Safe injection practice for nurses
- 1. WELCOME
- 2. CONTINUING NURSING EDUCATION, Nursing Service Division, GOVT. MEDICAL COLLEGE HOSPITAL, THIRUVANANTHAPURAM
- 3. SAFE INJECTION PRACTICE BIJUKUMAR.V, STAFF NURSE Gr.1 , MCH
- 4. AIM: Although a safe injection does not harm to patient, unsafe injection practices may leads some health problems. The most affected category of health care providers are the nursing personnel.
- 5. SAFE AND UNSAFE INJECTION PRACTICE An injection is said to be safe: if it does not harm the recipient, it does not expose the provider to avoidable risk, and it does not result in wastes that is dangerous for the community.
- 6. Injection safety is achieved by : * administering the injection using a sterile device (syringe, needle etc.), * adopting sterile technique by a qualified and well trained person and * discarding the used devices in a puncture-proof container specially designed for appropriate disposal. Any breach in the process makes the injection unsafe.
- 7. Unsafe injection practices in developing countries are due to the reuse of contaminated syringes and unsafe disposals Unsafe disposal of used injection equipment can facilitate scavenging, repackaging and reselling
- 8. Safety of recipient (patient) The risk of harming recipient can be avoided by administering right medication with a new sterile single use device, and observing proper technique by qualified and well trained health workers.
- 9. To ensure safety to the recipient there should be sufficient supply of quality single use devices throughout the year.
- 10. The injection provider can reduce avoidable risks by disposing used syringe in a puncture proof closed container immediately after use without recapping. Needle stick injury (NSI) is commonly encountered by the provider especially during recapping. Safety of the provider (Nurse)
- 11. About thirty infectious diseases may be transmitted by NSI but chances of acquiring hepatitis B infection are much higher than other infections. Risk of infection after Needle Stick Injury (NSI) HBV : 30% (30 in 100) HCV : 3% (3 in 100) HIV : 0.3% (3 in 1000)
- 12. Hence, full immunization against Hepatitis B is important to ensure safety of the provider.
- 13. These interventions (proper disposing technique without recapping and vaccination) can provide protection to the healthcare worker from occupational infections.
- 14. Safety of the community The used syringes should be immediately disposed in a specially designed puncture proof box or segregated for disposal after burning & cutting the needle.
- 15. Creating a climate of safety includes- - strengthening of an infection control committee - ensuring an adequate supply of quality disposable injecting devices and sharps containers - promoting injection safety awareness - vaccination of workers against Hepatitis B & other BBVDs(Blood Born Viral Diseases) - supervising workers with low performance & push them to CNE That is why CNE MCH is conducting Training in ‘safe injection practice’ for the injection NURSES. How to make our Nurses ‘SAFE’ ?
- 16. How to reduce the risk of infection? ---Good hand washing --- good hand drying ---- strict aseptic technique ----good skin preparation ---- good questioning of the client
- 17. INJECTION Injections are sterile solutions, either ready to use or prepared by dissolving an active ingredient in water for injection. ‘Injecting’ is the act of giving medication in to the blood vessels or body tissue through a hollow tube or needle. Good injection technique means less pain and less injury.
- 19. Types of injections commonly practiced by Nurses . 1.Intra dermal (ID) – in to the dermis just under the epidermis 2.Subcutaneous (SC) – in to the tissue below dermis (subcutaneous fat) 3.Intra muscular (IM) - in to the body muscle 4.Intravenous (IV) - in to a vein
- 20. Why give drugs in injection form ? (Purpose) - to get a rapid effect, drugs given by mouth take time for absorption - some medicines are ineffective in GI tract by the action of digestive juices. Eg. Insulin - To obtain a local effect. Eg; Xylocaine - For diagnostic test. Eg. Tuberculin test - Test for sensitivity - To restore blood volume in emergency conditions.
- 21. Needle length and size when choosing the needle it is important to assess the amount of muscle, subcutaneous fat and weight of the patient.
- 23. Needle size and colour Orange- 25G Blue- 23G Black- 22G Green- 21G Yellow- 20G Rose- 18G Ash- 16G
- 25. Equipments for the administration of injections -clean tray -Spirit or betadine -Syringes of appropriate size - cotton swab -Medicine vial or ampoule -Needles / cannula’s of appropriate size - gloves, apron, mask - patient prescription to check dose, route and timing - nurses record
- 26. Clinical room preparation for the administration of injections -protocol/ procedure or standards of injections -Wash basin for hand washing & Soap - alcohol hand rub - area for the patient to lie down - panic button for emergency help - sharp containers - resuscitation equipments such as defibrillator, laryngoscope, ambu bag etc. - emergency drugs to treat anaphylaxis - oxygen and mask
- 29. are administered into the dermis, just below the epidermis.
- 30. Intradermal injections are used for: -- Sensitivity tests -- allergy tests -- local anesthesia.
- 31. What gauge needle do you use for ID injections? 26- or 27-gauge needle
- 32. The angle of administration for an intradermal injection is? 5 to 15 degrees.
