Session 8 Administration of Drugs by Intradermal and Subcutaneous Routes

Session 8 Administration of Drugs by Intradermal and Subcutaneous Routes

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Learning Objectives

Learning Objectives

By the end of this session, students are expected to be able to:

Define intradermal and subcutaneous routes of drug administration

List different sites for intradermal and subcutaneous routes

Describe techniques (procedure) for administering drug by intradermal and subcutaneous routes

Describe major home considerations for subcutaneous injection

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Definition of Terms

Definition of Terms

Intradermal injection: The medicine is injected between the layers of the skin.

Solution is absorbed slowly via the capillaries.

Only a small (0.1ml) amount of medicine is injected.

Generally it is used for sensitivity tests and BCG vaccination.

The advantage of the intradermal route for the test is that the reaction of the body is easily visible.

Intradermal injection is injected at 5 to 10 degrees angle.

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Subcutaneous Injection

Subcutaneous Injection

The drug is deposited in the subcutaneous tissue which lies just beneath the skin.

It is good route for water soluble drug but not for suspensions and oily substances.

It takes about 15 to 20 minutes for the drug to be absorbed.

The amount of drug which can be given by this route is 0.5 to 2 mls.

It is recommended that the needle should be injected at 45 o angle.

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Sites for Intradermal and Subcutaneous Routes

Sites for Intradermal and Subcutaneous Routes

Different Sites for Intradermal Route

Inner surface of the fore arm, midway between wrist and elbow

Outer surface of the upper arm

On the back of the shoulder blade/Scapula

Sites for Subcutaneous Injection

Outer aspect of the upper arm

Anterior and lateral aspect of the thigh

Upper back

Any other sites where there is no bone prominence and where it is free from big blood vessels and nerves. E.g. insulin in diabetic patients

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Technique for Administering an Intradermal and Subcutaneous Injection

Technique for Administering an Intradermal and Subcutaneous Injection

Appearance of injection site

Specific drug action and expected response

Client’s knowledge of drug action and response check agency protocol about site to use for skin test

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Equipment and Supplies

Equipment and Supplies

Appropriately sized needle-syringe unit

Antiseptic wipe (spirit or alcohol)

Disposable gloves

Safety box

Medicine

Treatment chart

Wool swabs

Kidney dish for used swabs

Galipot

Patient’s case note

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Technique Procedure for Intradermal Route

Technique Procedure for Intradermal Route

Wash hands before.

Arrange tuberculin syringe or a 1 ml syringe and needle.

Identify the patient, help him/her to lie in a comfortable position and expose the selected site.

Clean the skin with antiseptic swab.

If BCG vaccine, clean with sterile water.

Stretch the patient’s skin taut and insert the needle into the skin at 2-15 angle (The needle is nearly flat with the patient’s skin) with the bevel of the needle upper most.

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Introduce the needle only about 0.5 cm.

Introduce the needle only about 0.5 cm.

Gently and slowly inject the drug while observing for a small wheel to appear.

Carefully withdraw the needle.

Do not massage the site after removing the needle as it may alter the test results.

Discard sharps into safety box.

If for diagnostic purpose e.g. Montour X tests circle the area with ball pen and record time and date.

Instruct the patient not to wash the area until it is assessed for the intended outcome.

Inspect for signs of reaction when the stated duration of time has reached.

Thank the patient leave patient comfortable.

Report and record for any side effect observed.

Clean equipment according to the hospital policy and return into appropriate place.

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Assessment

Assessment

Allergies to medication

Specific drug action, side effect and adverse reaction

Client’s knowledge and learning needs about the medication.

Status and appearance of subcutaneous site for lesion, swelling, inflammation and tissue damage from previous injection

Ability of client to cooperate during the injection

Previous injection site used

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Equipment and Supplies

Equipment and Supplies

Medicine

Appropriate sized needle-syringe unit

Spirit/alcohol

Disposable gloves

Safety box

Treatment chart

Galipot for keeping sterile swab

Kidney dish for keeping used swab

Ampoule file

Wool swabs

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Technique (procedure) for Subcutaneous Route

Technique (procedure) for Subcutaneous Route

Wash hands before the procedure.

Arrange tuberculin syringe or a 1 ml syringe and needle.

Follow the six Rights.

Identify the patient, help him to lie in a comfortable position and expose the selected site.

Work in a well-lighted, quite, clean area.

Obtain the appropriate equipment and supplies and correct medication.

Check expired date on medicine.

Calculate dose if necessary.

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Assess the patient and put on gloves.

Assess the patient and put on gloves.

Draw the correct amount of drug in the syringe.

Select an appropriate injection site.

Clean the skin with antiseptic swab.

Stretch the patient’s skin taut or pinch the skin and insert the needle into the skin at 45⁰ angles with the bevel of the needle upper most.

Gently and slowly inject the medicine.

Carefully withdraw the needle.

Discard sharps into safety box.

Remove gloves and wash hands.

Thank the patient and leave patient comfortable.

Report and record for any side effect observed.

Clean equipment according to the hospital policy and return into appropriate place.

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Home Care Considerations

Home Care Considerations

For frequent injections, develop a plan for site rotation with the client.

For cost-saving measures, teachable clients for example, diabetic clients to safely reuse disposable syringes until the needles become dull, which can vary from two to ten times.

For insulin dependant’s clients ensure that, at least one knowledgeable support person can correctly inject insulin in emergency situation and recognize and treat hypoglycaemia.

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Key Points

Key Points

Intradermal is the route used for diagnostic and testing purpose.

Intradermal route solutions are absorbed slowly via the capillaries and only small amount are needed (e.g. 0.1 ml).

Subcutaneous is the route used for water soluble and not suspension or oily form of medicine.

Subcutaneous injection the needle is recommended to be injected at 45o angles.

The amount of drug which can be given by subcutaneous route is 0.5-2 mls of medicine.

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Evaluation

Evaluation

What is an intradermal route of drug administration?

Mention the different sites for intradermal route.

List requirements used for administration of drug by intradermal route.

What is a subcutaneous route of drug administration?

Explain the different sites for subcutaneous route.

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References

References

Adams, M. P. et al. (2008). Pharmacology for Nurses. A Pathophysiologic Approach. (2nd ed.). New Jersey: Pearson.

Kozier, B. et al. (2004). Fundamentals of Nursing. Concepts Process and Practice. (7th ed.). New Jersey: Pearson Education, Inc.

MOHSW. (2008). Basic Nursing Procedures. A manual for Nursing Practice in Tanzania. (3rd ed.). Dar es Salaam, Tanzania: Ministry of Health and Social Welfare.

Rice, J. (2006). Principles of Pharmacology for Medical Assisting (4th ed.). Delmar Cengage Learning.

Wong, D.L. et al. (2003). Nursing Care of Infants and Children (7th ed.) Mosby

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STUDY AS IF TOMORROW YOU HAVE A TEST

STUDY AS IF TOMORROW YOU HAVE A TEST

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