Intravenous injection

Authors: Rednenko V.V., Rednenko L.I., Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• Workplace for injections and intravenous infusions (see PS1 - Preparing of the workplace for injections and intravenous infusions) including
  • venous tourniquet
  • venipuncture pad
• Medication in ampule or vial
• needle of size 0.8x 40 mm (green needle hilt, G21);
• 10 or 20 ml syringe with needle of size 0.8x 40 mm (green needle hilt, G21) 
• medical records

Clinical situation:

• You are a nurse at a hospital’s therapeutic department. The doctor prescribed to the patient a intravenous administration of the medication. Follow doctor's prescription

Order of the skill performance:

Preparatory stage:

• inform the patient about the injection, get verbal consent to giving it, ask him to take the required position
• withdraw the required medication into a syringe from an ampule (vial) and change the needle (see PS5 - Withdrawing of medicine from an ampule  into a syringe) or (PS6 - Withdrawing of medicine from a vial into a syringe)

Maine stage:

• ask a patient to sit next to the intravenous injection table and place his hand on it
• place a pad under a patient's shoulder
• put a tourniquet on patient's shoulder over clothing 10-12 cm above the venipuncture site
• make 2-3 massaging movements with the edge of the palm in the direction from the periphery to the center (with poorly contoured veins)
• ask the patient to clench fingers in a fist

• select, examine and palpate a injection site (vein) with your dominant hand
• take two swabs with your dominant hand, wet it with skin antiseptic;
• treat the skin at the injection site 2-3 times in one direction:
  
  • with one swab a “large field” (10x10 cm in size);
  • with second one the "small field" (size 5x5 cm) ;
• place the used swabs in the container “Disinfection of dressings, PPE”;
• wait until the disinfectant has completely evaporated from the surface of the skin;
• take one swab and wet it with skin antiseptic;
• keep this swab with fourth and fifth finger of non dominant hand
• take the syringe with a medication from the opened package with your dominant hand, place the second finger on the needle hilt, grasp the syringe barrel with others fingers;
• place the package in the "Package" container;
• remove a cap from the needle with your non dominant hand, holding the needle hilt with the index finger of your dominant hand, place the cap in the "Plastic" container
• put the syringe in your dominant hand: place the index finger on the needle hilt, grasp with other fingers the syringe barrel
• check the parallel position of the needle bevel and the syringe barrel scale
• fix the vein by pulling the skin below the venipuncture site with the first finger of the left hand
• holding the needle with the cut up, pierce the skin at a slight angle (no more than 15°), place the needle parallel to the vein, without changing the position of the syringe in the hand
• continuing to fix the vein, slightly change the direction of the needle, pierce the front wall of the vein (there is a “hit in the void”) and carefully push the needle along the vein until blood appears in the needle cannula (no more than half the length of the needle)
• make sure that the needle is in the vein: with your left hand fingers slowly pull the syringe plunger “towards you” until blood appears in the syringe barrel
• untie the tourniquet with your left hand, invite the patient to unclench his fist
• Pull the syringe plunger slowly “towards you” to make sure that the needle does not come out of the vein (blood should appear in the syringe barrel)
• place the second and third fingers of the left hand on the flange of the syringe barrel, the first finger on the piston
• slowly enter the medicine, without changing the position of the syringe, pushing the syringe plunger with the first finger of your left hand, leave 0.5 ml of medicine in the syringe barrel
• put a ball moistened with an antiseptic to the venipuncture site, remove the needle with a quick movement, press the ball for 3-5 minutes. For puncture of the ulnar vein, suggest that the patient bend the arm at the elbow joint.

Final stage:

• disinfect syringe and injection needle (see PS3 - Disinfection of disposable syringes and injection needles);
• take off the gloves, place it in the container “Disinfection of dressings, PPE” (see Removal contaminated gloves); 
• wash your hands (see Hygienic hand washing)
  
• register the medication administration in medical records;
• observe the patient for 5-7 minutes to detect an allergic reaction