Route of Parenteral

Administration
Sites of Injection Degree
Angle
Gauge of
Needle
Volume Syringe Nursing Implications
Intradermal (ID)
Intracutaneous (IC)
Skin Test (ST)
Under epidermis into dermis
o inner lower arm
o upper chest and back
o beneath scapulae

Avoid areas
o veins
o lesions (ex. moles)
o redness
o bony prominences if at the
back
10 15
Bevel UP
G 26 27

0.5 in long
0.5 0.1ml

Small volume

Tuberculin Syringe
(small, precise amount)



Allergy Testing check after 30mins for
erythema, pruritis, rashes, increased
circumscribed area
Tuberculin Testing / Mantoux Test
o Use Left Arm
o TB screening for +TB Bacilli
o Read result after 48-72hrs
o Antigen used: PPD
BCG Vaccine
Anti-Rabies vaccine

Inject to form a wheal or bleb
Do not massage to prevent absorption of drug
into subcutaneous.
Subcutaneous
(SC / SQ)

Advantage:
SLOWER absorption
compared to IM

Areas abundant in fat tissues just
below skin (dermis)

o Outer upper arms (lateral)
o Anterior thigh (lateral)
o Abdomen (either side of
umbilicus
o Scapular areas of upper back
o Ventrogluteal and
Dorsogluteal
45
thin client

(stretch,
bunch 1in
tissue)

90
obese clients



G 24 26

0.5 1 in long
0.5 1ml

NOT >1ml
Insulin Syringe

Tuberculin syringe


For Heparin Injection anticoagulant
o Use tuberculin syringe
o Preferred Site: lower abdomen fat pads
below umbilicus
o Always inject at 90degree angle
o Do not aspirate
o Do not massage to prevent hematoma

For Insulin Injection
o Use insulin syringe, G25 5/8 needle
o Inject at 90 degree angle
o Do not aspirate
o Do not massage to prevent hypoglycemia
o Regular Site Rotation to prevent
LIPOHYTROPHY, which makes skin look
lumpy and can delay absorption of insulin.

Anti Measles Virus Vaccine (AMV)

For other medications
o Aspirate before injection to check if blood
vessel had been hit.
o Inject at 45 degree
Intramuscular (IM)


Injected Into muscles
DELTOID
o small muscle and close to
radial nerve and artery
o Mid-deltoid can only
accommodate 1ml of
medication!!!!
o Adult - 2 3 fingers below
acromion process
o Child 1 2 fingers below
acromion process

VENTROGLUTEAL
VON HOCHSTETERS SITE
o Gluteus medius & minimus
o For >1yr and Adults
o Prone or Sidelying with
knees and hips flexed
o Advantages
greater thickness of
tissue and muscle
no large nerves or
blood vessels
less fat
less contaminated
sealed by a bone

DORSOGLUTEAL
o Gluteus medius @ upper
outer quadrant. palpate
posterior iliac crest to
ensure site is high enough
o Same with ventro position
o Not for <3yrs old b/c
muscles not yet developed
unless can walk for a year
o AVOID HITTING SCIATIC
NERVE


90 G 18 21,
15 long


If drug is
viscous,
use G21
Up to 3ml


NOT >3ml
For medications that is irritating to subcutaneous
tissue

Rapid absorption than SC


Z Track Technique
o Deep IM injection (90 degree) without leakage to prevent staining of skin
and tissues from dark-coloured and irritating medications
o Seals drug into muscle
o Patient gets full dose of medication

Drugs given via Z track
o Parenteral Iron Preparation
o Anti-histamine vistaril, hydroxyzine
o Vitamin B12 Cyanocobalamin folic acid derivatives
o Antipsychotic/Neuroleptic Drugs

Procedure
o Ideal Site: Dorsogluteal or Ventrogluteal
o Retract skin laterally, inject medication slowly
o Hold retraction of skin until needle is withdrawn
o Do not massage to prevent leakage into SC


VASTUS LATERALIS
o For neonates and infants
o Position: back-lying or
sitting
o Site: middle third of
anterior lateral thigh
Child upper outer third
Adult middle outer third

RECTUS FEMORIS
o Site: middle third of
anterior thigh (in line with
sciatic nerve)