Parts of a needle and syringe

The parts of a needle:

 The hub, which fits onto the syringe.
 The shaft, which is attached to the hub
 The bevel, which is the slanted part at the tip of the needle
(to penetrate the skin more easily)

 Gauge (or diameter) of the shaft.

The gauge varies from #18 to #30. The larger the gauge
number, the smaller the diameter
**The Length of the needle chosen depends on the depth
to which medication will be instilled.

Figure 23-4
Parts of syring:
 Plunger
 Barrel
 Tip

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.
Louis: Mosby.)

Parts of a syringe.

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 Withdrawing Medication from a vial

Vials: Are a single dose or multi dose plastic or glass

containers in which liquid or powdered medication with rubber
seal at the top.
Equipment:
 Clean gloves.
 Alcohol swab.
 Vial bottle.
 Diluent.
 Syringe ( 3 or 5 ml) , Needle ( 21 or 23 gauge).

Prepare vial containing a powder: (Reconstituting medication):

Steps Rational
1- Remove the cap from proper
diluent.

2- Clean the top of diluent with To prevent coating needle and

alcohol. Allow alcohol to dry. mixing with medication.

3- Pull the plunger back and draw air into the syringe
equivalent to volume of drug that aspirated from vial.

4- Inject the air into the diluent. To prevent buildup of negative

pressure in vial when aspirating.

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5- Invert the diluent bottle and Easy to aspirate medication.
withdraw the amount that you
need.

6- Remove the cover from vial medication and clean the

Rubber stopper.
7- Insert tip of needle on center of rubber seal of powder Diluent starts to dissolve.
medication, then Inject diluent into vial.
8- Mix medication by rolling in palms, do not shake. To prevent air bubbles and ensure
accurate measurement of drugs.
9- Once you want to aspirate medication, Invert the vial and To prevent aspiration of air
keep the needle below the fluid.
10- Gently draw up the solution. When we open a single Prepare medication for
dose vial discarded after use, the multi dose vial administration.
contain several doses and we can use several times.
11- Provide completion protocol.
Prepare vial containing solution.
Steps Rational
1- Remove cap covering from the The cover cannot be replaced
top of vial to expose sterile after removing.
rubber seal and clean with
alcohol swab.

2-Pick up the syringe and pull the plunger to draw air that is To prevent the buildup of
equivalent to volume of medication. negative pressure.
3-put the vial on flat surface, insert needle and inject air into
vial container.
4-Invert vial while keeping firm To prevent aspiration of air
hold on syringe and tip of needle
below fluid level.

5-Aspirate the appropriate amount.

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 6-Remove needle from vial and hold the syringe at eye level. Allow fluid to settle in
bottom of barrel.
7-If you need to inject medication to the patient change needle New needle is sharper, and
to appropriate gauge according to route of administration. No fluid is along shaft.
8- For multi dose vial, make label includes (date of opening Ensure the nurse will prepare
vial and initials). future dose correctly.
9 -Compare label of medication with MAR.
10- Provide completion protocol.

Preparing medication from ampules

Ampules: are made of glass with constricted neck that is snapped off
to allow access to the medication. In addition, they contain
single dose of injectable medication in a liquid form. They
are available in several sizes from 1 to 10 ML.

Implementation:
Steps Rational
Tap top of ampule lightly and All solution moves into lower
quickly with finger until fluid chamber.
moves from neck.

2-Place small gauze pad around Protect fingers from injury.

neck of ampule.

3-Snap (remove) the neck of the ampule quickly and firmly Protects fingers and face from
away from hands. shattering glass.

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Draw up medication quickly using To filter out any fragment of
a filter needle. glass.

Hold ampule on a flat surface and insert filter needle into the
center of opening.
Aspirate medication into syringe
by pulling the plunger.

