Injection Pushing Technique; Types, Procedure, Indications









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Injection Pushing Technique for delivering drugs by parenteral administration, that is, administration via a route other than through the digestive tract. Even when administered as a bolus, the medication may be long-acting, and can then be called depot injection. Many different types of amendments can be used for remediation of contaminants in soil and groundwater. A critical requirement for successful remediation is getting amendments in contact with the contaminants to be treated. Whether the amendments are promoting biodegradation, chemical reduction, chemical oxidation, or changing the geochemistry to sequester metals, effective distribution of amendments is a necessity.

Types of Injection Pushing Technique

Injection Pushing Technique

On the basis of working.

  • Spring systems.
  • Laser powered.
  • Energy propelled systems.
  • Lorentz force.
  • Gas propelled/air forced.
  • Shock waves.

On the basis of the type of load

  • Spring systems.
  • Liquid.
  • Powder.
  • Projectile.

On the basis of the mechanism of drug delivery.

  • Spring systems.
  •  Nano-patches.
  • Sandpaper assisted delivery.
  • Iontophoresis enabled.
  • Micro-needles.

On the basis of site of delivery

  • Spring systems.
  • Intradermal injectors.
  • Intramuscular injectors.
  • Subcutaneous injectors.

Intradermal injection

In an Intradermal Injection, medication is delivered directly into the dermis, the layer just below the epidermis of the skin. The injection is often given at a 5 to 15-degree angle with the needle placed almost flat against the patient’s skin. Absorption takes the longest from this route compared to intravenous, intramuscular, and subcutaneous injections. Because of this, intradermal injection is often used for sensitivity tests, like tuberculin and allergy tests, and local anesthesia tests. The reactions caused by these tests are easily seen due to the location of the injections on the skin. A tuberculin sensitivity test being administered intradermally.

Steps for administering the intradermal injection

  • Assemble equipment and check physicians older.
  • Explain the procedure to the patient
  • Perform hand wash and use disposable gloves.
  • If necessary, withdraw medication from the ampoule or vial.
  • Select an area on the inner aspect of the forearm that is not heavily pigmented or covered with hair. The upper chest or upper back beneath the scapulae are also sites for intradermal injections.
  • Cleanse the area with an alcohol swab by wiping with a firm circular motion and moving outward from the injection site. Allow skin to dry.
  • Use your non-dominant hand to pull the skin taut over the injection site.
  • Remove needle cap with non-dominant hand by pulling it straight off.
  • Place the needle almost flat against the patient’s skin, bevel side up.
  • Insert the needle so that the point of the needle can be seen through the skin–only about 1/8 of an inch.
  • Slowly inject agent while watching for a small wheal or buster to appear. If none appears, withdraw the needle slightly.
  • Withdraw the needle at the same angle it was inserted.
  • Do not massage the area after removing the needle.
  • Do not recap the used needle. Discard the needle and syringe in the appropriate receptacle.
  • Assist the patient in a position of comfort.
  • Remove your gloves and dispose of them properly. Perform hand hygiene.
  • Chart the administration of medication, as well as the site of the administration.  Some agencies recommend circling the injection site with ink.
  • Observe the area for signs of reaction at ordered intervals.

Subcutaneous injection

In a subcutaneous injection, the medication is delivered to the tissues between the skin and the muscle.[rx] Absorption of the medicine is slower than that of intramuscular injection. Since the needle does not need to reach the muscles, often a bigger gauge and shorter needle are used. The usual site of administration is fat tissues behind the arm. Certain intramuscular injection medicine such as EpiPen can also be used subcutaneously. Insulin injection is a common type of subcutaneous injection medicine. Certain vaccines including MMR(Measles, Mumps, Rubella), Varicella (Chickenpox), Zoster (Shingles) are given subcutaneously.[rx]

How to do a subcutaneous injection

To give a subcutaneous injection, people should follow these steps

  • Choose a fatty area of the body, such as the abdomen, back of the arm, or thigh – If you are giving several injections or have to do daily injections, rotate the sites to allow each area to heal between injections
  • Wash hands before cleaning the area with an alcohol pad – Wait for the area to completely dry before the next step.
  • Take the cap off the needle – Draw the medication into the syringe, according to the directions on the vial. This usually means turning the vial upside down then pulling the plunger back to suck in the medication. Tap the syringe to get rid of air bubbles.
  • Pinch a fold of skin – Pinch the fatty area about 2-inches thick in between the thumb and a finger.
  • While holding the needle like a dart, slide it into the skin at an angle of 90 degrees – Needles used for subcutaneous injection are usually short and small and should go all the way into the skin.
  • Push the plunger all the way down quickly – Do not push forcefully.
  • Cover the needle – Dispose of the needle in a needle-safe container.

