Download What You Need to Know To Administer an Injection

Injection
Administration
Techniques
Rachel Nowak, PharmD
Clinical Instructor, UWSOP
Bartell Drugs Clinical Coordinator
January 29, 2010
Objectives
Describe proper techniques for
administering injectable drugs
 Describe precautions to take when
administering injectable products
 Appreciate pharmacist role in
administering injectable
medications
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Vaccines 101
Immunity

Passive Immunity
– Antibody produced by one human or
other animal is transferred to another
– Temporary protection
• Example: Immunity an infant receives from
its mother
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Active Immunity
– Immune system is stimulated to produce
cellular and humoral immunity
– Lasting protection
• Example: Survive infection from the disease
causing organism
Basic MOA of Vaccines
Vaccinations produce active
immunity.
 Immune response and immunologic
memory produced is similar to that
caused by natural infection.
 Comes without the risks of the actual
disease and associated
complications.
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Classifications of Vaccines

Live attenuated
– Attenuated or weakened form of diseasecausing bacterium or virus
– Must replicate to be effective
• Uncontrolled replication of the vaccine
virus can cause severe reactions - only
occurs in patients with immunodeficiency
– Immune response is cellular & humoral
– Circulating antibodies interfere
– Usually produce immunity after one dose
Classifications of Vaccines

Inactivated
– Inactivated form of bacterium or virus
– Can’t replicate
• Can’t cause disease, even in
immunodeficient patients
– Immune response primarily humoral
– Less affected by circulating antibody
than live vaccines
– Always requires more than one dose
– Antibody titer decline over time
Immunization Procedures
Screening
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Standard Questions
– Do you have any drug/food allergies?
– Do you have any chronic diseases?
– What medications do you take?
Basic Vaccine Screening
Questions
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Are you sick today?
Are you allergic to latex?
Do you have any allergies to any vaccine or
vaccine components?
– Ex: Eggs, gelatin
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Have you ever had a serious reaction after
receiving a vaccine?
Have you had Guillian-Barre Syndrome in the
past?
Is it possible that you could be pregnant?
Breastfeeding?
Additional Vaccine Screening
Questions
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Do you have cancer, leukemia, AIDs, or any
other immune system problem?
Do you take cortisone, prednisone, other
steroids, anticancer drugs, or have you had
radiation treatments?
In the past year, have you received a
transfusion of blood or blood products or
been given immune globulin or an antiviral
medication?
Have you received any vaccinations in the
past 4 weeks?
Consent
Answer any questions patient may
have
 Patient needs to understand
benefits and risks of getting
immunized and consent to vaccine
administration.

– If it is a child under 18, then parent or
guardian consent should be obtained
Vaccine Information
Statements (VIS)

Patient education sheets developed
by the CDC
– Helps to explain the risks and benefits of
receiving a particular vaccine
 Federal law requires that VISs be used
for most vaccines when vaccinating
patients
– Should be given before vaccine
administered
Parts of a Syringe
Preparing Syringe

Choose correct SYRINGE size
– If <0.5ml need low-dose syringe (1mL, 3mL)
– Finely graduated syringe will ensure accurate
amount
– Fluzone (influenza) is 0.5mL dose
– Pneumovax (pneumonia) is 0.5mL dose

Maximum volumes
– Deltoid – No more than 0.5-1mL
– Large muscle (gluteus medius)
• Adult – no more than 4mL
• Child – no more than 1-2mL
Needle Lengths and Gauges
Preparing Needle
Choose correct needle LENGTH and
GAUGE
 Minimize tissue injury and SQ leakage
 Allow easy passage (23 vs. 25 gauge)
 Needle length depends on injection
site

– Adults 5/8” vs. 1” vs. 1.5”
– Children 5/8” vs. 1”
– If less SQ fat, use smaller needle
Get Organized

Get all supplies ready in advance
– ex: Band-Aid, alcohol pad, cotton ball, VIS

Double Check
– Correct vaccine, dose, & expiration date
– Go over screening/consent form with patient

Record
– Vaccine name, manufacturer, lot number,
expiration date
– Location of administration (L/R deltoid)
– Provider administering the vaccine
– Vaccine Information Sheet publication date
Administer the Vaccine

Cleanse area with alcohol swab
– Allow alcohol to dry

Target
– C technique and shoot (IM)
– Bunch skin (SQ)

