The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [563]
Procedure guideline 13.16 Medication: injection administration
Essential equipment
Clean tray or receiver in which to place drug and equipment
Sterile topical swab, if drug is presented in ampoule form
21 G needle(s) to ease reconstitution and drawing up, 23 G if from a glass ampoule
Drug(s) to be administered
Patient’s prescription chart, to check dose, route and so on
21, 23 or 25 G needle, size dependent on route of administration
Recording sheet or book as required by law or hospital policy
Syringe(s) of appropriate size for amount of drug to be given
Swabs saturated with isopropyl alcohol 70%
Any protective clothing required by hospital policy for specified drugs, such as antibiotics or cytotoxic drugs, such as goggles or gloves
Preprocedure
Action Rationale
1 Collect and check all equipment. To prevent delays and enable full concentration on the procedure. E.
2 Check that the packaging of all equipment is intact. To ensure sterility. If the seal is damaged, discard (NPSA 2007d, C).
3 Wash hands with bactericidal soap and water or bactericidal alcohol handrub. To prevent contamination of medication and equipment (DH 2007, C).
Procedure
4 Prepare needle(s), syringe(s), and so on, on a tray or receiver. To contain all items in a clean area. E.
5 Inspect all equipment. To check that none is damaged; if so, discard or report to MHRA. C
6 Consult the patient’s prescription chart and ascertain the following:
Drug
Dose
Date and time of administration
Route and method of administration
Diluent as appropriate
Validity of prescription
Signature of doctor.
To ensure that the patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (NMC 2008a, C; NPSA 2007d, C).
7 Check all details with another nurse if required by hospital policy. To minimize any risk of error (NMC 2008a, C).
8 Select the drug in the appropriate volume, dilution or dosage and check the expiry date. To reduce wastage. Treatment with medication that is outside the expiry date is dangerous. Drugs deteriorate with storage. The expiry date indicates when a particular drug is no longer pharmacologically efficacious (NPSA 2007d, C).
9 Proceed with the preparation of the drug, using protective clothing if advisable. To protect practitioner during preparation (NPSA 2007d, C).
10 Take the prepared dose to the patient and close the door or curtains as appropriate To ensure patient privacy and dignity. E
11 Check patient’s identity To prevent error and confirm patient’s identity (NPSA 2005, C).
12 Evaluate the patient’s knowledge of the medication being offered. If this knowledge appears to be faulty or incorrect, offer an explanation of the use, action, dose and potential side-effects of the drug or drugs involved. A patient has a right to information about treatment (NMC 2008a, C).
13 Administer the drug as prescribed. To ensure patient receives treatment. E.
Postprocedure
14 Record the administration on appropriate charts. To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NMC 2008a, C; NMC 2009, C; NPSA 2007d, C).
Intradermal injection
Definition
The intradermal route provides a local rather than systemic effect and is used primarily for administering small amounts of local anaesthetic and skin testing, for example allergy or tuberculin testing (Snyder 2007). The injection is given into the dermis of the skin just below the epidermis where the blood supply is reduced and drug absorption can occur slowly (Chernecky et al. 2002).
Evidence-based approaches
Observation of an inflammatory reaction is a priority, so the best sites are those that are lowly pigmented, thinly keratinized and hairless. Chosen sites are the inner forearms and the scapulae. The injection site most commonly used is the medial forearm area as this allows for easy inspection (Downie et al. 2003). Volumes of 0.5 mL or less should be used (Chernecky et al. 2002).
Preprocedural