Keep needle tip under surface of liquid. Prevent aspiration of air

bubbles.
To expel excess air bubbles, remove needle from ampule hold
and tap side of syringe and push plunger upward eject air.
If syringe contains excess fluid, use sink for disposal.
Cover needle with safely cap. Do not use filter needle for
injection.
Compare label with MAR .
Provide completion protocol.

Mixing medications in one syringe

Mixing medications: It is a combined between two vials or an ampule to avoid giving the
patient more than one injection.
Equipment:
- Single-dose or multi-dose vials and ampoules.
- Syringe and two needles.
- Alcohol swab, waterproof and clean gloves.

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Implementation:
Steps Rational
1- Provide stander protocol.
2- Check MAR. To reduce medication preparation errors.
3- Review pt. history of allergy. To prevent sides effect from medication.
4- Check medication rights.
5- Perform hand hygiene. To prevent infection.
Mixing medication from two vials:
1- Take a syringe and aspirate air (2ML) or as
prescribed.
2- Inject (1 ML) air into vial (A), do not touch To prevent formation of bubbles and
solution then withdraw the syringe. inaccurate dose.
3- Using the same syringe insert needle and inject
(1 ML) air into vial (B).
4- Invert the vial (B) and withdraw (1ML)
medication into syringe.
5- Hold the syringe and insert needle into vial (A) To allow fluid to settle in lower half of
then invert vial, and carefully draw back the container.
desired amount of medication into syringe.

6- Withdraw the needle and expel any excess air Accumulation of air cause dose errors.
from syringe.
7- Check fluid level in syringe and change needle if Does not track medication through tissue.
being injected.
8- Label syringe with two medications that mixed, To make sure prepared medication
date, time and initial. correctly.
9- Provide completion protocol.
Mixing medication from a vial and an ampule:
1- Prepare medication from vial first.
2- Take syringe and aspirate air (1ML) or as

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 prescribed.
3- Inject (1 ML) air into vial, do not touch solution. To prevent formation of bubbles and
inaccurate dose.
4- Invert the vial and withdraw (1ML) medication To allow fluid settle in lower half of
into syringe. container
5- Change the needle by using a filter needle. Using filter needle to remove any
fragments of glass.
6- Withdraw the amount of medication from an
ampule as prescribed.
7-Check fluid level in syringe and change needle Does not track medication through tissue.
if being injected.
8- Label syringe with two medication that mixed, To make sure prepared medication
date, time and initial. correctly
9- Provide completion protocol.

Parenteral medication administration

o Parenteral medications are given through a route other than the alimentary canal; these
routes are intradermal, subcutaneous, intramuscular, or intravenous.
o Because injections are invasive procedures, aseptic technique must be used to minimize
the risk of infection.
o The angle of injection and the depth of penetration will indicate the type of injection.
o Injection medications are absorbed more quickly and are used for:
 Patients who are nauseated or have vomiting.
 Patients who are restricted from taking oral fluids.
 Patients who or unable to swallow.
 When the drug is too irritating to the body if administered by other routes.

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 Intradermal Injection ( ID)
 Are typically used to diagnose tuberculosis, identify allergens, and administer local
anesthetics.
 ID injections are administered into the epidermis layer by angling the needle 10° to 15°to
the skin.
 The sites commonly used for ID injection are the inner aspect of the forearm, upper
chest, and upper back beneath the scapula.

Implementation:

