Purpose of Injections • A few of the reasons for giving injections are administration of: • Fluids • Biologics • Medications • Test Agents
Safety Considerations Use sterile injection techniques by preparing and giving injections without causing contamination or needle-sticks. Damaged packages are not sterile. Check each package for tears or damage.
Disposing of Sharps DO NOT RECAP NEEDLES! Properly dispose of sharps to prevent reuse and harmful waste.
Safety Considerations Carefully follow manufacturers’ instructions for the use of each medication and its proper storage. • Example, some medications must be: • Have no preservatives, therefore must be discarded after opening. • OR • Kept between 35-45oF • OR • Reconstituted with a specific diluent
Safety Considerations Wear all proper PPE for the procedure. Wash hands thoroughly and frequently!
Supplies Needed • Before giving an injection, gather the following: • The drug or substance to be injected. • Alcohol swab or alcohol moistened cotton ball • Correct size syringe • Correct size needle • Sharps Container- a hard plastic with a screw-on or tightly-secured lid
Prior to Giving The Injection • Disinfect the work area (where the drug and syringe, etc will be set up) • Check the drug label: • Is it what has been prescribed? • Check the expiration date on the vial. • Do not use a drug if: • It is past the expiration date • Precipitate is noted floating in the solution. • The solution is discolored.
Factors to Consider • When choosing needle size, syringe size, and injection site / route of injection there are several factors which need to be considered: • The type of the solution / medication. • The viscosity (Thin / watery? Thick / sticky?) • The absorption rate for the solution / medication. • The size of the patient (Beagle? Hound? Something larger?) • The mobility status of the patient (Anesthetized? Immobile? Fully conscious?
Venipuncture The cephalic vein on the inside of the front limb below the elbow may be used.
Venipuncture Hold off the vein by gripping and rolling laterally.
Venipuncture • Prepare the site. • Clip area • Wipe with alcohol
Venipuncture Insert needle, bevel up, into the vein. Gently pull back. Hold off when completed.
Venipuncture • Medial saphenous vein on the hind limb can also be used.
Venipuncture • Jugular Venipuncture should be performed in the middle 1/3 of the jugular vein. • Bending the needle, may help to maintain the angle.
Factors to Consider: IM Injections • For IM (intramuscular) injections, in general: • 21 to 23 gauge needle, 1 to 1.5 inches long. • Intramuscular tissue is richly supplied with blood vessels so the medication is more rapidly absorbed by this route. • Because there are fewer pain receptors in muscle tissue, consider this site for the more irritating or viscous solutions / medications. This will reduce the possibility of tissue damage.
Factors to Consider: IM Injections • Intramuscular injections may be performed in the thigh muscles on the front of the rear limb, or using the hamstring muscles on the back side of the rear leg.
Placement of intramuscular injection into quadriceps • Avoid hitting the sciatic nerve, so when injecting into muscle, be sure to direct the needle away from the sciatic nerve (located medially on the leg).
Factors to Consider: SQ Injections • For SQ (subcutaneous) injections, in general, use: • An 18 or 20 gauge needle, 1 to 1.5 inches long. • SQ medications are deposited into the loose connective tissue just below the dermis. • This tissue is not richly supplied with blood vessels so the absorption rate is slow. • There are many pain receptors in this tissue so only non-irritating, water-soluble medications in small doses should be given by the SQ route.
Placement of needle for subcutaneous injection The loose skin over the shoulders and neck is an ideal site for subcutaneous injection.
Placement of needle for subcutaneous injection • Syringes, extension sets, and direct lines from fluid bags can be used.
Complications from Injections • Some of the complications that can arise from an injection are: • Irritation / Inflammation • Allergic Reactions • Nerve Damage
How To Avoid Medication Errors • Check the medication order against the medication label. • Follow manufacturers instructions and the facility's protocols. • Observe the patient for how well the medication and the injection is tolerated. • DOCUMENT medication, dose, time, route, and immediate response. • Immediately report any adverse situations, including errors.
Helpful Websites • AALAS Learning Library-Dog Biomethodology Courses • https://www.aalaslearninglibrary.org/default.asp • Washington State University's College of Veterinary Medicine • http://www.vetmed.wsu.edu/ClientED/A-Z-Index.aspx • The University of Arizona Institutional Animal Care and Use Committee (IACUC) • http://www.iacuc.arizona.edu/training/dogs/index.html
Special Thanks! • Dr. Bradford Goodwin, DVM • Dr. Mary Robinson, DVM • Dr. Nadine Matthias, DVM • Peggy Bek, RVT • Jackie Bludworth, BS,RVT • Amanda Sutton, RVT, ALAT • Reinaldo Mendez, BS, LATG • And to our awesome dog models- • Bratt • Jammer • Bevo