Some people may find it difficult to judge variable doses, and others may not be able to inject themselves for various reasons. Different types of insulin administration devices are available to make it easier for people to inject themselves, such as devices which click loudly as the dosage is set to enable people with sight impairment to safely choose the correct dose. Individuals may need assistance with injections at home for whatever reason. Administration of injections is a common reason for arranging home visits by caregivers or nurses.
Experienced nurses can help to work out the appropriate dosage, administer routine injections and help with other medication and healthcare needs.
Private nurses with specialist training in diabetes can assist with regular blood sugar checks, insulin and other medication administration, and healthy lifestyle support. Provide the best care to your loved one today! Fill up the form below for a free consultation with our Care Advisory team. If you need professional support with injections or other nursing procedures at home , Homage Nurses can help.
Reach out to our Care Advisors at to learn more. Get started with a free consultation today, and learn why thousands of Singaporeans trust Homage to deliver the best care in their homes. She turned to writing to follow her passion for realistic medical communication.
She loves translating medical jargon into accessible language for the people who need to understand it most. What is an injection? Types of Injection One of the ways we describe injections is by the route or the type of body tissue they are administered into. Intravenous Injection IV Intravenous injections deliver medication directly into a vein. Other less common forms of injectable medication administration include: Intraosseous Injection IO Intraosseous injections are usually used in emergencies where medication or fluids need to get into the bloodstream quickly and venous access is difficult or impossible.
Intradermal Injection These are injections given in between the layers of the skin. Common Uses of Injection The most common injection people see outside of a hospital setting is probably an insulin injection for individuals with diabetes.
Common Injection Sites Intramuscular Injection Intramuscular injections should be given into as large a muscle as possible but where there is little chance of damage to a larger blood vessel or a nerve. Here are the steps taken to perform an IM injection using a Z-track method: Using your non-dominant hand, firmly pull your skin in one direction, away from the injection site.
Insert the needle into the injection site at a degree angle to the skin. Slowly and gently depress the plunger to release the medication into your muscle. Continue holding your skin with your non-dominant hand. After all the medication is emptied from the syringe, remove the needle at the same angle that you inserted it.
Release the skin that your non-dominant hand is holding on to and allow your skin to return to its original position. Subcutaneous Injection Subcutaneous injections are often self-administered, so the most common sites used are those which people can easily reach themselves. Intravenous Injection Normally, intravenous injections are only administered by trained healthcare professionals.
Fill out the details below and our Care Advisors can get back to you with the care information you need. This field is for validation purposes and should be left unchanged. Barnes, T.
Long-term depot antipsychotics. A risk-benefit assessment. Drug safety, 10 6 , — Intraosseous access. Clean the site with an alcohol swab or antiseptic swab. Use a firm, circular motion. Allow the site to dry. Pathogens from the skin can be forced into the tissues by the needle. Allowing the skin to dry prevents introducing alcohol into the tissue, which can be irritating and uncomfortable. Clean injection site. Remove needle from cap by pulling it off in a straight motion. This decreases risk of accidental needle-stick injury.
Remove needle from cap. Using non-dominant hand, spread the skin taut over the injection site. Taut skin provides easy entrance for the needle. Hold skin taut prior to injection.
Hold the syringe in the dominant hand between the thumb and forefinger, with the bevel of the needle up. This allows for easy handling of the syringe. Hold needle with bevel up. Hold syringe at a 5- to degree angle from the site. Keeping the bevel side up allows for smooth piercing of the skin and induction of the medication into the dermis. ID injection. Once syringe is in place, slowly inject the solution while watching for a small weal or bleb to appear.
The presence of the weal or bleb indicates that the medication is in the dermis. Presence of a bleb white raised circle. Withdraw the needle at the same angle as insertion, engage safety shield or needle guard, and discard in a sharps container.
Proper needle disposal prevents needle-stick injuries. Discard syringe in sharps container Massaging the area may spread the solution to the underlying subcutaneous tissue. Draw circle around injection site.
