• Clean your sites with alcohol, inner to outer (cleanest to dirtiest).
• Aspirate to ensure that you are not in a blood vessel (if you are, back out & start again, from the beginning).
• Whether or not to aspirate with insulin seems to be in debate… so follow your program, instructor or clinical guidelines.
• DO NOT aspirate with HEPARIN and do not massage heparin.
• You can massage other types of injections (it promotes absorption).
• Do not massage Z-track injections (since Z-track is used for sealing irritating preparations in the muscle).
• DO NOT RECAP YOUR NEEDLE after injections! (you will be tortured & shot by evil instructors!). Do remove your gloves, wash your hands, and go back to the M.A.R. to document date, time and site.

• Give at a 15-degree angle with bevel up into the dermis.
• Most commonly used for allergy and TB skin tests.
• Amounts administered are usually in tenths of a cc.
• Finding the injection site: move down 3-4 finger widths from the antecubital area (inner arm side of your elbow).
• Clean site with alcohol but do not wipe with alcohol afterwards.
• Will see these injections given with a 1cc syringe.
• DO NOT ASPIRATE.
• Injection of substance should form a wheal (looks like a fluid filled blister).
• These tests need to be read at a certain time i.e. TB skin test. Explain to pt that they will need to return to have a TB test read. Tell them exactly when.
• Reading a TB skin test: you are looking for redness or induration (hardened area). A test is positive if there is an induration greater than 10mm.
• How to chart it: Example - Indurated area of 7mm.

• subcutaenous tissue is under the dermis of the skin.
• Choose a site free from infection, without skin lesions, do not give in a scar, and do not give into a bony prominence.
• Be at least 1-2 inches away from the umbilicus.
• Inject at a 45 – 90 degree angle.
• The maximum amount that can be injected subcutaneously is 1cc.
• Sites for subcutaneous injections:
• 1. Outer aspect of the upper arm.
• 2. The abdomen – below the costal margin (rib cage) to the iliac crest.
• 3. Anterior aspect of the thigh.
• 4. Scapular region (upper back).
• 5. Buttocks – not usually used but available if you need to rotate sites.

• The maximum amount that can be injected into a large muscle is 3cc.
• If you must give more than 3cc, give 2 shots in 2 different injection sites.
• The maximum amount that can be injected into a small muscle is ½ to 1cc.
• Large muscle sites are used for irritating medications.
• Hold large muscles taut (tight) and pinch up small muscles for injection.

• Inject at a 90-degree angle (right angle).
• This site consists of the gluteus medius muscle lying over the gluteus minimus.
• This is a good muscle to work with because it is away form the sciatic nerve and blood vessels.
• To give this injection, position client on side with knee bent (bringing the leg up helps to relax the buttock muscles.
• The key to finding this site is to map it out, the nurse places her right hand on the clients left ventrogluteal (or the opposite).
• Landmarks to find the site – place your palm on the greater trochanter of the femur, place hand perpendicular to the femur, put your thumb toward the clients groin -> point the index finger toward the iliac crest. Does this sound confusing… well that’s cause it is!

• Inject at a 90-degree angle.
• Location of this site: the anterior lateral aspect of the thigh, usually well developed in adults and children, no major blood vessels or nerves near.
• Landmarks to fine the site: measure off a hands breaths (or width) above the knee at the patella and a hands breath below the greater trochanter. Give the injection into the middle third.

• Inject at a 90-degree angle.
• With this site there is a greater chance of giving an injection near the sciatic nerve.
• This area is not used in children less than 3 y/o unless they have been walking for a year (the muscle is developed by walking).
• Position the client in prone position with toes medial (turned inward) or position on side with upper leg flexed.
• Landmarks to find the site – locate the posterior superior iliac spine then locate the greater trochanter. Draw an imaginary line between the two and inject into the upper outer quadrant.

• Inject at a 90-degree angle.
• This muscle is less developed.
• Maximum amount injected at the site is ½ - 1cc.
• Landmarks to find the site – fully expose the shoulder and arm, then locate the acromion process and axillary line, form the point of a triangle between these points and inject there.

• Used when giving very irritating medications i.e. vistaril or a medication that would stain i.e. iron.
• Z-tracks are given into large muscles.
• How to do it: draw up medication, change needle, draw back 0.2 of air (gives you an air lock), find your site, pull skin laterally 1-1 ½ inches (displaces skin to the side & creates a broken line, pulls subQ over), give injection, push medication in slowly, push in air, remove needle, let skin replace itself. DO NOT MASSAGE.

SoutheasternNurse