Injection Techniques

 

Injection Techniques 

NEEDLE POSITION FOR ALL

The position depends on the age of the child, the site of injection, the number of injections to be given and convenience of vaccinator.

INTRAMUSCULAR INJECTION 

Preferred Site:
0-2 years: Anterolateral thigh
3 years old and above: Deltoid

(In children ages less than 15 months the deltoid muscle is not safe to use since it is not developed enough to absorb the vaccine and the radial nerve is close to the surface)

 

REQUIREMENTS:

Cotton, Antiseptic, 22-25 G needle, Syringe

PROCEDURE:

Child should be in mothers lap and mother holding hands of infant 

 

ADMINISTRATION: 

• Use aseptic precautions

• Hold the syringe barrel with fingers and thumb on sides of the barrel and with the bevel (hole) of the needle facing upwards

• Pinch and gather the muscle mass by one hand

• Stretch the skin over injection site

• Insert needle at 90 degree

• Aspirate to make sure a blood vessel is not punctured. DO NOT ASPIRATE WHEN YOU INSERT THE NEEDLE INTO THE INFANT FOR THE INJECTION. 

• Depress the plunger smoothly, taking care not to move the needle under the skin

• Pull the needle out quickly and smoothly at the same angle as it went in

• Place a clean swab gently over the site

• DO NOT RUB OR MASSAGE the injection site. Soothe and distract the infant

• Discard everything according to biomedical waste rules

Dosage of Anti-Rabies Serum: 20 IU/kg, half at bite site and half intra-muscularly

SUBCUTANEOUS INJECTION 

The injection is given into the layer below the skin on the upper arm 

REQUIREMENTS:

Cotton, Antiseptic, 22-25 G needle, Syringe

PROCEDURE:

POSITION:

Child should be in mothers lap and mother holding hands of child and exposing upper arm of baby  

 

 

 

ADMINISTRATION:

• Wash hand and wear sterile gloves  

• Hold the syringe barrel with fingers and thumb on the sides of the barrel and with the bevel (hole) of the needle facing upwards

• Quickly push the needle into pinched up skin at a 45degree angle

• Direct it towards the shoulder of the child

• Depress the plunger smoothly, taking care not to move the needle under the skin

• DO NOT RUB OR MASSAGE the injection site. Soothe and distract the infant

• Pull the needle out quickly and smoothly at the same angle as it went in

• Place a clean swab gently over the site

• Discard everything according to biomedical waste rules

 

 INTRADERMAL INJECTION  

BCG is the only vaccine that is injected intradermally (into the layers of the skin) for slow absorption. It is usually given in the left upper arm. To measure and inject the very small dose (0.05 ml) accurately, a special syringe and needle are used. 

POSITION:

 Cuddle position on caregiver’s lap (BCG recommended for infants only)

ADMINSTRATION: 

• Hold the syringe barrel with fingers and thumb on the sides of the barrel and with the bevel (hole) of the needle facing upwards

• Lay the syringe and needle almost flat along the infant’s skin

• Insert the tip of the needle under the surface of the skin just past the bevel

• Keep the needle close to the skin at the same angle as you inserted it

Place your other thumb on the lower end of the syringe near the needle to hold the needle in position, but do not touch the needle. 

Hold the plunger end of the syringe between the index and middle fingers. Press the plunger in slowly with the thumb. If you feel no resistance to the plunger, you are not in the right place and should reposition  

• A pale flat-topped swelling with small pits like an orange peel should appear on the skin

• Remove the needle smoothly at the same angle as it went in

• The caregiver should place a clean swab gently over the site

• DO NOT RUB OR MASSAGE the injection site. Soothe and distract the infant

• Discard everything according to biomedical waste rules

   

REFERENCES:

http://www.who.int/immunization/policy/Immunization_routine_table2.pdf? ua=1 

https://vikaspedia.in/health/child-health/immunization

 

Written by our guest author Shreedhar Dhopat

Illustrations by Devi Bavishi

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