Discard remaining supplies, remove gloves, and perform hand hygiene. This prevents the spread of microorganisms. Hand hygiene with ABHR. Document the procedure and findings according to agency policy. Proper documentation helps ensure patient safety.
Document time, date, location, and type of medication injected. Evaluate the patient response to injection within appropriate time frame. The patient will need to be evaluated for therapeutic and adverse effects of the medication or solution. Special care must be taken to ensure the correct amount of medication and type of insulin is administered, at the correct time.
It is highly recommended to always get your insulin dosages double-checked by another health care provider. Always follow the standard for medication preparation at your agency. Insulin is only administered using an insulin syringe. Insulin is the only drug with its own type of syringe with a needle attached. Insulin is always ordered and administered in units, based on a blood sugar reading and a diabetic insulin protocol or sliding scale. Some hospitals have preprinted physician orders, and some hospitals have handwritten orders.
Insulin syringes can come in , , or unit measurements. Always read the increments calibration carefully. There are rapid-, short-, intermediate-, and long-acting insulins. For each type of insulin, it is important to know how the insulin works and the onset, peak, and duration of the insulin.
If a patient is ordered two types of insulin, some insulins may be mixed together in one syringe. Do not mix Lantus Glargine or Levemir Determir. If administering cloudy insulin preparations Humulin — N , gently roll the vial between the palms of your hands to re-suspend the medication. Always draw up the short acting insulin first, to prevent it from being contaminated with the long acting.
If too much insulin is drawn up from the second vial, discard syringe and start again. Always check with the PDTM for the most current guidelines regarding insulin administration. Insulin orders may change from day to day. Always ensure the most current physician orders are being followed. Injection site rotation is no longer necessary as newer insulins have a lower risk for hypertrophy of the skin. Typically, a patient will pick one anatomic area e.
Insulin absorption rates vary from site to site. The abdomen absorbs the fastest, followed by the arms, thighs, and buttocks. It indicated that IV insulin administration achieved better glycemic control during the intraoperative period, whereas it did not offer advantages over the SC route during the other two periods.
Epoetin alfa may be given either as an IV or as an SC injection. Clinical and pharmacokinetic studies have shown that target hemoglobin or hematocrit levels can be maintained using a reduced epoetin dosage by switching from IV to SC administration.
Wazny et al conducted a cost analysis of a conversion from IV to SC epoetin in patients receiving chronic in-center hemodialysis during a 6-month period of IV or SC usage. Overall, epoetin doses increased. Twenty patients with venographically proven DVT were randomized to receive SC or IV heparin for 3 days followed by 3 days of the other treatment. Incorporating the cost of human resource in vein cannulation, infusion preparation, and medication administration with the use of heparin syringes, SC heparin therapy was significantly more cost-effective than IV heparin therapy.
The reduction in cost and liberation of nursing time mean that the SC route should be preferred. Ketamine can suppress hyperalgesia and allodynia. Evidence has shown that IV ketamine is more appropriate than SC ketamine in controlling postoperative analgesia.
Honarmand et al evaluated the clinical efficacy of preincisional IV or SC infiltration of ketamine 0. Preincisional IV administration of low-dose ketamine provides analgesia for 24 hours after surgery without significant side effects in patients undergoing appendectomy, whereas SC ketamine at the same dose only controls analgesia within the first 6 hours after surgery.
Ketamine is also known to have major cardiovascular side effects. It has been shown that, in some patients, ketamine may temporarily increase heart rate and blood pressure by increasing sympathetic nervous system activity.
A prospective randomized double-blind study compared the efficacy of SC and IV ketamine 0. Results showed that SC ketamine was as effective as, but safer than, IV ketamine. There were no differences between two groups regarding pain intensity, recall rate during the surgery, and surgeon satisfaction; however, SC administration of ketamine for induction of conscious sedation is accompanied by a significantly lower rise in systolic blood pressure and rate-pressure product before skin infiltration, after insertion of the second trocar, and at the end of surgery.
