CHAPTER 25

CHAPTER 25: INTRAVENOUS INJECTION (IV INJECTION) – EXPLANATION 

An intravenous (IV) injection is the process of administering medication or fluids directly into a vein using a needle or catheter. This method allows the substance to be absorbed rapidly into the bloodstream, providing almost immediate effects. It is commonly used in hospitals and emergency situations where quick delivery of medication is needed. 

Indications for Intravenous Injection 

• Medications: Antibiotics, chemotherapy drugs, pain medications (e.g., morphine), fluids (e.g., saline or glucose), electrolytes, and contrast media for imaging. 

• Fast Absorption: IV injections are ideal when immediate or rapid onset of action is needed (e.g., pain relief, shock management). 

• Hydration and Fluid Resuscitation: Used to replace lost fluids quickly in cases of dehydration, shock, or surgery. 

Common Sites for Intravenous Injection 

1. Veins in the Arm: 

1. Preferred Site: The median cubital vein, located in the crease of the elbow, is most commonly used. 

2. Other Sites: Veins in the forearm and hand may also be used, especially if the median cubital vein is not accessible. 

2. Veins in the Leg (in specific cases): 

1. Used for: Infants or when veins in the arms are not suitable. 

2. Sites: Veins in the dorsum of the foot or ankle. 

3. External Jugular Vein (neck): 

1. Use: For emergency situations where arm veins are not available, such as in cases of severe trauma or shock. 

4. Central Venous Access (e.g., Central Line): 

1. Use: In cases requiring long-term infusion or when peripheral veins are difficult to access. 

2. Sites: Subclavian vein, internal jugular vein, or femoral vein. 

Procedure for Administering an Intravenous Injection 

1. Preparation: 

1. Gather Equipment: Syringe, IV needle (cannula), antiseptic swab, tourniquet, gloves, and the prescribed medication. 

2. Check the Medication: Verify the drug, dose, and patient details before preparation. 

3. Wash Hands: Perform thorough hand hygiene before starting. 

2. Patient Positioning: 

1. Ask the patient to be in a comfortable, relaxed position. If possible, have them extend their arm to make veins easier to see and feel. 

2. Apply a tourniquet above the intended injection site (usually just above the elbow) to engorge the veins and make them more prominent. 

3. Site Selection: 

1. Choose a suitable vein based on the patient’s anatomy. Use the median cubital vein for most patients, or other accessible veins as necessary. 

4. Cleaning the Injection Site: 

1. Use an alcohol swab to clean the selected area in a circular motion from the center outward. Allow the skin to dry. 

5. Inserting the Needle: 

1. Hold the syringe with the needle at a 15-30° angle to the skin. 

2. Insert the needle into the vein, aiming towards the blood vessel, and observe for a flash of blood in the syringe, confirming the needle is in the vein. 

3. Advance the catheter carefully into the vein, then withdraw the needle, leaving the catheter in place. 

6. Administering the Injection: 

1. Attach the syringe with medication to the catheter hub. 

2. Slowly and gently push the medication into the vein. 

3. Monitor for adverse reactions (such as swelling, pain, or redness). 

7. Post-Injection Care: 

1. Once the injection is complete, remove the syringe and needle. 

2. Apply pressure to the site with a sterile gauze pad or cotton ball to prevent bleeding. 

3. Bandage the site if necessary, and dispose of the needle and syringe in a sharps container. 

4. Observe the patient for any side effects or complications like allergic reactions or pain at the injection site. 

Procedure for Administering an Intravenous Injection 

1. Preparation: 

1. Gather Equipment: Syringe, IV needle (cannula), antiseptic swab, tourniquet, gloves, and the prescribed medication. 

2. Check the Medication: Verify the drug, dose, and patient details before preparation. 

3. Wash Hands: Perform thorough hand hygiene before starting. 

2. Patient Positioning: 

1. Ask the patient to be in a comfortable, relaxed position. If possible, have them extend their arm to make veins easier to see and feel. 

2. Apply a tourniquet above the intended injection site (usually just above the elbow) to engorge the veins and make them more prominent. 

3. Site Selection: 

1. Choose a suitable vein based on the patient’s anatomy. Use the median cubital vein for most patients, or other accessible veins as necessary. 

4. Cleaning the Injection Site: 

1. Use an alcohol swab to clean the selected area in a circular motion from the center outward. Allow the skin to dry. 

5. Inserting the Needle: 

1. Hold the syringe with the needle at a 15-30° angle to the skin. 

2. Insert the needle into the vein, aiming towards the blood vessel, and observe for a flash of blood in the syringe, confirming the needle is in the vein. 

3. Advance the catheter carefully into the vein, then withdraw the needle, leaving the catheter in place. 

6. Administering the Injection: 

1. Attach the syringe with medication to the catheter hub. 

2. Slowly and gently push the medication into the vein. 

3. Monitor for adverse reactions (such as swelling, pain, or redness). 

7. Post-Injection Care: 

1. Once the injection is complete, remove the syringe and needle. 

2. Apply pressure to the site with a sterile gauze pad or cotton ball to prevent bleeding. 

3. Bandage the site if necessary, and dispose of the needle and syringe in a sharps container. 

4. Observe the patient for any side effects or complications like allergic reactions or pain at the injection site. 

Advantages of Intravenous Injection 

1. Immediate Effect: Since the medication is delivered directly into the bloodstream, it works faster than oral or intramuscular injections. 

2. Precise Control: The rate of infusion can be controlled with IV drips, allowing for steady, consistent administration of medication. 

3. Suitable for Large Volumes: Larger volumes of fluid (e.g., saline, electrolytes) can be administered through an IV line over time. 

Complications of Intravenous Injection 

1. Infiltration: Occurs when the IV catheter becomes dislodged from the vein, and the fluid or medication leaks into the surrounding tissue. 

1. Signs: Swelling, pain, and coldness at the site. 

2. Treatment: Stop the infusion, elevate the area, and apply a warm compress. 

2. Phlebitis: Inflammation of the vein caused by irritation from the needle or medication. 

1. Signs: Redness, swelling, warmth, and pain along the vein. 

2. Treatment: Discontinue the IV, apply warm compresses, and switch to another vein if necessary. 

3. Infection: Infection at the IV site can occur if the insertion technique is not sterile. 

1. Signs: Redness, swelling, pus, fever. 

2. Prevention: Use aseptic techniques, clean the site properly, and monitor for signs of infection. 

4. Air Embolism: If air enters the vein, it can lead to serious complications, including cardiac arrest. 

1. Prevention: Always remove air bubbles from syringes and IV lines before administration. 

5. Extravasation: The leaking of drugs into the surrounding tissue, especially if the drug is irritating or vesicant (e.g., chemotherapy). 

1. Signs: Burning, redness, and swelling at the injection site. 

2. Treatment: Discontinue the IV, and follow protocols for specific drugs to manage extravasation. 

Needle and Syringe Sizes for Intravenous Injections 

• Needle Size: Typically, a 22-25 gauge needle is used for most IV injections, depending on the viscosity of the medication. 

• Syringe Size: Syringes of 1-10 mL are commonly used, depending on the volume of medication.