NO Steps Rationale
1 Assess for:
- The patient’s history of allergies. To maintain patient safety and
- Injection site. prevent drug error.
- Vital signs.
- Laboratory results. To provide baseline data about the
- Determine if the patient understands the patient.
reason for the skin test.
2 Prepare the equipment:
- Medication chart.
- Syringe (1 ML) and Needle (25-27 gauge)
- Medication (vial or ampule).
- Alcohol swab
- Gauze & adhesive tape
- Clean gloves. - Skin pencil.
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3 Prepare the medication: To maintain patient safety and
- Using aseptic technique. prevent drug error.
- Check the label of the medication carefully
against the MAR or the computer.
- Check the rights of medication administration.
- Prepare the injection from the vial or ampoule.
4 Perform hand hygiene. To prevent infection.
5 Introduce yourself and explain the purpose to the Patient has a right to be informed and
client. understanding of each medication to
improve adherence with drug
therapy.
6 Provide client privacy. Respect dignity of patient while
exposing injection area.
7 Raise the bed to a comfortable working height. Stabilizes injection site for easiest
accessibility
8 - Select the appropriate site for ID injection. An ID injection site is free of
(Note lesion or discoloration of skin). discoloration so, you can see the
- Have the patient extend his or her elbow and results of skin test and interpret them
supported on flat surface.
correctly.
9 Apply clean gloves. Reduce transfer of microorganism.
10 Clean the site with an antiseptic swab. Starting Remove secretions containing
from the center of the injection site, rotate the microorganism.
swab outward in a circular direction for about 5
cm (2 inches).
11 -Remove the needle cap and hold the needle To deposit medication into tissues
parallel to the skin surface with bevel of needle below dermis.
up with angel 15 degree.
12
-Using your non dominant hand, stretch the skin
over the site with your forefinger
13 Insert the tip of the needle for enough to place the Ensure that needle tip is in the
bevel through epidermis and stabilize the syringe dermis.
and the needle.
14 Inject the medication carefully and slowly. To minimizes discomfort at site.

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15 While injecting medication note that small bleb Bleb indicates that you deposited
approximately 6 mm resembling mosquito bite medication in dermis.
appears on skin surface.

16 Remove the needle quickly. -To prevent damage of adipose tissue.

17 Remark around the injection site -To detect any abnormal finding such
as tenderness, swelling, redness, and
itching.
18 Apply gauze at the injection site. -Don’t massage site. Apply bandage
19 Stay with the patient for several minutes. if needed.
20 Dispose the syringe and needle safely. Prevents injury to patients and health
care staff.
21 Documentation:
Document and the patient’s response and
unexpected outcome.

Intramuscular ( IM) injection

There are four common sites for administrating IM injections:

1- VENTROGLUTEAL SITE
It is located halfway between the hip and the head of the femur
The ventrogluteal site is the preferred site for intramuscular injections because the area:
o Contains no large nerves or blood vessels.
o Contains less fat than the buttock area, thus eliminating the need to determine the depth
of subcutaneous fat.

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2- DORSOGLUTEAL SITE:
The dorsolateral site is close to the sciatic nerve and
the superior gluteal nerve and artery. As a result,
complications (e.g., numbness, pain, paralysis)
occurred if the nurse injected a medication near or
into the sciatic nerve.

3- VASTUS LATERALIS AND RECTUS FEMORIS INJECTION SITE

The vastus lateralis muscle is usually thick and well developed
in both adults and children.
It is recommended as the site of choice for intramuscular
injections for infants and young children because it is the largest
muscle mass & there are no major blood vessels or nerves in the
area.

4- DELTOID SITE
 The deltoid muscle is found on the lateral aspect of the upper
arm. It is not used often for intramuscular injections because it
is a relatively small muscle and is very close to the radial nerve
and radial artery. (no more than 1 mL of solution can be
administered).
 The deltoid muscle is not well developed in infants and children.

Implementation:
N
O
Steps Rationale
1 Assess for:
- Client allergy to medication. To maintain patient safety
- Assess the site free of tenderness, swelling, and prevent drug error.
itching, burning and inflammation.
- Client age and weight to determine site and needle size.
- Vital signs.
2 Prepare the equipment:
- Medication chart. - Medication. - Alcohol swab.
- Gauze. - Gloves.
- Syringe (3 ML) , Needle ( 21-22 gauge, or 23-25 gauge for
small muscle).
3 Prepare the medication and check the Medication rights.
4 Provide patient's privacy.
Perform hand hygiene. To prevent infection
5 Introduce yourself and explain the purpose to the client. The patient has a right to be
10
 informed and understanding
of each medication to
improve adherence with drug
therapy.
6 Select an appropriate injection site (ventrogluteal site is To prevent injury to nerves,
preferred). bone and blood vessels.