Raj et al observed the time course of reversal of anticoagulant effect of warfarin by vitamin K1 via IV or SC route. Mean INR at baseline was 8. At 8 hours, mean INR was 4. Mean decrease in INR 8 hours after administration of vitamin K1 was 3. Gauthier et al compared the IV administration of ceftriaxone to SC administration in patients older than 75 years. SC route seems to be preferred for fragile elderly patients, while it is not associated to an impaired effectiveness or to an increased death rate.
Compared with the IV group, patients in the SC group were significantly older, more often bedridden, and more frequently had dementia. Nevertheless, this does not justify an excessive use of SC administration, as for septic shock. Daoust et al assessed the impact of age, sex, and route of administration on the incidence of adverse events due to opioid administration in the emergency department.
The IV route was linked with higher rates of all adverse events, the SC route with moderate rates, and the oral route with fewer overall rates. A prospective survey evaluated parenteral morphine-prescribing patterns among inpatients with pain from advanced cancer. Epinephrine has a pivotal role as first-line treatment for acute anaphylaxis. Campbell et al compared rates of cardiovascular adverse events and epinephrine overdoses between various routes of epinephrine administration among patients with anaphylaxis in the emergency department.
Similarly, overdose occurred with IV bolus epinephrine compared with IM epinephrine There was no difference between the two routes of HBIG administration regarding satisfaction, positive feelings, impact, and support scales. Pegaspargase, a modified version of L-asparaginase that is covalently conjugated to monomethoxypolyethylene glycol, is important for treatment of acute lymphoblastic leukemia. Generally, antibiotics available for IM injection should be considered as an economically efficient alternative to IV injections in appropriate patients.
Regarding cefazolin, gentamicin, penicillin, and imipenem, the IM route was found to be up to one-tenth the expense of the IV route and may facilitate early discharge and self-administration in the home. A study showed that the dosing of imipenemcilastatin mg given intra-muscularly every 12 hours is a more cost-effective method of drug delivery with equal efficacy and safety when compared to imipenemcilastatin mg given intravenously every 6 hours.
Ketamine can be given by IV and SC route. Thus, IV ketamine may be the desirable approach for orthopedic procedures in sedating children. Total time in the emergency department triage to discharge between the two routes was not significantly different. Patients in the IM group reported significantly less pain and lower distress during the painful procedure but experienced more commonly vomiting and significantly longer length of sedation.
IV morphine has a more rapid and extensive initial effect compared with IM, which is supported by the findings of the pharmacokinetic study by Dale et al. Tveita et al compared patient safety and analgesic efficacy of a single high dose of morphine given intramuscularly or intravenously for postoperative pain management.
During 5—25 minutes after morphine administration, pain status in the IV group was significantly improved compared with the IM group. A 10 mg bolus dose of IV morphine given to patients with moderate pain after surgery can provide more rapid and better initial analgesia than 10 mg dose of IM morphine without causing severe respiratory depression.
A prospective study investigated the safety, efficacy, and complication rate of intermittent IM versus continuous IV infusion of morphine sulfate in 46 nonventilated children following major chest, abdominal, or orthopedic surgical procedures. IV infusion provided better pain relief than IM injections without respiratory depression. Redback spider antivenom can be given by IM or IV route. The manufacturer recommends IM use, with IV administration reserved for life-threatening cases.
Thus, IM redback spider antivenom should not be recommended in the treatment of redback spider bite. A prospective, randomized, blinded, parallel-group study in 17 children with a history of anaphylaxis compared two injection methods SC injection of 0.
Only two out of the nine children receiving SC epinephrine achieved C max by 5 minutes, while six out of the eight children receiving IM epinephrine achieved C max by 5 minutes. Fatal anaphylaxis is associated with delayed epinephrine administration. Therefore, the IM route of injection is preferable during an episode of systemic anaphylaxis. A retrospective review in a military hospital showed that epinephrine was given largely by the SC route and no IM epinephrine was administered.
