Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient.
   To ensure that the patient understands the procedure and gives their valid consent (Griffith et al. [91], E; NMC [178], C).
2. 2.Show
   Consult the patient's prescription sheet, and ascertain the following:

   1. Drug.
   2. Dose.
   3. Date and time of administration.
   4. Route and method of administration.
   5. Diluent as appropriate.
   6. Validity of prescription.
   7. Signature of doctor.
   8. Allergy status.
   To ensure that the patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (DH [44], C; NMC [177], C; NPSA [167], C).

Procedure

1. 3.Show
   Assist the patient into the required position.
   To allow access to the injection site and to ensure the designated muscle group is flexed and therefore relaxed (Workman [274], E).
2. 4.Show
   Put on apron and gloves.
   To ensure the practitioner is protected from possible accidental exposure (Polovich [192], C).
3. 5.Show
   Remove the appropriate garment to expose the injection site.
   To gain access for injection (Workman [274], E).
4. 6.Show
   Assess the injection site for signs of inflammation, oedema, infection and skin lesions.
   To promote effectiveness of administration. To reduce the risk of infection (Workman [274], E). To avoid skin lesions and avoid possible trauma to the patient (Elkin et al. [69], E; Workman [274], E).
5. 7.Show
   Clean the injection site with a swab saturated with isopropyl alcohol 70% for 30 seconds and allow to dry for 30 seconds.
   To reduce the number of pathogens introduced into the skin by the needle at the time of insertion. To prevent stinging sensation if alcohol is taken into the tissues upon needle entry (Hunter [108], E; Workman [274], E).
6. 8.Show
   With the non‐dominant hand, pull the skin 2–3 cm sideways or downwards from the injection site.
   To displace the underlying subcutaneous tissues to slide over the underlying muscle by 1–2 cm (Antipuesto [6], E; Hunter [108], E).
7. 9.Show
   Holding the syringe in the dominant hand like a dart, inform the patient and quickly plunge the needle at an angle of 90° into the skin until about 1 cm of the needle is left showing.
   To ensure that the needle penetrates the muscle (Hunter [108], E; Workman [274], E).
8. 10.Show
   Pull back the plunger. If no blood is aspirated, depress the plunger at approximately 1 mL every 10 seconds and inject the drug slowly. If blood appears, withdraw the needle completely, replace it and begin again. Explain to the patient what has occurred.
   To confirm that the needle is in the correct position and not in a vein (Antipuesto [6], E). This allows time for the muscle fibres to expand and absorb the solution (Hunter [108], E; Workman [274], E). To prevent pain and ensure even distribution of the drug (Ostendorf [186], E).
9. 11.Show
   Wait 10 seconds before withdrawing the needle.
   To allow the medication to diffuse into the tissue (Antipuesto [6], E).
10. 12.Show
    Withdraw the needle rapidly and release the tension on the skin but do not massage the site.
    This causes the tissues to return to their original position to create a disjointed pathway and seals the injection entry point to prevent medication from seeping into the subcutaneous tissues or from leaking out through the injection site (Antipuesto [6], E).
11. 13.Show
    Apply gentle pressure to any bleeding point and then apply a small plaster over the puncture site.
    To prevent tissue injury and haematoma formation (Ostendorf [186], E).

Post‐procedure

1. 14.Show
   Ensure that all sharps and non‐sharps waste are disposed of safely and in accordance with locally approved procedures, for example put sharps into sharps bin and syringes into cytotoxic clinical waste bag.
   To ensure safe disposal and to avoid laceration or other injury to staff (DH [49], C).
2. 15.Show
   Record the administration on appropriate charts.
   To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NMC [178], C; NPSA [167], C).