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Chapter 54
Administering Injections
and Immunizations
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Parenteral Injectable Medication
• Indications for parenteral routes
– Patient is unable to tolerate medication by mouth
– Other routes do not provide the desired effect
quickly enough
– Oral medications would be destroyed by the GI
tract
– Continuous delivery is required
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Injection Types
• Medical assistants typically administer
injections by the following routes:
– Intradermal
– Subcutaneous
– Intramuscular
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IV Medications
• Medical assistants are not permitted by
provide direct IV injections or start an IV
• It is important to be able to recognize a
problem and report it to the provider
immediately
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Needles
Parts of a Needle
Needle Gauges and Sizes
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Needles
• Different needles
used for various
routes of
administration
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Syringes
• The parts of a syringe
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Syringes
• Sizes of syringes
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Medication Containers
• Ampules and vials
• Cartridge units
• Single-dose, prefilled disposable syringe and
cartridge unit
• Powdered medication to be reconstituted
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Needle Safety
• Handling and disposing needles safely
• Use needle safety devices
• What to do in the event of a needlestick
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Preparing the Patient
• Explain the procedure and ensure patient
comfort
– Special considerations for children
• Ensure immunization forms are signed
• Prepare the skin
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Angles of Injection
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Intradermal Injections
Needle size: 26G or 27G, ⅜ - ⅝ inch long
Angle of injection:
Medication amount given:
Medications given:
Common sites of injection:
10-15 degrees
0.01 to 0.05 mL
Tuberculin skin tests, allergy testing
Anterior forearm, mid-back areas
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Intradermal Injections
• A small wheal should develop at the site of the
injection
– Record: speed of the reaction, size of the wheal
– Observe the patient about 20 minutes (or longer) for any
reaction
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Subcutaneous Injections
Needle size: 25G to 27G, ½ to ⅝ inch
Angle of injection:
Medication amount given:
Medications given:
Common sites of injection:
45 degrees
Less than 2 mL
Insulins
Upper outer part of the arm,
abdominal area, or upper thigh
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Intramuscular Injections
Needle size: 18G to 23G, 1 to 3 inches
Angle of injection: 90 degrees
Medication amount given: 0.5 to 3.0 mL
Medications given: Narcotic pain medications, loading
dose of antibiotics
Common sites of injection: Deltoid, gluteus medius,
ventrogluteal, and vastus lateralis
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Z-Track IM Method
• This technique prevents the medication from
following the path of the needle and leaking
out into the tissues
• Used for injecting substances that may be
irritating or cause discoloration of the
subcutaneous tissues
• Do not massage the injection site after
administration
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Injections and Children
• Considerations
– Needle length: The size of the child’s arm or leg
will help to decide the size of the underlying
muscle, which determines the needle length
appropriate for the muscle thickness.
– Needle gauge: Determined by the viscosity of the
medication.
– Injection site: The vastus lateralis is the preferred
injection site for infants and young children
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Immunizations
• Natural immunity: After recovery from
exposure to certain illnesses, antibodies are
generated
• Artificial immunity: Produced by administering
immunizations or vaccines that trigger an
immune response in the body, which in turn
stimulates the production of antibodies
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Types of Vaccines
• Live attenuated (changed) pathogens
– Examples: varicella and measles
• Pathogenic toxin
– Examples: diphtheria and tetanus
• Killed pathogen
– Examples: pertussis (whooping cough), rabies, and
poliomyelitis
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Vaccine Schedules
• The CDC publishes annual immunization
schedules for children and adults
• The most current schedules can be
downloaded from www.cdc.gov/vaccines
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Preparing for Immunization
• Every patient or parent of a minor patient
must be made aware of the benefits and risks
of all vaccines
• A signed copy of the VIS is put in the patient’s
permanent record
• Authorization forms should be in order before
immunizations are administered
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Illnesses Reduced by Immunization
•
•
•
•
•
Influenza
Pneumonia
Haemophilus influenza type B (Hib, HIB)
Measles, mumps, and rubella (MMR)
Diphtheria
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Illnesses Reduced by Immunization
•
•
•
•
•
Pertussis (whooping cough)
Rabies
Tetanus
Rotavirus
Varicella zoster (chicken pox)
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Illnesses Reduced by Immunization
•
•
•
•
•
Hepatitis A
Hepatitis B
Human papillomavirus (HPV)
Meningitis
Polio
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