Three Type Technique Injecting namely:
1. Intramuscular Injection
2. Intravenous Injection
3. Injection subcutan
Although aspiration is no longer done on subcutaneous injection method, inintramuscular and intravenous injection procedure should be carried out. If at the intramuscular injection inadvertently tip of the needle penetrates the blood vessels, the drug is injected intravenously finally entered. This can lead to the formation of emboli as a result of reaction of chemical components of the drug.When this happens, and you are doing the injection technique is intravenous injection, the procedure that you have done so far is true. The needle has entered a blood vessel, and the drug is now ready to be inserted directly into the veins.When blood enters interested, and you are doing the injection technique is intramuscular, then the procedure you are doing wrong. The needles should reach muscle tissue apparently lodged in the vessel darah.Hal This usually occurs because of improper injection site. Disconnect the injection needle and repeat the procedure from the beginning.
SKIN DISINFECTION TECHNIQUE IN LOCATION INJECTION
Although the technique of skin disinfection with an alcohol swab before injection procedure is well known, in fact there are differences in the findings. For example using an alcohol swab before injecting insulin subcutaneously often makes the skin become hardened because of the effects of alcohol.Dann (1969) and Koivisto & Felig (1978) found that the technique disinfection with alcohol is not always absolutely necessary, and when the procedure was dispensed with, apparently post-injection infection rates occurring no more than do alcohol swab before.Experts argue that if the patient looks clean physically, and medical personnel also follow standard aseptic correct, skin disinfection prior to intramuscular injection is not necessary. And if it is deemed necessary, then it should diswab skin with an alcohol swab for 30 seconds, and then wait 30 seconds so that the skin becomes dry again.
If the injection is done before the skin is dry, there is still the possibility of bacteria is not dead, and even together with alcohol can be involved inoculating the injection site thereby increasing the risk of infection.Intramuscular injectionIs the act of injecting the drug into the muscles terperfusi well, so it will be able to provide a systemic effect in a short time, and also typically capable of absorbing large doses. Location injection should be considered keeping in mind the patient's physical condition, age of the patient, and the amount of drug to be administered. If the desired injection site are swelling, inflammation, infection, or there are lesions in any form, injecting at this location should be avoided.
There are five locations intramuscular injection proven that the medicine will be absorbed well by the body.
ON THE REGIONAL ARMS (deltoid)Easy and can be done at various positions, but the most minor shortcomings injection area, and the amount of the smallest ideal drug (between 0.5-1 ml).Needle injected approximately 2.5 cm below the bulge right acromionImportant organs that may be affected are a.brachialis or n.radialis. This happens if we inject further down than it should beAsk the patient to put his hands on her hips (like a mannequin style), thereby muscle tone will be an easy condition to be injected and can reduce pain.
ON REGIONAL DORSOGLUTEAL (gluteus MAXIMUS)The most easy to do, but the highest numbers complications occur.Beware of n.sciatus and superior a.gluteaDraw an imaginary horizontal line as high as the mid gluteal, then create two imaginary vertical line intersecting the horizontal line earlier in the mid buttocks on each side. Suntiklah in the gluteal region at the upper lateral quadrant.Ideal injection volume between 2-4 ml.Minta patient lying on the side with your knees slightly flexed.
ON REGIONAL VENTROGLUTEAL (gluteus medius)Put your right hand on the patient's left hip trochanter major (or vice versa). Position the index finger that touches the SIAS. Then move your middle finger as far as possible away from the index finger along the crista iliaca. Then the index finger and middle finger you will form the letter V.Inject the needle in the middle of the letter V, then the needle would pierce m. gluteus medius.Ideal volume between 1-4 ml
THIGH AREA ON THE OUTSIDE (vastus lateralis)In adults, m. vastus lateralis lies in the middle third of the outer thighs.In infants or the elderly, sometimes overlying skin should be withdrawn or slightly pinched to help the needle reaches the proper depth.Ideal injection volume between 1-5 ml (for infants between 1-3 ml).
THIGH AREA ON THE FRONT (rectus femoris)In adults, m. rectus femoris lies in the middle third of the front of the thigh.In infants or the elderly, sometimes overlying skin should be withdrawn or slightly pinched to help the needle reaches the proper depth.Ideal injection volume between 1-5 ml (for infants between 1-3 ml).This location is rarely used, but it is usually very important to perform auto-injection, for example, patients with a history of severe allergy usually use this place to inject steroid injection which they carry everywhere.
PROCEDURES ACTIONPrepare the drug to be injected, insert it into the syringe.First of all, make sure the identity of the patient. You do not want to inject the drug into the wrong patient.Position the patient in a comfortable position, and also easy and ideal for you to perform the desired injection.Determine the correct injection site in accordance with the instructions above. Clean the skin over it with alcohol or other disinfectant.Hold the syringe with your dominant hand (use your thumb and index finger).Use your non-dominant hand to tighten the skin around the injection site.Insert the needle that penetrates the muscle is sought. Use your anatomical knowledge to estimate the depth of the needle.Perform aspirasi.Bila no blood, continue. If there is blood, remove the needle, repeat the procedure.Enter the drug slowly (1 ml per 10 seconds) until the desired dose is reached.Once finished, pull the syringe needle. Depending on the type of drug is included, there are some medications that require a light massage to help absorption, but some are not. Understand thoroughly that you inject drugs, or simply read the recommendation of the manufacturer of the drug.Separate needle from the syringe. Discard both in medical trash bins.Check the injection site once again to ensure that there is no bleeding, swelling, or other reactions that occur.Recorded in patient medical records included the type of drug, amount, and time of administration.
