Fundamentals of Nursing Care: Concepts, Connections, & Skills
Chapter 37
Administering Intradermal,
Subcutaneous, and Intramuscular
Injections
Fundamentals of Nursing Care: Concepts, Connections, & Skills
First-Pass Metabolism
 Metabolism of oral medication by the liver,
decreasing the effect of the medication
 Can be bypassed by using sublingual, buccal,
and parenteral routes
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Advantages of Parenteral
Administration
• Bypasses gastrointestinal tract; no irritation
 Rapid onset time compared to oral route
 Ease of administration to uncooperative or
unconscious patients
 Better absorption of drugs that are otherwise
poorly absorbed via oral route
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Disadvantages of Parenteral
Administration





Invasive and uncomfortable for patient
Expensive
Requires additional supplies and equipment
Requires qualified personnel to administer
Carries risk of infection and nerve injury
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Types of Syringes
 Standard syringe
 Used for intramuscular or subcutaneous injections
 Insulin syringe
 Used only for injecting insulin
 Tuberculin syringe
 Used for small volumes of meds and TB test
 Prefilled syringe
 Single dose, ready to use syringes
Fundamentals of Nursing Care: Concepts, Connections, & Skills
True/False Question
The nurse giving injections in a hospital setting
knows that syringes are available in numerous
sizes, ranging from 0.3 to 60 mL, with the
most common sizes being
1 and 3 mL.
A. True
B. False
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Answer
A. True
Rationale: Syringes are available in numerous
sizes, ranging from 0.3 to 60 mL, with the
most common size being 3 to 5 mL. Each
syringe has calibrations marked on the barrel
in milliliters or units indicating the volume of
medication to administer.
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Parts of a Syringe
 Barrel
 Plunger with flange on the end
 Tip for connecting to the needle
 Luer-Loc tip: has threaded grooves that screw
onto the needle hub and lock it in place
 Slip-tip: has a smooth, slightly tapered tip that
inserts into the needle hub
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Parts of a Needle




Angled bevel on the tip of the needle
Cannula or shaft
Plastic hub
Safety guard
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Sites for Subcutaneous Injections
 Back of the upper arms
 Abdomen (staying a minimum of 2” from the
umbilicus)
 Anterior aspect of thighs
 Area of the back just below the scapulae
 Upper buttocks
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Injection Sites
 Ventrogluteal: site of choice for those 7
months and older
 Deltoid: common site for injection of small
volumes
 Vastus lateralis: second choice for injections
larger than 1 mL
 Rectus femoris: last choice of sites, used
only in adults
 (Dorsal gluteal: ONLY if no other site is
accessible)
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Maximum Volume
to Inject Intramuscularly
 3 mL for injecting a large gluteus medius or gluteus minimus
of the ventrogluteal site or a very large vastus lateralis muscle
of the leg, in an adult
 1 to 2 mL for the vastus lateralis muscle in a trim, average size
adult, older children with adequate muscle development,
older adults, and thin patients
 0.5 to 1 mL for the deltoid muscle in small children up through
older adults (not infants)
 0.5 to 1 mL for the ventrogluteal site and the vastus lateralis
muscle in infants older than 7 months and small children
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Gauge of a Needle
 Refers to the diameter of the needle and is
indicated by numbers; the larger the
number, the smaller the diameter
 Gauge used depends on
 Viscosity of the medication
 Route of medication
 Size of patient and muscle mass
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Length of Needles for Injections
 Intradermal: 1/4” to 5/8” in length with a very
tiny diameter between 25 and 30 g
 Subcutaneous: between 3/8”and 7/8” in
length with a diameter between 24 and 29 g
 Intramuscular: 1” to 1.5” in length, with a
diameter between 20 and 22 g
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Administering
an Intradermal Injection
 Position needle with the angled bevel upward
 Use a 15-degree angle for insertion of the
needle
 Do not aspirate
 Instill the medication between the layers of
the dermis to create a bleb (fluid-filled blister)
 Do not apply pressure to or massage injection
site
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Administering
a Subcutaneous Injection
Administer the injection at a 45-degree angle;
angle of needle insertion and length of needle
may vary, based on the percentage of body fat
and size of the patient
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Administering an IM Injection
 IM: use dominant hand to inject at a 90-degree angle into
the body of the target muscle
 Needle should swiftly pierce skin and muscle in one
smooth motion
 Stabilize needle with nondominant hand
 Aspirate; if no blood, then instill medication slowly
 Remove needle
 Cover site with 2” x 2” gauze using nondominant hand,
massaging site gently while activating the needle safety
guard with dominant hand
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Administering a Z-Track Injection
 Place lateral aspect of nondominant hand
against patient’s skin next to intended
insertion site
 Pull/displace skin and subcut layer 1” to 2”
to one side, holding the tissue back
 Using dominant hand, insert needle swiftly,
piercing the skin, tissue, and muscle with
one smooth motion
 Aspirate; if no blood, instill drug slowly
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Z-Track Injection (cont.)
 After drug is instilled, wait for 5 to 10 seconds
before withdrawing needle
 As you are withdrawing needle, release the
tissue held back by your nondominant hand,
allowing tissue to close over the needle track
in the muscle layer
 Avoid massaging injection site
Fundamentals of Nursing Care: Concepts, Connections, & Skills
True/False Question
The only part of a needle that can be touched
is the barrel.
A. True
B. False
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Answer
B. False
Rationale: The only part of a needle that may
be touched is the plastic needle cap. The hub
of the needle that attaches to the syringe
must be kept sterile while you prepare to
attach it.
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Safety Reminders
 Do not recap a needle either new or used
(except when you must carry it down the
hall to the room)
 Do not inject air directly into medication
 Do not contaminate any part of the needle
or syringe
 Avoid using single-dose vials more than
once; they do not have preservatives
(although multiple-dose vials do)
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Safety Reminders (cont.)
 Never use multiple-dose vials of bacteriostatic
diluent with preservatives to reconstitute
drugs intended for newborn injection!
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Causes of Complications From
Intramuscular Injections
 Needle puncture
 Incorrect technique
 Drug solution itself
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Types of Medication
Incompatibilities
 Physical: visible reactions such as color changes,
precipitate formation, cloudiness, gas formation, or
haze
 Chemical: involves the degradation of the drug
resulting from a chemical reaction
 Therapeutic: occurs within the patient, as the result
of two concurrently administered drugs that interact
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Types of Diluents
 Sterile bacteriostatic normal saline 0.9%
(multiple-dose vial with preservatives)
 Sterile normal saline 0.9% (single-dose vial
without preservatives)
 Sterile bacteriostatic water for injection
(multiple-dose vial with preservatives)
 Sterile water (single-dose vial without
preservatives)
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Two Medications
Requiring Dosage Verification With
Another Nurse
 Insulin
 Very rapid-acting, rapid-acting, intermediate-acting, longacting, and very long-acting
 Heparin
 1,000 units/mL, 5,000 units/mL,
10,000 units/mL, and 20,000 units/mL
 Can be life threatening if incorrect dosage is administered
Fundamentals of Nursing Care: Concepts, Connections, & Skills
True/False Question
When administering insulin or heparin, the
nurse should apply gentle pressure to the
injection site after removing the needle for
better absorption.
A. True
B. False
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Answer
B. False
Rationale: When giving a subcutaneous
injection, the nurse should apply gentle
pressure to the site after removing the needle
and gently massage to distribute the
medication into the tissue for better
absorption, unless administering insulin or
heparin.