Different Types of Injections are being explained in this article.There is difference between intradermal injection and hypo dermal or subcutaneous injection. Intra-dermal means into the dermis(skin). Hypo dermal or subcutaneous means below dermis (skin). Hypo or sub means below or under.
Usually intra-dermal injections are given for diagnostic purpose by testing the reaction on the skin. By a thin needle it is injected into the depth of skin not underneath skin.
(i) Tuberculin test—Schick test.
ii Testing for sensitivity like ATS, penicillin, other serums xylocaine etc.
Hypo-Dermal or Subcutaneous Injection
By this method the drug reaches bloodstream by way of absorption from the local site. Usually not more than 2 ml of drug is given by subcutaneous route. This route is preferred when oral route is contraindicated and rapid action is desired.
- Intimate the patient about the procedure.
- Wash hands.
- Fit parts of the syringe together firmly, touching only knob of the plunger and out side of syringe barrel. Keep the syringe with needle resting on sterile cotton swab. Never touch the needle except the base.
- If drug is in ampoule pour spirit on one cotton ball and clean the neck of the ampoule and the cutting file with spirit. File the ampoule at the base of the neck and break top portion off holding the cotton ball over neck to protect fingers.
- Insert the needle carefully into the ampoule being careful that it does not touch the glass. Draw drug as per requirement not more than 2 ml for subcutaneous.
- If the Drug is required to be mixed with water, open sterile water ampcus first as described above. Draw required amount of water and mix well with drug in vial and then draw into syringe as required.
- If the the injection is in vial with rubber cap, proceed as mentioned in intra muscular injection.
- Select site for injection usually upper and outer part of the arm or front of thigh.
- Clean the area thoroughly by Spirit swab.
- Grasp the skin of the part with left hand.
- Expel air from the syringe by holding it in upright position and gently pressing the plunger until a drop of solution comes to the tip of needle.
- Insert the needle steadily and quickly at 45° angle and administer the drug.
- After removing the needle again wipe the site of injection with spirit.
- Watch for 10 minute for any untoward reaction.
- Instruct the patient not to rub or scratch at the site.
- PrecautionAll hypodermic injection should be given in an upward direction towards head end because this corresponds to flow of lymph in lymphatic channel, through which the drug is carried to blood stream. Subcutaneous injections should not be given over skin of a joint. It should not puncture a vein.
Insulin for diabetic patients is always given hypodermically or by subcutaneous route. Before giving, insulin ask the patient to take food immediately otherwise he may develop hypoglycemia.
Being A Medical Doctor And Nurse, You Must Know About Different Types of Injections
- IntraThecal! InjectionUsually intrathecal injections are given by doctors not by nurses. These are given to introduce medication in the cerebrospinal fluid (CSF) to meninges and subarachnoid space. Special lumbar puncture needles are used for intrathecal injection. Great sterilization care is taken to handle all equipment as there is always possibility of introducing bacteria to meninges or brain directly if proper sterile technique is not adopted. Drugs like streptomycin, penicillin, sulfadiazine and certain sera are given intrathecally usually in meningitis. This route is preferred for quick action.
Peritoneum is a thin paper like membrane which covers the abdominal organs. Peritoneum provides a good surface area for absorption of drugs in liquid form to blood stream. Proper aseptic care is taken before injecting intra peritoneal injections as there is possibility of spreading infection to peritoneum. Anti-
rabic vaccine is usually given intra peritoneal over abdomen around umbilicus. During intra peritoneal dialysis also, injection are required to be given intra peritoneally. Like subcutaneous injection the whole thickness of abdominal skin and muscles are held by left hand and needle is punctured into the abdomen. The needle is. kept at 30° angle and then pierced.
Intra Cardiac Injection
Intra cardiac injections are given during cardiac arrest or to revive a failing heart during terminal stage of death. Usually cosamine, micoren and adrenaline 1 : 1000 are given intracardially. As usually these drugs are given in very acute emergency to revive heart beat, sometimes ordinary aseptic care is followed to save time while giving intracardiac injection. Though usually the attending doctor does this procedure, still in absence of doctor, the nurse should know how to administer intra-cardiac injection, the site is pre cardiac region in 2nd or 3rd intercostal space in midclavicular line. Here in this case the needle is pierced perpendicularly at 90° angle to the chest wail.
Intra Articular Injections
This is a local administration of drugs into joint cavity. Here the drugs act locally and not by absorption to blood stream. Usually hydrocortisone injections are given intra articularly in orthopedic practice. Great aseptic care is taken for this producer as there is chance of introducing infective organism to joint cavity. Usually intra articular injections are given by orthopedic surgeon or by a nurse specially experienced in orthopedic ward. Big joints like shoulder, knee, ankle elbow and wrist joints are given intra articular injections.
Intra Ventricular Injection
This is to introduce medication to ventricle of brain and not of heart. The administration may be required either for therapeutic or diagnostic purpose. Usually neurosurgeon administer medication and perform such procedures. Great aseptic care is taken before giving intra ventricular injection.
Intra Amniotic Injection
This procedure of introducing medication to amniotic fluid is done in obstetric practice by obstetricians. The procedure is indicated for therapeutic abortion. Before 16 weeks of pregnancy the amniotic sac is punctured through vaginal route by a 10 cm. special tap needle in the anterior vaginal fornix. After lb weeks of pregnancy the amniotic sac is punctured through abdominal route. Usually 50% glucose or 20% saline solution is injected to amniotic sac after removing about 200 ml of amniotic fluid. All aseptic care is strictly followed. Bladder is emptied before the procedure. For convenience and to detect the bladder puncture, the bladder is filled with 15-20 ml of methylene blue by catheterization