Mr.Upendra Yadav (M.Sc.

)
Child Health Nursing
College of Nursing,
B.P.Koirala Institute of Health Sciences Dharan
Nepal. 1
Parenteral therapy includes:
2. Intradermal
3. Subcutaneous
4. Intramuscular and
5. IV injections.

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Types of Injections
• Intradermal Injection: Injected into the
dermis, chiefly used for diagnostic
purposes e.g. Skin test for sensitivity
• Subcutaneous (hypodermic) injection: into
fatty tissues.
• Intramuscular Injection: Injected between
the layers of muscles. This route is used
when rapid action is required or when a
drug would irritate upper layers of tissues.
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 Types of Injections (Conti..)
• Intravenous Injection: Injected into veins.
When large quantity of fluid is given, it is
called infusion or venoclysis.
• Intra cardiac: into the heart.
• Intra peritoneal: into the peritoneal cavity.
• Intra spinal or intrathecal: into spinal canal.
• Intra pleural: into the pleural cavity.
• Intra articular: into a joint. 5
A syringe and needle is essential to give parenteral
medication.
Syringes
• Are made up of glass and plastic (disposable).
• Glass syringes need to be sterilized. Most
commonly used syringes are hypodermic syringe,
tuberculin and insulin syringes.
• Followings are the parts of syringe:
– Barrel and piston (plunger) 6
Barrel:
• It may be touched anywhere outside except the
tip but one should not touch anywhere to the
piston except the flat surface at the top called
flange.
• There is a marking over the outside of the
barrel. The usual sizes of the syringes are 2cc,
2.5cc, 5cc, 10cc, 20cc, 50cc (rarely used), etc.
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 Syringes (Conti.)
• Tuberculin syringes have a small slender
holding 1 ml.
• An insulin syringe has a same size and
shape of a tuberculin syringe, but with
marking in the units specially made for
insulin.

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 Syringes (Conti.)
Needle:
• Are made up of steel or other metal and are reusable
or disposable.
• It has two parts: the hub and the shaft.
• The hub (hilt) fits on the rip of the syringe. The hub
of the needle can be touched when preparing to give
an injection.
• The shaft is long and slender. It has a flat surface
diagonally across the end called the bevel, which is
very sharp for piercing the skin. The opening inside
the shaft is called lumen.
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 Syringes (Conti.)

Sizes:
• According to the diameter of the lumen.
• The diameter sizes of the lumen are
indicated by the number from 14 to 27. The
increase in the gauge number, the smaller
is the diameter of the needle.
• The gauge of the needle is selected
according to the viscosity of the medication
to be given. Water preparations are given
with 22 – 25 gauge needles. 10
 Syringes (Conti.)

Length:
• Vary from 0.6 - 5.0 cm.
• The length of the needle is selected
according to the site of the injection and
the size of the patients.

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Drugs may be dispensed in:
1. Ampule
2. Vial
3. Prefilled cartridges

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 Ampoule:
• An ampoule is a glass flask that contains a
single dose of medication for parenteral
administration.
• If all medications are not used, the
remainder must be discarded. Medication
can be removed from an ampoule by
breaking its thin neck

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 Vial:
• A glass bottle with a self-sealing stopper
through which medication is removed.
• The rubber stopper that exposed is the
means of entrance into the vial, to facilitate
the removal of medication, the nurse
should inject air into the vial. The amount
of the air is the same as desired quantity of
solution.

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 Prefilled cartridges
• Provide a single dosage of medication.
• The nurse inserts a cartridge into a reusable
holder.
• Before giving the injection, the nurse should
check the dosage in the cartridge and clears the
cartridge of excess air.
• Most Prefilled cartridges are over filled and the
nurse should eject any excess medications to give
an exact dose and avoid medication errors.
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 Purposes (Conti..)
• To get the rapid and systemic effect of the
drugs.
• Some medications are not given by mouth.
Some drugs are rendered ineffective in the
GI tract by the action of gastric juice
(insulin) .
• Some drugs are not retained in the
intestines for sufficient periods for its
absorption due to diarrhea, vomiting, or
gastric suction.
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 Purposes (Conti..)
• Some drugs are poorly absorbed from GI tract
and some drugs are toxic and irritating to the
gastric mucosa.
• To give required effects when the patient is
unconscious, unable to swallow due to
surgical or neurological problems or when the
patient is not cooperative.