Greater educational efforts and collaboration are needed between the allergy community and other providers regarding the importance of administering epinephrine intramuscularly. The advantage of IM administration over SC administration is challenged by the anatomical site of injection.
Simons et al conducted a prospective, randomized, blinded, placebo-controlled, six-way cross-over study of IM versus SC injection of epinephrine 0. An identical dose of epinephrine injected IM into the deltoid did not result in significant elevation of C max in comparison with endogenous epinephrine concentrations measured after saline solution injections.
Therefore, IM injection of epinephrine into the thigh was recommended as the preferred route and site of injection of epinephrine in the initial treatment of anaphylaxis; otherwise, the advantage of IM epinephrine versus SC epinephrine will disappear. The SC group exhibited faster and more pronounced effects in decreasing new cortical lesions development and cortical atrophy progression compared with IM group.
For the treatment of rheumatic diseases, the antimetabolite drug methotrexate MTX can be administered weekly by different routes: oral, SC, or IM. Studies compared the serum concentrations and the pharmacokinetics of low-dose MTX after both IM and SC injections in patients with rheumatoid arthritis.
SC administration may be a more convenient and less painful way of administering low-dose MTX. Although serum MTX levels were not significantly affected by the route of administration, seven out of eight preferred self-administration by the SC route at home.
Self-administration was associated with reduced hospital visits and improved patient satisfaction; therefore, parenteral MTX should be prescribed by the SC route instead of the IM route.
The total smaller volume of administered drug and the improved usability of a pre-attached needle in combination with a smaller prefilled syringe resulted in preference of the patients of HC over MC. Human chorionic gonadotropin hCG is used to induce final oocyte maturation and to provide luteal phase support during in vitro fertilization treatment. SC administration achieves a significantly higher hCG level in serum SC hCG obtains the desired clinical effects with less patient inconvenience.
Hahner et al evaluated the pharmacokinetics and safety of hydrocortisone after SC and IM injection mg and after SC administration of sodium chloride 0.
Both IM and SC injections increased serum cortisol rapidly and were well tolerated. Regarding the administration route of hydrocortisone, eleven SC administration of mg hydrocortisone shows excellent pharmacokinetics for emergency use with a good safety profile and is preferred by patients over IM injection. A prospective randomized double-blind cross-over study compared intermittent IM and SC morphine boluses for postoperative analgesia. Patients received 0. The majority of patients indicated a strong preference for the SC route despite no significant differences in pain scores, respiratory rate, arterial oxygen saturation, heart rate, mean arterial pressure, sedation, or nausea scores between IM and SC administration of morphine.
Postoperative analgesia by SC morphine bolus injection is as effective as IM injection with a similar side-effect profile but with greater patient acceptance and less risk. Significantly shorter mean T max and greater mean C max were achieved following SC dosing of morphine with rHuPH20 than without rHuPH20, although the extent of exposure of morphine was similar. Some medications have been observed with the existence of optimal injection route Table 1.
Obviously, it is inappropriate to simply say that one injection route is overwhelmingly better than another route. With respect to insulin and ketamine, there seems to be conflict over whether IV is superior to SC. This can also partly be explained by the fact that the ketamine dose was different between two studies 0.
The belief that insulin delivered by the IV route should act more rapidly and decrease blood glucose levels faster than the SC route has become questionable because continuous SC insulin infusion using an insulin pump seemed to control the glycemia better compared to IV insulin infusion in medical intensive care unit patients. Bodur et al explained that continuous SC insulin infusion could avoid extra problems brought by IV insulin infusions including fold dilution 50 IU in 50 mL which may bring slight variations in the preparation of the final syringe and change the concentration of insulin considerably, adsorption of insulin to the surface of the syringe and the lines, and sharing the lumens of central catheters where other treatments are streamed with the potential for interference with infusion rates.