How do I give a subcutaneous injection?

The best location for a subcutaneous injection depends on a person’s pain sensitivity and where they have some subcutaneous fat.

A few commonly chosen locations include:

  • The backs or sides of the arms
  • The fatty part of the stomach
  • The front of the thighs
  • The top of the buttocks, where there is more fat than muscle

Some subcutaneous injections come in the form of an auto-injector. An auto-injector is a self-contained device that does not require drawing the medication up first. People can follow the instructions on the package if they are using an auto-injector.

Intramuscular injections

Intramuscular injections (IM injections) deliver a substance deep into a muscle, where they are quickly absorbed by blood vessels. Common injections sites include the deltoid, vastus lateralis, and ventrolateral muscles.[rx] Most inactivated vaccines, like influenza, are given by IM injection.[rx] Some medications are formulated for IM injection, like Epinephrine autoinjectors. Medical professionals are trained to give IM injections, but patients can also be trained to self-administer medications like epinephrine.


How do I give an intramuscular injection?

Wash your hands with soap and dry them completely. Put on gloves if necessary.

  • Open the alcohol wipe – Wipe the area where you plan to give the injection. Let the area dry. Do not touch this area until you give the injection.
  • Prepare the needle – Hold the syringe with your writing hand and pull the cover off with your other hand. Place the syringe between your thumb and first finger. Let the barrel of the syringe rest on your second finger.
  • Hold the skin around where you will give the injection – With your free hand, gently press on and pull the skin so that it is slightly tight.
  • Insert the needle into the muscle – Hold the syringe barrel tightly and use your wrist to inject the needle through the skin and into the muscle at a 90-degree angle.
  • Check the needle – Let go of the skin with your other hand. Hold the syringe so it stays pointed straight in. Pull back on the plunger a little to make sure you did not hit a blood vessel. If blood comes back, remove the needle immediately. Do not inject the medicine. Dispose of both the syringe and the medicine. Get more medicine in a new syringe. When you give the second injection, give it on the other side.
  • Inject the medicine – Push down on the plunger to inject the medicine. Do not force the medicine by pushing hard. Some medicines hurt. You can inject the medicine slowly to reduce the pain.
  • Remove the needle – Once the medicine is injected, remove the needle at the same angle as it went in. Place gauze over the area where you gave the injection.

Where can I give an intramuscular injection?

  • Thigh – Look at your thigh and divide it into 3 equal parts. The middle third is where the injection will go. The thigh is a good place to give yourself an injection because it is easy to see. It is also a good spot for children younger than 3 years old.
  • Hip – Have the person getting the injection lie on his or her side. To find the correct location, place the heel of your hand on the upper, outer part of the thigh where it meets the buttocks. Point your thumb at the groin and your fingers toward the person’s head. Form a V with your fingers by separating your first finger from the other 3 fingers. You will feel the edge of a bone along with the tips of your little and ring fingers. The place to give the injection is in the middle of the V. The hip is a good place for an injection for adults and children older than 7 months.
  • Upper arm muscle – Completely expose the upper arm. You will give the injection in the center of an upside-down triangle. Feel for the bone that goes across the top of the upper arm. This bone is called the acromion process. The bottom of it will form the base of the triangle. The point of the triangle is directly below the middle of the base at about the level of the armpit. The correct area to give an injection is in the center of the triangle, 1 to 2 inches below the acromion process. This site should not be used if the person is very thin or the muscle is very small.
  • Buttocks – Expose one side of the buttocks. With alcohol, wipe draw a line from the top of the crack between the buttocks to the side of the body. Find the middle of that line and go up 3 inches. From that point, draw another line down and across the first line, ending about halfway down the buttock. You should have drawn across. In the upper outer square, you will feel a curved bone. The injection will go in the upper outer square below the curved bone. Do not use this site for infants or children younger than 3 years old. Their muscles are not developed enough.

How to perform an insulin injection

You will need:

  • An insulin pen
  • Enough insulin inside to give the required dose
  • A new pen needle
  • A sharps disposal box for used pen needles to go into

Make sure you have your kit available at all times and if possible, inform your family as to its location. If you suffer from a hypo, this will allow your family to act quickly.

