Before attempting any procedures described in this chapter, wash and disinfect your hands and wear disposable gloves.
Absolute: Edema or inflammation at the planned injection site, shock and peripheral hypoperfusion (this can impair absorption), patients refusing consent to the procedure.
Relative: Coagulopathy, thrombocytopenia, use of anticoagulants (risk of hematoma).
Phlebitis, hematoma, infection, drug extravasation.
Nonsterile disposable gloves; skin disinfectant (single-use alcohol swabs or single-use cotton swab with disinfectant solution); syringe; short needle (bore up to 0.7 mm [22 gauge]); needle for drawing drug from ampoule (or a syringe prefilled with the drug, with or without a needle); sterile gauze and bandage; sharps container.
The abdomen or lateral thigh, alternatively the lateral arm.
1. Close the curtains to ensure privacy for the patient. Explain the planned procedure to the patient and confirm consent.
2. Prepare the medication, if necessary, by drawing the medication from the ampule or vial into the syringe using a sterile needle. It is unnecessary to clean the top of a sealed vial. Remove the needle used to draw up the drug from the syringe and replace with a sterile 20-gauge or 21-gauge needle.
3. Perform hand hygiene and don nonsterile disposable gloves.
4. Disinfect the planned injection site using the single-use alcohol swab or single-use cotton swab with disinfectant solution. Start over the planned injection site and work outwards. Allow the disinfectant to dry completely.
5. Grab and lift the skin using 2 or 3 fingers, elevating a skin fold that is ~2 cm thick.
6. Insert the needle at a 90 degree angle to the skin fold and aspirate by pulling the syringe plunger to avoid intravascular administration. If blood is aspirated, withdraw the needle and prepare another drug dose using a new needle and syringe.
7. Immobilize the needle by holding the needle hub with one hand and slowly inject the drug, then withdraw the needle at a 90 degree angle to the skin.
8. Immediately cover the site with clean dry cotton gauze and apply pressure. If bleeding occurs, protect the injection site with a dressing.
9. Dispose of all sharps securely in a sharps container. Do not recap needles to avoid needle-stick injuries. Remove gloves and perform hand hygiene.
Alternative technique: After inserting the needle, release the skin fold, hold the syringe with both hands, aspirate to confirm the needle tip is not in a vessel, and inject as per steps 7 to 9.