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 Purposes (Conti..)
• To get local effects at the site of injection:
– For diagnostic purposes (tuberculin test)
– For local anesthesia (xylocaine)
– For allergy test (penicillin test) and
– For treating local condition (hydrocortisone
injection into joint cavity).

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 Purposes (Conti..)
• To restore blood volume and electrolyte
balance by replacing fluids e.g. shock.
• To give nourishment when it can not be
taken by mouth.

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 Preparation of drug from Vial
• Clean the rubber stopper of the vial with a
spirit swab, rubbing it in a rotatory motion.
Discard the swab.
• Fix the needle on syringe using aseptic
technique. Dissolve the drug if needed.
• Put some amount of air into the syringe
that is equal to the volume of the
medication to be drawn by pushing the
plunger.
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 Preparation of drug, Conti..
• Inject the air through rubber stopper into the
vial. This is done by grasping and inverting the
vial in one hand.
• Withdraw the required amount of medication by
keeping the level of the needle immersed in the
solution.
• This is done by grasping and inverting the vial
in one hand and pulling back on the plunger
with the other hand. Hold the syringe straight
and at eye level with the other hand.
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 Preparation of drug, Conti..
• Remove the needle from the vial holding
the barrel of the syringe securely.
• Cover the needle immediately with its
sterile cover. If the cover is not available,
place the needle between sterile gauges.
• Place the syringe on the tray.
• Dispose of the vial or return to the storage
place.
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 Preparation of drug, Conti..
• Remove any medication that is lodged in the
head of the ampoule by flicking the head with
your index finger nail.
• Open the ampoule by filling across the neck of
the ampoule and then breaking off the top away
from you.
• Prepare the needle and the syringe.
• Insert the needle into the ampoule touching the
sides of the ampoule. Do not invert the ampoule.
Once the ampoule is opened, it is not airtight.
So one does not require injecting air into it
before withdrawal of medication. 25
 Preparation of drug, Conti..
• Withdraw medication into syringe.
• Cover the needle immediately with its
sterile cover or with sterile gauge.
• Dispose off the ampoule and unused
solution.

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Equipment needed

• Two vials of insulin

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 Procedure

• Gather equipment.
• Wash your hands.
• If necessary, remove the metal cap that protects
the rubber stopper in the vial.
• If insulin is a suspension, rotate the vial between
your palms to mix before withdrawal.
• Cleanse the rubber tops with alcohol swabs.

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 Procedure (Conti..)
• Remove cap from needle. Inject air into the
modified insulin preparation (e.g. NPH insulin).
Use an amount of air equal to the amount of
medication to be withdrawn in the vial. Remove
the needle.
• Inject air into the clear insulin without
additional protein (regular insulin). Use an
amount of air equal to the amount of
medication to be withdrawn in the vial. Do not
bubble the air through the medication.
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 Procedure (Conti..)
• Invert the vial of clean insulin and aspirate
the amount prescribed. Remove the needle
from the vial.
• Clear the rubber top of the modified insulin
vial. Insert the needle into the vial, invert it
and withdraw the medication. Cap the
needle.
• Store the vial according to the agency
recommendation.
• Wash your hands. 31
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 Reconstitution (Conti..)
• Many drugs are supplied as powers in vials.
• A liquid or diluents must be added to the
powder before it is administered as a
solution.
• The technique of adding diluents to a
powdered drug is called reconstitution.
• The nurse must know the amount and types
of diluents to be added to the powders. 33
 Reconstitution (Conti..)
• Common dilutes are water for injection and
normal saline.
• After the diluents are added to the solution,
the nurse reads the label further to
determine the concentration of the drug per
millimeter of solution. This is essential to
the dose computation.

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 Reconstitution (Conti..)

• If all the medication is not given at the time of

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