7 Assist the client to assume suitable position (supine, Reduces strain on muscle and
lateral). minimizes injection
discomfort.
8 Prepare the skin: Reduce transfer of
Wear gloves. Clean the site with antiseptic swab. microorganism
Apply swab at center of site and rotate outward in circular
direction for about 5 cm (2 inches).
9 - If the size of the muscles is big, pull the skin.
- If the size of the muscles is thin, pinch the skin.
10 Holding the syringe between the thumb and the forefinger. Quick, smooth injection
requires proper manipulation
of syringe parts.
11 Using Z- track technique Z-track creates zigzag path
through tissues that seals the
needle track to avoid tracking
medication.
12 Inject the needle at 90 degrees.
13 Aspirate at the injection site for about 5 - 10 sec , . If Aspiration of blood into
blood appears, remove and discard the needle and syringe indicates possible
syringe and start over,. If no blood appears, injected placement into a vein.
the medication.
14 Inject the medication slowly about 10 sec . Slow injection reduces pain
and tissue trauma.
15 Remove the needle and released the skin. To prevent tissue damage.
16 Apply gauze at the injection site with gentle pressure to Dry gauze minimizes
site, do not massage site. discomfort associated with
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 alcohol on non-intact skin.
17 Discard the syringe and needle safely. Prevents injury to patients
and health care personnel.
18 Stayed with the patient for several minutes. To observe any allergic
reaction.
19 Documentation.

Subcutaneous (SC) Injection

Subcutaneous (SC or SQ) injections are commonly used in the administration of medications
such as insulin and heparin because these drugs are absorbed slowly, to produce a sustained
(continuous) effect.
Site: into the subcutaneous tissue, between the dermis and the muscle.
Common sites for SC injections are:
- The lateral and anterior aspects of the upper arm or thigh
- The scapular area on the back
- The abdomen
- Upper ventrodorsal gluteal areas.
The amount of medication:
- Not exceed 1.0 ml; if repeated drug doses are given, rotate
the sites.
- 1 - to 3-ml syringe with a 25- to 29-gauge.
- The medication is administered by angling the needle 45° or
90° to the skin.
Implementation:

NO Steps Rationale
1 Assess for:
- Client allergy to medication. To maintain patient safety and prevent
- Assess the site free of tenderness, swelling, drug error.
itching, burning and inflammation.
- Vital sings.
- Laboratory results.
2 Prepare the equipment:
- Medication chart. - Medication vial.
- Alcohol swab. - Gauze. - Gloves
- Syringe (1 ML or 3ML), needle (25 - 27 gauge).
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3 Prepare the injection and check the medication To maintain patient safety and prevent
rights. drug error.
4 Perform hand hygiene. To prevent infection
5 Ensure patient privacy. Respect dignity of patient while
exposing injection area
Introduce yourself and explain the purpose of Patient has a right to be informed and
6 medication to the patient. understanding of each medication to
improve adherence with drug therapy.
5 Assist the client to a position depending on the Stabilizes injection site for easiest
site to be used. accessibility or relaxation of site
minimizes discomfort.
6 Select appropriate site for SC injection and Injection sites are free of abnormalities
inspect skin surface. that interfere with drug absorption.
7 Wear gloves. Reduce transfer of microorganism
8 Cleanse site with antiseptic swab. Apply swab at Remove secretions containing
center of site and rotate outward in circular microorganism.
direction.
9 Insert the needle quickly and firmly at a 45- to Quick, firm insertion minimizes
90-degree angle and slowly inject the discomfort.
medication.
10 Remove the needle at the same angle. To prevent tissue damage.
11 Do not massage the site. Massage can be damage underling
tissue.
12 Apply gauze at the injection site.
13 Discard the syringe and needle safely in a sharp Prevents injury to patients and health
container. care staff.
14 Documentation.

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