- 33. Small volume of 0.01 to 0.05 ml are injected because of the small tissue space.
- 35. Cont….. -- Check the expiry date of medicines, syringes, needles and other materials -- follow the 7 rights of medicine administrations -- check for discolouration
- 38. The appearance of a wheal indicates that the medication has entered the area between the intradermal tissues. If a wheal does not appear, withdraw the needle and repeat the procedure in another site.
- 40. Dispose of Equipment. Dispose of equipment according to the standard protocol
- 41. Record Administration of Intradermal Injection. Record the injection information on the patient’s chart or nurses record.
- 42. Remember: -- drug preparation for test dose is 0.9 ml of sterile water & 0.1 ml of the drug -- inject the solution intradermally just enough to form a wheal -- encircle the site correctly and write the time -- check the site after 20 to 30 minutes for the signs of reaction -- if negative document it as (-) and if positive (+)
- 44. What is a subcutaneous injection? A subcutaneous injection is an injection given into the fat layer between the skin and muscle..
- 46. Upper Arm The area between the elbow and the shoulder at the outer aspect. One hand with above from the elbow and one hand width below from the shoulder
- 47. THIGH Area between the knee and hip slightly to the side. One hand width above the knee and one hand width below the hip.
- 48. Abdomen Two inches around the umbilical button
- 49. Why are subcutaneous injections given? Because there is little blood flow to fatty tissue and the injected medicine is absorbed slowly.
- 50. General instructions - Pinch up fatty tissue always before giving subcutaneous injections.
- 51. -- Place the needle at 90 degree. But for children and thin adults try it at 45 degree.
- 54. Medicines injecting in to the body muscles are called Intramuscular injections
- 55. IM injection sites 1. Upper arm (Deltoid) 2. Thigh ( Vastus Lateralis) 3. Hip ( ventrogluteal or gluteal medius) 4. Buttocks ( dorsogluteal or gluteal maximus)
- 56. 1. DELTOID MUSCLE Location- upper and outer aspect of the upper arm.
- 57. How to locate deltoid area? -The safe area for injection is generally defined as about three fingers ( 1-2 Inches) below the shoulder joint at the outer side. -- ‘V’ shape method- injection should go in the ½ outer side of the ‘V’ shape
- 58. Age limit 3 years and above Maximum amount to be injected – 0.5 to 2 ml.
- 59. 2. THIGH MUSCLE ( VASTUS LATERALIS) -It is located on the outer lateral aspect of the thigh. -- one hand’s width above the knee to one hand’s width below the groin or hip joint. -
- 61. -- When injecting in to the thigh, lift up the Vastus Lateralis muscle away from the bone. -- Maximum amount to be injected is 4 to 5 ml. -- This site is safe for infants and children
- 62. 3 . Hip Muscle ( Ventro-Gluteal or Gluteal Medius muscle)
- 63. How to locate Ventro Gluteal or hip injection site? Place the heel of your hand over the patients greater trochanter and feel the anterior superior iliac spine with index finger( or point the thumb towards the patients abdomen). The middle finger then slides across up to the iliac crest to make ‘ V’ shape. The injection site is at the middle of the ‘V’
- 64. Age Limit- 7 months to adult. Maximum amount of fluid – 2.5 to 5 ml. Ventro gluteal site is the safest site for IM injections because it avoids all major nerves and blood vessels
- 65. Buttocks (Dorso Gluteal or Gluteus maximus muscle) Location- Divide one buttock in to 4 quarters (from top to bottom and side to side) The injection should be given in the upper and outer quarter.
- 66. Maximum amount of fluid – 4ml. This site is high risk of hitting sciatic nerve and superior gluteal artery. To avoid this injury, divide the upper outer quadrant again in to 4 equal part and give injection to the upper outer quadrant of this division.
- 67. Remember: The thickness of fat in buttock’s area is greater than the length of standard needles in obese patients. This may cause decreased absorption and deposition of medicines under the subcutaneous layer . Later this may be an injection abscess.
- 68. ONCE MORE FOR YOU……
- 72. Z- track: stretching the skin downwards or sideways at the site before injection the track is closed when the skin is released, preventing leakage.
- 73. NURSING IMPLICATIONS - IM injections can be an unpleasant experience for patients - Extra caution is required when administering IM injections to children. - Look at the skin to ensure there are no signs of infection, damage or poor blood supply. - Where frequent IM injections the use of a rotation chart may be considered. - Oedematous limbs will not absorb medication as effectively as well-perfused limbs. - The nurse must have a good knowledge of the appropriate technique and anatomy to avoid any damage to surrounding structures. - IM injections should be avoided in patients with thrombocytopenia (a decreased number of platelets), in whom clotting problems may occur. - Caution must be exercised to ensure that the medication is suitable for IM injection.
- 75. SEEK MEDICAL CARE IF: The patient feels like he or she is having side effects or an allergic reaction from the medicine. The medicine was injected incorrectly. You or someone else is unable to give the injection. The patient has a rash, swelling, or continued bleeding or pain at an injection site.