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Injections

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HealthWiki > A Book for Midwives > Chapter 19: Advanced skills for pregnancy and birth > Injections


It is more dangerous to inject a medicine than to take it by mouth. But sometimes, especially in emergencies, injections are the most effective way to give a medicine. Give injections only when absolutely necessary, and learn to do so safely.

Injections are given much too often. In many places, when someone feels sick, the first thing they do is get an injection — sometimes of vitamins, sometimes of antibiotics or some other drug. These types of injections rarely do anything to heal the sickness. They are often an unnecessary expense, and can be dangerous.

WARNING! Injections can be dangerous:

an abscess on a person's buttock.
Sterilize your needle before you use it — or it can cause an abscess.
  • The place an injection is given can become infected and can cause an abscess.
  • Some injected medicines can cause strong allergic reactions.
  • Injections with unsterile needles can spread disease — like hepatitis or HIV.
  • A midwife (or anyone who gives an injection) has a small risk of accidentally sticking the needle in herself after giving an injection. If this happens, she is at risk of catching diseases like hepatitis or HIV.
  • Injections to speed up labor can harm the baby and mother. Never use an injection to speed up labor.


Here are some times when an injection is helpful or necessary:

  • severe bleeding after birth. Injecting oxytocin can stop bleeding.
  • convulsions or pre-eclampsia during labor and birth. Giving magnesium sulfate can prevent a convulsion.
  • infections of the mother after birth. Injecting antibiotic medicines can quickly stop the infection.
  • sewing tears after birth. Injecting pain medicine makes sewing hurt less.
Remember: Never give an injection if medicine by mouth will work just as well.

Contents

Allergy

Remember that some medicines can cause serious allergic reactions. Learn more about allergic reactions and how to treat them.

How to give an injection

Prepare the syringe and needle

There are 2 kinds of syringes: reusable and disposable. The reusable ones must be taken apart, cleaned, and sterilized before each use. The disposable kind come in sterile packages. If the sterile package is dry and unbroken, the syringe and needle can be used directly out of the package. They do not need to be sterilized first.

Sometimes you can use a disposable syringe and needle several times, but you must sterilize them before each use.

a syringe with parts labeled.
syringe
hub
needle
barrel
bottom
plunger

There are also disposable syringes that cannot be reused. Sometimes these syringes come with a dose of medicine already inside. These may be called autodisabled syringes.

WARNING!    After a syringe and needle have been sterilized, never touch the needle with your fingers or let anything else touch the needle. If you do, it will not be sterile anymore. Only touch the outside of the barrel or the plunger of the syringe.


Draw up the medicine

Injectable medicines come in 3 forms:

In a small bottle called an ampule. You must break off the top of an ampule to get the medicine.


As a liquid in a small bottle with a lid. You push the needle through a soft spot in the lid to get the medicine.


As a powder in a bottle with a lid. You must add sterile water to these medicines.

An ampule usually contains the right amount of medicine for 1 dose. Bottles usually contain enough for several doses. The barrel of the syringe has markings to show how much medicine you have drawn up.


If the medicine comes in an ampule:
1. Wipe the ampule clean with a cloth or some alcohol. Then wrap a clean cloth around the top and break it off.
how to break the top off an ampule; an arrow points up and slightly to one side.
2. Put the needle into the ampule. Be careful that the needle does not touch the outside of the ampule. Hold the barrel of the syringe steady and pull the plunger — this will draw the medicine into the syringe.
3. Hold the syringe with the needle pointing up. Gently tap the barrel of the syringe until all the air bubbles rise to the top. Then push the plunger in just a little to get the air out.


If the medicine comes as a liquid in a bottle:
1. Clean the rubber top of the bottle with a sterile gauze or cloth that has been soaked in alcohol. This keeps dirt off the needle and out of the medicine.
2. Pull the plunger back to fill the syringe with air. Then push the syringe through the top of the bottle, and inject the air into the bottle.
3. Turn the bottle upside down. Be sure the tip of the needle points into the medicine inside the bottle and not into the air. Hold the barrel of the syringe still and slowly pull the plunger until the correct amount of medicine enters the syringe. Pull the syringe out of the bottle.
4. Hold the syringe with the needle pointing up. Gently tap the barrel of the syringe until all the air bubbles rise to the top. Push the plunger in just a little to get the air out.


If the medicine comes as a powder in a bottle:
1. Clean the rubber top of the bottle with a sterile gauze or cloth that has been soaked in alcohol.
2. Draw up the correct amount of sterile water to dilute the medicine. You can sterilize water by boiling it for 20 minutes — then let it cool before you use it.
3. Inject the sterile water into the bottle with the powdered medicine inside. With the needle still inside, gently shake the bottle to mix the powder and water completely.
4. Turn the bottle upside down. Be sure the tip of the needle is in the medicine — not the air. Hold the barrel of the syringe still and slowly pull the plunger until the correct amount of medicine enters the syringe. Pull the syringe out of the bottle.
5. Hold the syringe with the needle pointing up. Gently tap the barrel of the syringe until all the air bubbles rise to the top. Push the plunger in just a little to get the air out.
Inject safely

Inject an adult in the buttock or thigh.

Imagine that each buttock is divided into 4 parts. Inject into the upper outer part.
illustration of the below: where to inject.
inject here
or here
Or inject into the long muscle on the front of the thigh.



Inject a baby only in the large muscle on the front of the thigh — never in the buttock or anywhere else. Pinch the muscle loosely between your thumb and finger so you don't hit the bone.


How to give an injection

1. Clean the skin with soap and water
or with alcohol. Let it dry.
2. Put the needle all the way in. Move quickly and smoothly
as you insert the needle and it will not hurt much. Do not move the needle once it is in.
3. Pull the plunger of the syringe out just a little. If any blood comes into the syringe, you have gone into a vein. Take the needle out and try again.
4. If no blood enters the syringe, slowly but steadily push the plunger in to inject the medicine into the muscle.
5. Pull out the syringe.
6. Immediately put the used syringe somewhere where it cannot stick anyone.


a box labeled "Danger: Used Needles".

If you are using a disposable syringe, you should have a box or can close by where you can safely get rid of the needle.

If you will use the syringe again, you should drop it in a bucket of bleach, or bleach mixed with water, and then sterilize it.

Note: Before you inject a person, practice injecting plain water into a fruit
or soft vegetable to get experience using a syringe.

WARNING!    Used needles are dangerous. They may carry serious diseases like hepatitis or HIV/AIDS.

  • Do not try to put a cap back onto a dirty needle — you might stick a needle into your own skin and pass harmful germs from the needle into your blood.
  • Never throw a needle in the trash or leave it where other people might stick themselves.
  • If you reuse a needle, always sterilize it first.


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