Entry angle needle plays an important role in the degree of pain the patient when the injection. Intramuscular injection should be done by inserting a needle perpendicular to the skin (90 degrees) to make sure the needle on the muscle in question. Research by Katsma and Smith (1997) found that nurses in the UK do not always inject the needle 90 degrees at the intramuscular injection, and apparently it affects the assessment of the degree of pain that is felt by the patient.
Injection technique performed almost all over the world is to tighten the skin around the injection site with the aim of: (Stilwell, 1992)
1. Facilitate needling. The needle will more easily pierce the skin at an angle of 90 degrees when the skin is punctured in a state stretched.
2. With teregangnya skin, then mechanically will help to reduce the sensitivity of the ends of nerve fibers in the skin surface.
ver the past two decades, has evolved intramuscular injection technique called Z-track technique. Keen (1986) was first put forward in his research that this technique mampi reduce the sensation of pain and is also able to minimize "leakage" (the drug is injected into the sub cutis space when the needle is removed).This technique is done by pulling the skin over the injection site to the other direction, approximately as far as 1-2 cm. This will move the network cutan and subcutan those on the muscle to be injected. Remember that the target injection is muscle, so when you pull the skin we do not release our eyes from the injection site properly. Then do the injection as usual, and when after the draw needle, remove the skin who had been to hold. This resulted in injury needle penetration in the muscle tissue will be covered by the cutis and subcutaneous tissue intact. Menggerakkankan injected limb thereafter also believed to help the process of absorption of the drug because it increases blood flow to the area injectedSubcutaneous injectionThis technique is used when we want a drug that is injected will be absorbed by the body slowly and long duration (slow and sustained absorption). Usually the drug is injected volume is limited to 1-2 ml per one injection.
Subcutaneous injection is done by injecting a needle angle of 45 degrees from the surface of the skin. The skin should be slightly pinched to keep the subcutaneous tissue of the muscle tissue. Peragallo & Dittko (1997) using a CT scan in their research and found that subcutaneous injection often go into muscle tissue, especially when performed in the abdomen or thigh. This is dangerous because the insulin is injected into the muscle will be absorbed faster by the body and as a consequence will occur shocks blood glucose levels that can bring patients to a state of hypoglycaemia.
From the same study also found that subcutaneous injections believed to no longer require aspiration. From the description of CT scan found that injections with subcutaneous technique almost never penetrate blood vessels. Springhouse Corporation (1993) even stated that when subcutaneous injection diawalin with aspirations, will increase the risk of hematoma in the subcutaneous area.
NB: Since 1994 the development of insulin injection therapy very quickly. Currently branded insulin syringe needle Alay has made such that at a 90 degree angle with the skin, the insulin can enter the subcutaneous tissue. Therefore do not be surprised to see people with diabetes inject insulin into his own thigh with a needle entry angle perpendicular to the skin
This technique is used when we want a drug that is injected will be absorbed by the body slowly and long duration (slow and sustained absorption). Usually the drug is injected volume is limited to 1-2 ml per one injection. Subcutaneous injection is done by injecting a needle angle of 45 degrees from the surface of the skin. The skin should be slightly pinched to keep the subcutaneous tissue of the muscle tissue. Peragallo & Dittko (1997) using a CT scan in their research and found that subcutaneous injection often go into muscle tissue, especially when performed in the abdomen or thigh. This is dangerous because the insulin is injected into the muscle will be absorbed faster by the body and as a consequence will occur shocks blood glucose levels that can bring patients to a state of hypoglycaemia.
ESTIMATING THE VALVE VENA AND AVOID
Because we are going to inject drugs with a needle into a vein, it is important for us to avoid the venous valves. If the venous valve is accidentally punctured, it can cause permanent damage to the valve and can even cause the collapse of the vein in question.These valves exist in order to prevent blood flow through the vein (prevents blood flow away from the heart). To find out where these valves alone there, doing pressure on the veins distal concerned. It aims to encourage the blood in the veins behind the distal direction, approaching the last valve in its path. Follow the pressure and eventually you'll find there are certain places where you push the blood can not "pass" again. That's where there is a vein valve. Now you know that you should not tampat perform injections. Seem simple, but sometimes localize the position of the valve can be difficult to do.
PROCEDURES ACTIONWash your hands first, When you need to use gloves to protect you.Determine the location of the injection. Look for peripheral veins that appear or are large enough so that it will allow you to do injection later. There are times when the vein is ideal does not exist, and then it will depend on the skills and experience to successfully perform the injection.Clean the injection site with an alcohol swab.Torniquet pairs in the proximal part of the injection site.Inject the needle at an angle of about 45 degrees or less into a vein that you specified. Needle point toward proximal so that later injected drug would not cause turbulence or efflorescence at the injection site.AspirateIf there is no blood, then your estimate is wrong. Teach some nursing organizations to continue berusahan to probe and find the vein, as long as no hematoma. Several again advocated for direct revoked and the procedure repeated.
If there is incoming blood, bright red, slightly foamy, and have the pressure, pull the needle immediately and directly apply pressure on the former site of injection earlier. That means you're on the arteries. Although it rarely happens, because unless you stab and to probe too deep, you still have to know about these risks.If there is incoming blood, dark red, and not have the pressure, it is a vein. Continue with the following steps:Remove the tirniquet with caution, not to move the needle that has been entered correctly.Inject the drug slowly. Sometimes rubbed vein in the proximal part of the injection site with an alcohol swab can reduce pain during post a drug.
Once completed, remove the needle and immediately apply pressure on the former site of injection with an alcohol swab. Emphasis is performed approximately 2-5 minutes. Or you can also use a band-aid to cover the injection wound. Dispose of syringe and needle into the trash. Wash your hands, remove the gloves, and wash your hands again.