Venipuncture
And Injections
Needle parts
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Hub
Cannula (shaft)
Bevel
Point
Needle Selection
• Length ¼ - 6”
• Gauge 13 – 30g
Syringe Parts
• Plunger
• Barrel
• Tip
Prepared Medications
• Ampule: Sterile prefilled container;
single dose
• Cartridge-Needle Unit: Disposable
sterile cartridge w/ premeasured
amount.
• Vial: Sterile prefilled bottle
Flip top
Drawing Medications
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Ampule
Vial
Never remove ………
Never touch ………..
Draw measured amount
of air and exchange
INJECTIONS
Site Selection
• Intramuscular
• Subcutaneous
• Intradermal
Intramuscular
• Used when meds given subcu are irritating;
faster absorption; larger amount needed
• 90 degree insertion
• Gluteus medius: Z-trak
• Middeltoid
• Ventrogluteal
• Vastus Lateralis
Intramuscular Injections
• Wipe surface in circular pattern
from center to 2”
• Let dry
• Spread skin and insert needle 3/4
• Do NOT insert needle to hub
• Draw plunger to look for blood
• Remove needle and massage muscle
Sites to Avoid
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Scar tissue
Burned areas
Edematous
Traumatized
Areas near large vessels
Change in skin texture or pigment
Areas with a mole or wart
Gluteus Medius
• Draw line from greater trochanter to
PSIS.
• Injection given above and outside
this line.
• Watch out for sciatic nerve & gluteal
artery.
Gluteus Medius
Z-Trak
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Upper outer quadrant of buttocks
Slide skin and gluteal muscle to side
Inject
Slide muscle back
Better absorption; less painful; less
irritation; no discoloration due to
leaking
Middletoid
• 3 fingers below edge of acromion and
above axilla
• Can only tolerate small amounts of
meds
• Major vessels, nerves and bones to
be avoided here.
Middletoid
Ventrogluteal
• No major vessels or nerves here
• Patient on side or supine
• Palpate greater trochanter, iliac
crest, ASIS.
• Place your right palm on pts left
troch, index finger on ASIS and
middle finger along iliac crest.
Ventrogluteal
Vastus Lateralis
• Free of major blood vessels and
nerves
• Divide distance between greater
troch and patella into thirds.
• Use middle third.
Vastus Lateralis
Subcutaneous
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Small amounts (2> ml)
Absorption through capillaries
Administer slowly
45 degree insertion
Heparin, epinephrine, insulin, vaccines
Subcutaneous
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Administered below epidermis
Outer surface of upper arm
Lateral aspect of thigh
Upper 2/3 of back
Abdomen (2” around umbilicus)
Front of thigh
Rotate injections
Intradermal
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Skin tests for allergies
Sensitivity to drug
TB test (susceptibility to disease)
To aid in diagnosis of parasitic
infection and fungal diseases
Subcutaneous Tips
• Avoid edematous or scarred tissue
• If patient is thin, grasp skin in a
bunch
• Do not aspirate
• Do not rub area after injection
Intradermal Injection
• Injected between layers of skin
• Inner surface of forearm 4” distal to
elbow
• Insert bevel up at a 5-15 degree
angle
NEEDLE SELECTION
Subcutaneous 2-3cc
½-5/8”
23-25g
Intramuscular 2-5cc or
.5-2cc middletoid
1-1½”, 18-22g
1”, 22-23g
.5>cc
¼½
Intradermal
3/8”
25-27g
Insulin
30,50,100units ½ - 5/8”
27-29”
VENIPUNCTURE
• Site Selection
– Short or long term use
– Start looking distal
• Needle Selection
– Butterfly
– Angiocath/Heplock
Venipuncture Insertion
Veins of Arm
Hand Veins
Recommended sites for
venous cannulas
Sites To Avoid
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Tortuous
Repeatedly used veins
Poor skin condition
Thin, superficial veins
Bifucating veins
Veins affected by surgery
Infiltration
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Swelling or redness
Cool skin at the site
Pressure or burning at site
No blood return