Intramuscular injection of bicillin

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)
• Medication (bicillin)  in vial
• Bicillin solvent in ampoule (vial)
• Hot water
• termometr
• needle of size 0.8x 40 mm (green needle hilt, G22);
• 5 ml syringe with needle of size 0.8x 40 mm (green needle hilt, G22)
• medical records

Clinical situation:

• You are a nurse at a hospital’s therapeutic department. The doctor prescribed to the patient a intramuscular administration of "bicillin-3" (antibiotic of the penicillin group of prolonged action). 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

Maine stage:

• Prepare a needle for bicillin injection:
  • take the 0.8x40 mm (green) needle package (extra needle) from the manipulative table
  • tear up the package from the needle hilt side (without touching needle) and place it on the manipulative table
  • take the package of the syringe from the manipulative table, tear up and open the package from the side of the plunger
  • take the syringe from the opened package in your dominant hand (leave the needle inside package)
  • put on the 0.8x40 mm needle (green) on the syringe needle cone with your left hand, without removing the needle from the package
  • remove the needle from  a package and place the package on the upper shelf of manipulative table
  • fasten the needle with the first and second fingers of the left hand on the syringe needle cone
  • withdraw air into the syringe, pulling the plunger, then completely remove the air from the syringe;
  • take the opened package of needle and place it back onto the capped needle
  • disconnect the needle from the syringe (leave the needle inside the needle package)
  • place the package with needle on the manipulative table
• Prepare a bicillin solvent
  • take an ampoule (vial) with a solvent
  • place it for 3-5 minutes in a container of warm water at a temperature of 40-45° C;
• Prepare a vial of bicillin (see PS6 - Withdrawing of medicine from a vial into a syringe));
• Prepare a vial with a heated solvent for bicillin (see PS6 - Withdrawing of medicine from a vial into a syringe);
• Prepare a site of injection (see PS10 - Intramuscular injection)
• Prepare a syringe for a solvent:
  • take the opened syringe package with needle and connect the needle and syringe inside this package;
  • remove the package and place it on the manipulation table
  • fasten the needle with the first and second fingers on the syringe needle cone
• Withdraw the required amount of the solvent into a syringe (see PS5 - Withdrawing of medicine from an ampule  into a syringe) or (PS6 - Withdrawing of medicine from a vial into a syringe)
• Dissolve "bicillin-3"
  • pierce the rubber stopper of the "bicillin-3" vial with the needle of syringe and inject the solvent into the vial along it wall (to avoid foaming);
  • disconnect the needle from the syringe
  • put the syringe into the opened syringe package
  • achieve complete dissolution of the powder by rolling the vial between the palms (about 30 seconds)
  • put the vial with a suspension of bicillin on the manipulation table
• Withdraw the required amount of diluted bicillin (suspension) into the syringe:
  
  • take again the syringe from the opened package, place this package in the container "Package",
  • connect the syringe with the needle which is inserted into the diluted bicillin vial
  • withdraw the required dose of bicillin to the syringe  (see Withdrawing of medicine from a vial into a syringe)
• Change needle
  • remove the needle from the syringe and place it into the container "Disinfection of sharp items"
  • take the needle for bicillin injection and connect it with syringe
  • remove the package from the needle and put it in the container "Package"
• Give the bicillin intramuscular injection (see PS10 - Intramuscular injection)

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