 19(2) p. 37
• Hunter, J. (2008) Subcutaneous injection
  technique. Nursing Standard. 22(21) pp. 41-44
• Workman, B. (1999) Safe injection techniques.
  Nursing Standard. 13(39) pp. 47-53.
• Department of Health (2013) Immunisation against
  infectious disease Green book online
  https//www.gov.uk/government/organisations/public
  -health-england/series/immunisation-against-infect
  ious-disease-the-green-book accessed 30/7/2013