Safety, efficacy, patient preference, and pharmacoeconomics are four principles governing the choice of injection route Figure 2. Safety and efficacy must be the preferred principles to be considered. Firstly, clinicians should know whether there is a contraindicational route in some cases. Prescribing information for some medications has described the IV, SC, or IM route-related contraindication information.
For example, calcium gluconate injection is only for IV use. SC or IM injection may cause severe necrosis and sloughing, and thus, they are contraindicational routes. SC promethazine is contraindicated as it may result in tissue necrosis. Norepinephrine bitartrate injection must be diluted in dextrose-containing solutions prior to infusion.
Use of IM and SC is contraindicated because of poor absorption and potential local necrosis due to the vasoconstrictive action of the drug. Chlorpromazine hydrochloride injection is intended for deep IM use. The SC route is contraindicated for chlorpromazine administration to avoid causing skin irritation, while IV route is only for severe hiccups, surgery, and tetanus.
Potassium chloride injection must be diluted and infused over a certain period of time. Second, literature, rather than prescribing information, has provided good suggestions regarding safety and efficacy issue in the choice of injection route.
For example, epinephrine should be given intramuscularly during an episode of systemic anaphylaxis, IM morphine should not be given for pain management, and IM redback spider antivenom should not be recommended in the treatment of redback spider bite. Besides the four principles, the following detailed factors are related with the choice of injection route:.
Sex SC-IG for lifelong treatment of primary antibody deficiencies Anatomical site of injection SC bortezomib, IM epinephrine 24 , Dose SC versus IV rituximab regarding bioavailability Administration time SC versus IV: insulin during pre-, intra-, and postoperative periods Indication SC versus IV ketamine for different purposes [postoperative analgesia and dissociative conscious sedation] 57 , Flexibility in the route of administration eg, among prescribing patterns of morphine including IV-to-oral, IV-to-SC, IV-only, SC-only and mixed mode, the mixed mode achieves the best clinical outcomes Further studies are needed.
First, it is necessary to conduct prospective intervention studies with multiple outcome measures following a switch to a more appropriate injection route.
Second, both retrospective and prospective pharmacoeconomic studies should be encouraged. Third, patient preference is important in medical decision making when choosing treatment methods because it has implications for adherence and quality of life.
This site is difficult for self-injection, and may require the help of a friend, family member, or caregiver. Place the heel of your hand on the hip of the person receiving the injection, with the fingers pointing towards their head.
Position the fingers so the thumb points toward the groin and you feel the pelvis under your pinky finger.
Spread your index and middle fingers in a slight V shape, and inject the needle into the middle of that V. The dorsogluteal muscle of the buttocks was the site most commonly selected by healthcare providers for many years. However, due to the potential for injury to the sciatic nerve , the ventrogluteal is most often used now. This site is difficult to use this site for self-injection and not recommended. Any person who administers intramuscular injections should receive training and education on proper injection technique.
The needle size and injection site will depend on many factors. These include the age and size of the person receiving the medication, and the volume and type of medication. Your doctor or pharmacist will give you specific guidelines about which needle and syringe are appropriate to administer your medication.
The needle should be long enough to reach the muscle without penetrating the nerves and blood vessels underneath. Generally, needles should be 1 inch to 1.
Wash your hands with soap and warm water to prevent potential infection. Be sure to thoroughly scrub between fingers, on the backs of hands, and under fingernails. Clean the site selected for injection with an alcohol swab and allow the skin to air dry. Remove the cap. If the vial or pen is multi-dose, take a note about when the vial was first opened.
The rubber stopper should be cleaned with an alcohol swab. Draw air into the syringe. This is done because the vial is a vacuum and you need to add an equal amount of air to regulate the pressure.
This also makes it easier to draw the medication into the syringe. Insert air into the vial. Remove the cap from the needle and push the needle through the rubber stopper at the top of the vial.
0コメント