Before attempting any procedures described in this chapter, wash and disinfect your hands and wear disposable gloves.
Repeated IV drug injections are performed similarly to IV drug infusions via a peripheral intravenous catheter and, when necessary, via a central venous catheter. The procedure described below is a peripheral IV injection using an injection needle; this is most frequently performed when only one injection is planned or if an IV catheter is not available.
Absolute: Patients refusing to consent for the procedure.
Relative: Avoid peripheral vein catheterization at sites of local infection, burns, in the veins of the upper limb with an arteriovenous fistula used for hemodialysis, or in the veins of a limb postmastectomy with lymph node dissection or lymphedema.
Phlebitis, hematoma, infection, drug extravasation.
Nonsterile disposable gloves; skin disinfectant (single-use alcohol swabs or single-use cotton swab with disinfectant solution); tourniquet; needle (usually bore 0.9 mm [20 gauge]); syringe; needle for drawing drug from ampoule; sterile gauze and bandage; sharps container for disposal.
In adults the sites of IV injections are usually the forearm and outer surface of the hand or less commonly the outer surface of the foot. In urgent situations other sites can be used: veins of the cubital fossa and external jugular veins.
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 ampoule 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. Select a suitable superficial vein. This can also be done using ultrasonography, as when obtaining intravenous access.
4. Wrap a tourniquet (usually on the upper arm) to fill the peripheral veins. Visualizing and puncturing a vein can be facilitated by warming the limb and massaging (tapping) the planned injection site. Spread the skin taut below the planned injection site using a thumb or fingers of one hand. Alternatively ask the patient to open and close their fist several times.
5. Perform hand hygiene, and don nonsterile disposable gloves.
6. Clean and disinfect the planned injection site using a 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.
7. Spread the skin taut below the planned injection site using a thumb or fingers of one hand. Insert the needle with a syringe attached into the skin at a ~30 degree angle, simultaneously aspirating the syringe plunger.
8. When blood is seen in the syringe, release the tourniquet and inject the drug (this is usually done slowly), then withdraw the needle.
9. Compress the injection site with a sterile gauze immediately after the needle is removed to stop bleeding, then protect it with a small adhesive dressing.
10. Dispose of all sharps securely in a sharps container. Do not recap needles to avoid needle-stick injuries. Remove gloves and perform hand hygiene.