Injection Techniques

AimTo gain the knowledge and skills required to safely prepare and administer intramuscular

and subcutaneous injections to children

Learning outcomes

The student will be able to:• Explain the rationale for selecting sites and

methods for injection• Demonstrate safe and evidence based

techniques in SC and IM injection• Discuss the care and support of the child and

family

Children and injections

• Injections are given only when there is no alternative route

• Receiving an injection is one of the most traumatic events that children can experience

• Vaccination is by far the most common reason to give a child an injection

Route of injection

Intramuscular

• Means ‘in the muscle’

• Well perfused so rapid absorption

• Larger area

• Can absorb larger doses

Subcutaneous

• Means ‘under the skin’ – this is the fatty layer of adipose tissue

• Less well perfused so slower, sustained absorption

SC Method(s)

IM Method

Z Track technique

Injection sites

• Type of medication and manufacturers instructions

• Size and age of child• Safe positioning• Size and condition of muscle• Frequency or number of injections

SC Injection sites

IM injection sites•Adults/adolescents: deltoid or antero-lateral aspect of the thigh

•Infants: antero-lateral aspect of the thigh NEVER THE DORSOGLUTEAL SITE

•Infants: deltoid?>12 months>15 months (WHO

2005)

Positioning

Needle size?

• Sometimes come as integral to syringe so no option to change

• If drawing up through a rubber bung, replace with new needle

• Needle length is important – it needs to be long enough to reach either subcutaneous tissue or muscle

• Remember, needles differ in length and gauge and the colour denotes the gauge

Cleansing of injection site?

• Only if visibly dirty – soap and water• Not necessary to use steri-wipe, but if used it

must dry

Do you need to aspirate?

• No – not necessary

• Subject of debate for some time

Post injection site care

• Gentle pressure of required• Do not rub site• Plasters?

Preparation and distraction

• Prepare child and parent where possible• Must be age appropriate• Distraction may be used before during and

after procedure

• For infants and young children, positioning and comfort can be helpful

• Toys with noises!

Preparation and distraction

• Older children – behavioural contracting (informal)

• Reward based!• Visual distraction• Parental comfort

Remember..

• Sometimes preparation does not mean that a child (and parent) will not get upset

• Distraction does not work for all children• Continue to provide comfort and reward

References• Hockenberry, M.J. & Wilson, D. (2009) Wong’s Essentials of Pediatric Nursing 8th Edition. St

Louis: Mosby• Perry, A., Potter, P. & Ostendorf. (2014) Clinical Nursing Skills and Techniques 8th Edition. St

Louis: Mosby• RCPCH (2002) Position Statement on Injection Technique. London: RCPCH• Cocoman, A. & Murray, J.(2006) IM Injections: How’s your technique? [online]

http://www.inmo.ie/MagazineArticle/PrintArticle/5676 accessed 30/7/2013• HPA (2013) Correct Administration of vaccines [online]

http://www.hpa.org.uk/EventsProfessionalTraining/HealthProtectionAcademy/AdditionalOpportunitiesAndInformation/ImmunisationTrainingResources/hpacadvacc05SlideSetsforCoreCurriculumTeaching/ accessed 30/07/2013

• Paediatric Nursing [practice guide] (year) Intramuscular injection technique. Paediatric Nursing. 19(2) p. 37

• Hunter, J. (2008) Subcutaneous injection technique. Nursing Standard. 22(21) pp. 41-44• Workman, B. (1999) Safe injection techniques. Nursing Standard. 13(39) pp. 47-53.• Department of Health (2013) Immunisation against infectious disease Green book [online]

https://www.gov.uk/government/organisations/public-health-england/series/immunisation-against-infectious-disease-the-green-book accessed 30/7/2013