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Fundamental Nursing
Chapter 34
Parenteral Medications
Inst.: Dr. Ashraf El - Jedi
Needles

The needle gauge (diameter) refers to its
width. For most injections, 18- to 27-gauge
needles are used; the smaller the number, the
larger the diameter. For example, an 18-gauge
needle is wider than a 27-gauge needle. A
wider diameter provides a larger lumen, or
opening, through which drugs are administered
into the tissue.
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Injection Routes

There are four injection routes for parenteral
administration:
intradermal
injections
(between the layers of the skin), subcutaneous
injections (beneath the skin but above the
muscle), intramuscular injections (in muscle
tissue), and intravenous injections (instilled
into veins; Fig. 34-8).
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Injection routes: intradermal( A ,)subcutaneous( B ,)intramuscular and
subcutaneous in other than thin persons( C ,)and intravenous( D .)
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Intradermal Injections

Intradermal injections are commonly used for
diagnostic purposes. Examples include
tuberculin tests and allergy testing. Small
volumes, usually 0.01 to 0.05 mL, are injected
because of the small tissue space.
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Injection Sites

A common site for an intradermal injection is
the inner aspect of the forearm. Other areas
that may be used are the back and upper chest.
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Injection Equipment

A tuberculin syringe holds 1 mL of fluid and
is calibrated in 0.01-mL increments (Fig. 349). It is used to administer intradermal
injections. A 25- to 27-gauge needle measuring
a half-inch in length commonly is used when
administering an intradermal injection.
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Figure 34-9 • A tuberculin syringe.
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Injection Technique

When giving an intradermal injection, the
nurse instills the medication shallowly at a 10to 15-degree angle of entry
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Subcutaneous Injections

A subcutaneous injection is administered more deeply
than an intradermal injection. Medication is instilled
between the skin and muscle and absorbed fairly
rapidly: the medication usually begins acting within
15 to 30 minutes of administration. The volume of a
subcutaneous injection is usually up to 1 mL. The
subcutaneous route commonly is used to administer
insulin and heparin.
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Injection Sites


The preferred site for giving a subcutaneous
injection of insulin and heparin is the
abdomen.
Additional or alternative injection sites for
insulin are the outer back area of the upper
arm, where it is fleshier, and outer areas of the
thigh and upper buttocks
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Injection Sites


Rotating within one injection site, preferably
the abdomen, is recommended rather than
rotating to a different area with each injection
The rate of drug absorption at various
subcutaneous sites from fastest to slowest is
abdomen, arms, thighs, and buttocks.
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Injection Equipment

Insulin is prepared in an insulin syringe A 25gauge needle is used most often
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Injection Technique


To reach subcutaneous tissue in a normal-sized
or obese person who has a 2-inch tissue fold
when it is bunched, the nurse inserts the needle
at a 90-degree angle.
The tissue usually is bunched between the
thumb and fingers before administering the
injection to avoid instilling insulin within the
muscle.
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Figure 34-11 • Angles and needle lengths for subcutaneous injections.
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Intramuscular Injections

An
intramuscular
injection
is
the
administration of up to 3 mL of medication
into one muscle or muscle group. Because
deep muscles have few nerve endings,
irritating medications commonly are given
intramuscularly.
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Injection Sites

The five common intramuscular injection sites
are named for the muscles into which the
medications are injected: dorsogluteal,
ventrogluteal, vastus lateralis, rectus femoris,
and deltoid.
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Dorsogluteal Site

The dorsogluteal site is the upper outer
quadrant of the buttocks and is a common
location for intramuscular injections. The
primary muscle in this site is the gluteus
maximus, which is large and therefore can
hold a fair amount of injected medication with
minimal postinjection discomfort. This site is
avoided in clients younger than 3 years
because their muscle is not sufficiently
developed.
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
If the dorsogluteal site is not identified
correctly, damage to the sciatic nerve with
subsequent paralysis of the leg can result. To
locate the appropriate landmarks
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
Divide the buttock into four imaginary quadrants.

Palpate the posterior iliac spine and the greater
trochanter.

Draw an imaginary diagonal line between the two
landmarks.

nsert the needle superiorly and laterally to the
midpoint of the diagonal line.
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Ventrogluteal Site


The ventrogluteal site uses the gluteus medius
and gluteus minimus muscles in the hip for
injection.
This site has several advantages over the
dorsogluteal site: it has no large nerves or
blood vessels, and it is usually less fatty and
cleaner because fecal contamination is rare at
this site. The ventrogluteal site is also safe for
use in children.
22

To locate the ventrogluteal site:
Place the palm of the hand on the greater
trochanter and the index finger on the anteriorsuperior iliac spine (Fig. 34-15).
 Move the middle finger away from the index
finger as far as possible along the iliac crest.
 Inject into the center of the triangle formed by the
index finger, middle finger, and iliac crest.

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Figure 34-14 • Dorsogluteal site.
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Figure 34-15 • Ventrogluteal site .
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Vastus Lateralis Site

The vastus lateralis site uses the vastus
lateralis muscle, one of the muscles in the
quadriceps group of the outer thigh. Large
nerves and blood vessels usually are absent in
this area,
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
The nurse locates the vastus lateralis site by
placing one hand above the knee and one hand
just below the greater trochanter at the top of
the thigh (Fig. 34-16). He or she then inserts
the needle into the lateral area of the thigh
(Fig. 34-17).
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Figure 34-16 • Locating the vastus lateralis muscle .
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Figure 34-17 • Spreading the skin at the vastus lateralis site and darting the tissue
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Rectus Femoris Site

The rectus femoris site is in the anterior
aspect of the thigh. This site may be used for
infants. The nurse places an injection in this
site in the middle third of the thigh, with the
client sitting or supine (Fig. 34-18).
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Figure 34-18 • Location of rectus femoris injection site .
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Deltoid Site


The deltoid site in the lateral aspect of the
upper arm (Fig. 34-19) is the least-used
intramuscular
injection site because it is a smaller muscle
than the others. It is used only for adults
because the muscle is not sufficiently
developed in infants and children. Because of
its small capacity, intramuscular injections into
this site are limited to 1 mL of solution.
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Figure 34-19 • Deltoid site.
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
There is a risk for damaging the radial nerve and
artery if the deltoid site is not well identified. To use
this site safely:
Have the client lie down, sit, or stand with the
shoulder well exposed.
 Palpate the lower edge of the acromion process.
 Draw an imaginary line at the axilla.
 Inject in the area between these two landmarks.

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Injection Technique

When administering intramuscular injections,
nurses use a 90-degree angle for piercing the
skin (Skill 34-3).
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Reducing Injection Discomfort

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

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
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Use the smallest-gauge needle that is appropriate.
Change the needle before administering a drug that is irritating
to tissue.
Select a site that is free of irritation.
Rotate injection sites.
Numb the skin with an ice pack before the injection.
Insert and withdraw the needle without hesitation.
Instill the medication slowly and steadily.
Use the Z-track method for intramuscular injections.
Apply pressure to the site during needle withdrawal.
Massage the site afterward, if appropriate.
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Nursing Implications
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Acute Pain
Anxiety
Fear
Risk for Trauma
Deficient Knowledge
Ineffective Therapeutic Regimen Management
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