Basic Practical Skills: Injection Techniques - Essay Example

REFLECTION ON INJECTION TECHNIQUE by Student Name Course Name Lecturer Name University/College Name August 09, 2012 Injection techniques A three months experience in my clinical placement did not end without a degrading incident. On one occasion, I was asked by my placement supervisor to administer an intramuscular (IM) injection to a diabetic patient. I was confident that I would perform the injection without much challenge given that I had previously administered IM injections to two patients in two different occasions, albeit, under supervision. Furthermore, I had wide knowledge in the practice acquired through my study and observation of the clinical practice. Intramuscular injection was a common technique for drug administration in the orthopaedic in- and outpatient health centre I was attached. In spite of the experience, my IM injection to the patient caused unprecedented pain to the patient. The outcome of my procedure prompted me to revisit my clinical skills and to question injection techniques. A model of reflection developed by John (1995) necessitates discussion of feeling and thoughts after events description. In the event of administering the intramuscular injection, I was conscious that a more qualified and experienced nurse was watching me perform the procedure. As a result, I was a bit nervous, tense, and very cautious; I knew that a mistake would contribute to the supervisors rating of my practice. My understanding that different situations may require different injections techniques further increased my consciousness. However, when my supervisor asked whether the IM injection technique was applicable to the patient’s condition, I became a bit confused. I knew that there was inconsistence in practice and evidence about the best injection techniques for specific situations. Literature has highlighted that it is common for patient to experience pain during intramuscular injections. According to Agac and Gunes (2010), intramuscular injection is seen as a basic technique, yet it is often a painful experience for a number of patients. However, literature reveals that some IM injection techniques cause less pain than others do. For instance, changing needles before administration of an IM injection significantly minimizes pain (Agac & Gunes, 2010). Evidence and literature touts this technique as practice that is why when I administered the intramuscular injection to the diabetic patient, I used one needle to draw the injectable and another one to administer it. However, it was not clear to me why the patient had experienced extreme pain during my procedure. A number of research studies have insinuated that a number of factors can contribute to the level of pain that a patient experience when receiving an injection procedure. One of these factors is the diameter of the need used. According to Stefano et al. (2011), higher gauge (30 or 31 gauge) needles – or needles with smaller diameter - cause minor tissue injury and lesser pain than needles with larger diameter. Although Stefano et al. (2011) study was specific to the intravitreal injection technique, separate studies concur that a 30 or 31 gauge needle is appropriate for intramuscular injection. I was aware during the IM procedure that the correct needle caliber to use was a 30 or 31 gauge. The shape of the needle is also another important factor to consider when administering an injection. Stefano et al. (2011) have noted that shape of needle used in intravitreal injection influence scleral penetration pressure and consequently patient discomfort. Poor intravitreal injection technique can cause intraocular inflammation, pain and discomfort to the patient (Stefano et al., 2011). Chang, Leong, Hong, Wang and Fu (2011) have examined the effectiveness of high-resolution injection techniques in conveying sample plugs in a microfluidic chip. The study highlights the importance of the shape of an injection system, pointing out that a 45° U-shaped injector eradicates sample leakages. Although the study provides insight into the effectiveness of injection techniques in relation to the shape of a needle, its relevance is indirect to the practice of intramuscular injection. Elsewhere, literature consents that tunneled scleral incision is a better than straight or perpendicular scleral incision in preventing vitreal reflux, which can be experienced during vitreal injection procedures (Stefano et al., 2011). Coninck et al. (2010) have recommended to diabetic patients to select different sites for injection to avoid other complications; same site injection for a prolonged period can result in lipohypertrophy. This realization leads me to question whether the same is applicable to non-diabetic patients or to the IM injection procedure I was conducting. It also highlights to me that a nursing professional should read widely and be up-to-date with clinical developments. It may not be straightforward that the four sterile water injection (SWI) technique is more appropriate and effective than the single sterile injection in treating lower back pain (Lee et al., 2011), a condition that is common in pregnant women. Chandra, Banavaliker and Agarwala (2011) have explained that although intravenous sedation is associated with low mortality and morbidity, it requires that adequate anaesthetic resources be used. This implies that adequacy of an injectable is a determinant of the effectiveness of an injection technique. However, literature has not linked inadequacy of an injectable to the painful experience. Chandra, Banavaliker and Agarwala (2011) have further revealed that the transcricoid injection technique is more suitable than the “spray as you” technique. Although Chandra, Banavaliker and Agarwala (2011) study provides insight into the suitability of transcricoid injection technique, it is limited to the fibreoptic bronchoscopy procedure. The subject of injection techniques is wide and the available literature is not