IM 

1-1½ IN needle depending on site of injection & age

21-25 gauge

Insert at 90˚ angle

Use 2-3 mL  syringe

Vastus Lateralis: 1 Hand breadth below greater trochanter and 1 hand breadth above knee.  Give injection in middle 3^rd of muscle between anterior midline and lateral midline.

Dorsogluteal: Locate greater trochanter.  Locate posterior superior iliac spine.  Draw imaginary line between greater trochanter and posterior superior iliac spine.  Give between line.

Ventrogluteal: Place nondominant hand over/below greater trochanter. Point fingers  Up towards waist then move 1 finger forward toward anterior superior iliac spine. Extend adjacent fingers posteriorly along iliac crest toward butt.  Give in middle of “V”

Deltoid:  Fully expose upper arm and shoulder.  Place 4 fingers across deltoid muscle with the top finger along the acromion process.  Injection site 3 finger widths below acromion process

Use Z-Track method:  Pull skin approx 2.5 – 3.5 cm laterally to side with ulnar side of nondominant hand, hold skin in position until administer injection. After prep with antiseptic swab inject needle deep into muscle.  Aspirate slightly and check for blood. 

If no blood inject medication slowly.  Keep needle inserted for 10 sec to allow medication to disperse evenly then release skin afAlways alternate injection routes

Always select a site with no scars, bruising, sores, or wounds

Do not massage IM site after medication administration

SUBQ

 3/8-5/8 IN needle

27-25 gauge

Insert at 45-90˚ Angle depending on body size

Use 1-3 mL syringe

Outer Posterior Aspect of Upper Arms

Abdomen: Below costal margins of ribs to iliac crest & at least 2” from umbilicus

Anterior Aspects of Upper Thighs

Upper Back below Scapula

Just above DG & VG IM sites

Alternate Sites for each injection

Never massage injection site

For obese patients pinch skin. For average size pinch or pull taught.

Insulin Shots:  0.3, 0.5, or 1 mL syringe

28-31 gauge

5/16 – 1/2 IN needle

Mixing 2 kinds of insulin:  Check accuracy of medication order. 

Verify insulin labels carefully against MAR.

If insulin is cloudy, roll bottle between hands.  Do NOT shake.

Verify insulin dosages against MAR 2^nd time.

Aspirate volume of air equivalent to dose to be withdrawen from long-lasting insulin (NPH) first.

Insert needle and inject air into NPH.

Do not let needle touch solution.

Remove syringe from vial.

Aspirate air equivalent to be withdrawen from short-acting insulin (R). Withdraw correct dose into syringe. Remove air bubbles.

Verify Insulin 3^rd time.

Place needly into NPH vial and draw back correct amt.

Withdraw needle and check amt.

If amt incorrect dispose of and start over.

Be careful not to inject NPH into R.

ID

1/4-1/2 IN Needle

26-27 gauge

Insert at 5-15˚ Angle

Use 1 mL Tuberculin Syringe

Inner aspect Lower Forearm

Scapula area of Upper Back

Put finger under syringe to get the 15˚ angle.  After inject medicine check for a bleb (like a mosquito bite).  If does not appear then possible medication entered Sub-Q tissues.

Only insert bevel.

To Mix Medications:  Do not contaminate one med with another. 

Ensure final dosage is accurate.  Aspirate volume of air equivalent to 1^st med dose into syringe.

Make sure needle doesn’t touch solution.

Withdraw needle from 1^st vial and aspirate volume of air equivalent to 2^nd med dose into syringe. 

Immediately withdraw medication from 2^nd med into syringe.

Change needle.

Withdraw desired amt of med from 1^st vial.

Change needle for patient comfort.

Make sure there are no air bubbles.  Once medication in syringe, cannot over-draw (because of mix of meds)