Inject – DO NOT Aspirate
– Dart-like motion with steady pressure
– Inject at:
• 90° angle for IM
• 45° angle for SQ
Final Steps
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Do not recap needle
Dispose of needle properly
Apply pressure to injection site with
cotton ball (if necessary)
Apply adhesive bandage
Provide patient with immunization record
& Vaccine Information Statement (VIS)
Record all necessary information
Have patient remain under surveillance
for ~15 minutes
Routes of Administration
Intramuscular (IM) Injections
Subcutaneous (SQ) Injections
Self-Injection Teaching:
Insulin
Advise patients to wash hands
 Have patient confirm type of insulin on bottle
label
 Roll vial or pen in palms, if appropriate
 Show patients in counseling where to read dose
on syringe and appropriate amount to draw

– Ensure using best syringe for dose
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Inject at 90° angle for SQ insulin
Injecting into the subcutaneous fat of the belly
most common
– Site should be approximately 2 inches from belly
button

Rotate sites
– avoid formation of fatty deposits or scarring
Insulin Injection Sites

Alternate sites include the back of the
arms, thighs, and buttocks
– Slower onset with alternate sites
Self-Injection Teaching:
Insulin

Go over insulin storage
– Generally insulin not in use should not be
stored in fridge
– Extreme temperatures and excess agitation
should be avoided

Discard dates
– Important to go over how long insulin can be
stored at room temperature
Insulin inspection
 Mixing of Insulins
 Proper disposal of sharps
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Self-Injection Teaching

Pen devices/ insulin cartridges:
– Deliver insulin subcutaneously through a
needle.
– All a little different and might require extra
teaching time
– In specific patient populations these devices
have been demonstrated to improve:
• accuracy of administration
• adherence
– Requires needle to be left embedded in skin
for at least 5 seconds after plunger depressed
Managing
Adverse Reactions
Vasovagal Syncope
(Fainting)
Be aware of patient behavior
 Have patient sit before
administration
 Lay patient down if necessary
 Check airway, breathing and vital
signs

Anaphylaxis
Rare but potentially fatal
 Occurs within 15 minutes
 Call 911
 Lay patient down, check airway,
breathing, vital signs
 Be prepared and ready to administer
epinephrine (Epipen)

Delayed Adverse Reactions
Child – fever, fussy, crying, injection
site
 Adult – injection site discomfort
 Symptomatic relief

– Fluids
– Pain medications
• No aspirin for children
• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
Reporting Adverse
Reactions

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Vaccine Adverse
Event Reporting
System (VAERS)
Required for:
- Rare, serious or
unexpected
events
Emergency Plan and
Training
Access to Emergency Medical
Services (EMS) – phone on hand
 Be prepared for adverse reactions

– CPR trained staff
– Necessary medications on hand
– Have patient remain under surveillance
after administration
Universal Precautions
Controlling Infection
Transmission
Be Prepared

Control infection transmission
– Use universal precautions
– Proper cleaning and disposal of waste

Anticipate adverse effects
 Assure patient safety
– Know your equipment
– Establish quality procedures
– Practice good technique
Protect Yourself:
Use Universal Precautions

Infection control guidelines
designed to protect workers from
exposure to diseases spread by
blood and certain body fluids

Assume all patients to be infectious
for blood-borne diseases
Universal Precautions Apply To:
Blood
 semen
 vaginal secretions
 synovial fluid
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cerebrospinal fluid
pleural fluid
peritoneal fluid
pericardial fluid
amniotic fluid
Universal precautions should be applied
to all body fluids when it is difficult to
identify the specific body fluid or when
body fluids are visibly contaminated
with blood.
Universal Precautions
DO NOT necessarily apply to:
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feces
nasal secretions
sputum
sweat
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tears
urine
vomit
saliva (except in
the dental setting)
But, you must still be mindful of
transmitting infectious material.
They may not carry blood-borne
illness, but they do carry viruses and
bacteria.
Universal Precautions

Wear gloves if likely to touch body
substances or mucous membranes
– Latex or non-latex
– Monitor for allergies
Wear eye protection if likely to be
splashed
 Wear lab coat or gown if likely to be
soiled

Universal Precautions
Place needles in special
containers (Sharps
Container)
 Place soiled articles in
plastic bag for disposal
 Place soiled linen in
laundry bag
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Pharmacists Role
Pharmacist Role
Dispensing versus administration
 Makes sense for:

– Vaccinations
– Teaching patients to self-inject
• Insulin and glucagon
• Increasing availability of self-injection
products
– Allergic reactions, migraine, MS, infertility

Proper training required
Why are immunizations
so important?

Profession:
– Establishes the role of the pharmacist

Patients:
– Pharmacists are easily accessible

Population:
– Preventing disease
For More Information
APhA: Pharmacy-Based Immunization
Delivery Certificate Program
– www.pharmacist.com
 Center for Disease Control – Vaccines
– http://www.cdc.gov/vaccines
 Vaccine Adverse Event Reporting System
– http://vaers.hhs.gov
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