Injecting your insulin shot

To perform your insulin injection:

  • Wherever possible, wash your hands with soap and water before injecting.
  • Put a new needle onto your pen.
  • Remove the caps of the pen needle.
  • Hold the pen upright and perform an air shot. This requires dialing up at least 2 units and pressing the plunger to expel a test shot of insulin. This helps to clear any bubbles out of the needle. If you do not get a steady stream, repeat the air shot until you do get a steady stream of insulin coming out.
  • Dial-up your dose.
  • Pick a soft fatty area to inject. Tops of thighs, belly, bum, and triceps (triceps; the top and back of the upper arm, are not always recommended for children or thinner people).
  • Some people may need to raise a fold of fatty flesh slightly between your thumb and fingers. If you are unsure about whether you need to do this, ask your health team.
  • Put the needle in and keep the pen steady.
  • Push the plunger relatively slowly to inject the dose.
  • After the dose has been injected, hold the needle in for a good 10 seconds to help insulin get delivered and prevent any of the dose escaping out.
  • Ensure that the used needle bin is deposited into a sharps bin.

Pre-Injection Assessment

Clinical assessment

A thorough patient assessment should precede therapy initiation.[] Concerns with regard to dexterity problems, injection anxiety, misconceptions, denial of the benefits of timely injections, vision and hearing impairments, and other barriers are to be checked for (B3).[,]

Environmental assessment

It should be ensured that the correct type and device of insulin are used. As insulin is sensitive to extreme temperatures,[] it is essential to inquire as to what kind of conditions the injection supplies have been stored in (B2). If injection cold storage facilities are not readily available, insulin pens can be used instead of vials (C1).

Sociocultural assessment

Socio-cultural sensibilities should be respected. In Indian women, the choice of injection site should be discussed beforehand.

Pre-Injection Counseling

More than one-quarter of patients may refuse insulin therapy once it is prescribed.[] Little is actually known about this phenomenon, often termed as psychological insulin resistance (PIR). Giving the patients a sense of control over their treatment plan, and usage of devices which help reduce pain improves acceptance.[]

Children

In childhood, the diagnosis of diabetes itself creates a sense of distress and anxiety in both parents and children. This hinders parents’ ability to administer insulin or encourage children themselves to administer insulin (A1). It is important to include the child and the parents as important partners in diabetes care. The attention of child should be diverted or if required, cognitive-behavioral therapies (relaxation training, guided imagery, graded exposure, active behavior rehearsal, modeling and reinforcement, and small incentives) have to be employed (A2). Explanation of the role of insulin in diabetes management and the need for regular injections, using simple and clear words, helps allay their misconceptions and concerns (A2).

Adolescents

In adolescents, peer pressure, lack of seriousness, pain, and frustration may prevent them from adhering to injection schedule. Fear of weight gain, especially among girls, might lead to skipping of injections. It is important to help adolescents overcome any possible misconceptions related to insulin injection by sharing information with them (A2). Positively reinforcing their commitment to diabetes care helps them realize their key role and ensure their active participation (B1). Clinicians should avoid the use of terms which might show that such a therapy is a failure, a form of punishment or threat (A3).

Adults

While adults are expected to be easy to handle and well prepared to take injections, this is usually not the case. Educate all newly-diagnosed patients about the course of diabetes and the need to start insulin therapy (A3).[] Interference with the quality of life, worsening of diabetes condition, failure to self-manage the disease, guilt, daily injections, and hypoglycemia are some of the major factors that could pose challenges in on-going diabetes care. Helping the patient understand that having such concerns is not unusual encourages them to discuss these issues and find solutions (A3).

Complications

The most common complication of subcutaneous injection is pain near the injection site for 1 to 2 days afterward.

Pain near the injection site can happen when inserting the needle at the wrong angle, or when it moves slightly during the injection. Some medications can cause a bruise or irritation at the injection site.

Other complications are much less frequent and include:

  • Infection – Any puncture in the skin can allow bacteria to enter and cause an infection. Properly cleaning the area and always using a clean needle can reduce the risk of infection.
  • Contaminated needle – Reusing needles or sharing needles can spread diseases from one person to another. Always dispose of used needles in an appropriate container.
  • Injecting medication into a blood vessel – A person may have hit a blood vessel if there is blood in the syringe. Injecting medication into a blood vessel can change the way the drug is absorbed.


References

Injection Pushing Technique

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