adequate to clarify every question about injection techniques. Uraoka et al. (2011), for instance, have examined the suitability of using carbon dioxide during submucosal (SM) injection necessary during endoscopic submucosal dissection. However, a carbon dioxide may not be suitable in other different procedures and as Uraoka et al. (2011) recommends, there need for further research not only on the specific technique but also on submucosal injection techniques. Stefano et al. (2011) have stated that there is currently little research on techniques, materials, size of syringes and needle used in intravitreal and intramuscular injections. Even with the inadequacy in literature in clarifying, the best IM injection technique that would cause minimal pain to a patient, evidence show that pain can be minimized during IM injection procedures. Agac and Gunes (2010) have advocated for using one needle to draw an injectable and another needle to administer an injection. However, more research is necessary to clarify the suitability of the technique when different injectables are used. In addition, although separate studies conducted by Stefano et al. (2011), and Chang, Leong, Hong, Wang and Fu (2011) are not specific to the intramuscular injection technique, it is clear that appropriate needle diameter and size are important in any injection procedure. The unpleasant outcome of the IM injection procedure I performed on the patient may not have been purely because of lack of knowledge. Literature has revealed that it painful experiences are common during IM injection procedures. In addition, a number of factors, which I was aware of when administering the IM injection to the patient, can contribute to pain experienced during administration of an injection. Research have also highlighted that using alcohol wipes can help reduce pain during I know that different nurses employ evidence in different manner and may apply varying techniques. Nonetheless, as long as my clinical practice is evidence-based and safe I can perform clinical procedures safely. I also understand that the field in which I am practicing will greatly influence my future clinical practice and that I have to learn about trust protocol related to clinical procedures prior to starting a procedure. One of the aims in my action plan is to investigate further the idea of changing needle before administering intramuscular injection. I also recommend to other researchers to further research on the subject and clarify the importance of changing needles prior to IM injection and the appropriate shape and diameter of needle to use in IM injection procedure. I am also intending to have further discussions with highly qualified and experienced nursing professional on the subject of intramuscular injection. As I conclude, I note that I have developed considerably in terms of reflection skills while producing this essay. Applying a reflection model has helped me to arrange my ideas, feelings, and thoughts properly. I am now more aware of, and better informed about evidence-based clinical practice and its significance; the awareness has been improved greatly by the critical discussions in my reflection. In addition, my competency in clinical skills, but more specifically in IM injection has been developed further, which gives me a feeling of progression in my professional and personal development. The reflection and the model applied in the reflection have also helped me discover that learning is a participatory and proactive process, which encourage me to be proactive in my learning. Also important is the realization that the reflection is a very useful tool in learning. Therefore, as a student in the nursing field I should not only know its importance but how to use it effectively. Reference list Agac, E & Gunes, UY, 2010, Effect on pain of changing the needle prior to administering medicine intramuscularly: a randomized controlled trial, Journal of Advanced Nursing, vol. 67, no. 3, pp. 563-569. Chandra, A, Banavaliker, JN, Agarwala, MK 2011, Fibreoptic bronchoscopy without sedation: Is transcricoid injection better than the “spray as you go” technique? Indian Journal of Anaesthesia, vol. 55, no. 5, pp. 483-489. Chang, C, Leong, J, Hong, T, Wang, Y, and Fu, L 2011, Experimental and Numerical Analysis of High-Resolution Injection Technique for Capillary Electrophoresis Microchip. International Journal of Molecular Sciences, vol. 12, pp. 3594-3605. Coninck, C, Frid, A, Gaspar, R, Hicks, D, Hirsch, L, Kreugel, G, Liersch, J, Letondeur, C, Sauvanet, J, Tubiana, N & Strauss, K 2010, Results and analysis of the 2008–2009 insulin injection technique questionnaire survey, Journal of Diabetes, vol. 2, pp. 168–179. John, C 1995, ‘Framing learning through reflection within Carper’s fundamental ways of knowing in nursing’, Journal of Advanced Nursing, vol. 22, no. 2, pp.226-234. Lee, N, Coxeter, P, Beckmann, M, Webster, J, Wright, V, Smith, T & Kildea, S 2011, A randomised non-inferiority controlled trial of a single versus a four intradermal sterile water injection technique for relief of continuous lower back pain during labour. BMC Pregnancy and Childbirth, vol. 11, no. 21. Rodrigues, EB, Grumann, A, Penha, FM, Shiroma, H, Rossi, E, Meyer, CH, Stefano, V, Maia, M, Magalhaes, O & Farah, ME 2011, Effect of needle type and injection technique on pain level and vitreal reflux in intravitreal injection, Journal of Ocular Pharmacology and Therapeutics, vol. 27, no. 2, pp. 197-203. Stefano, VSD, Abechain, JJK, Almeida, LFS, Verginassi, DM, Rodrigues, DB, Freymuller, E, Maia, M, Magalhaes, O, Nguyen, QD & Farah, ME 2011, ‘Experimental investigation of needles, syringes and techniques for intravitreal injections’, Clinical and Experimental Ophthalmology, vol. 39, pp. 236–242. Uraoka, T, Kawahara, Y, Ohara, N, Kato, J, Hori, K, Okada, H & Yamamoto, K 2011, Carbon dioxide submucosal injection cushion: an innova technique in endoscopic submucosal dissection, Digestive Endoscopy, vol. 23, pp. 5–9. Read More