This document contains all relevant information on how to inject drugs in a patient/ mannequin, for teaching purpose to MBBS students.

1. DEMONSTRATION OF ADMINISTRATION OF DRUGS BY VARIOUS ROUTES IN
MANNEQUINS
Equipment tray: Syringe, gloves, alcohol/spirit swabs, cannula, labeled IV fluids, gauze piece,
adhesive, IV set, Emergency drugs, tourniquet, subcutaneous needle, etc.
IV Cannula and drip set:
SIZE COLOUR FLOW RATE USED IN:
26G PURPLE 13 ml/min Neonates
24G YELLOW 20 ml/min Neonates, Children
22G BLUE 36 ml/min Children
20G PINK 60 ml/min Females, Blood Transfusion
18G GREEN 90 ml/min Males, Trauma cases
16G GREY 180 ml/min Trauma cases
14G ORANGE 240 ml/min Trauma cases
INTRAVENOUS
Checklist:
1. Check the patient details
2. Communicate to the patient about what procedure you are going to do & take consent
3. Draw the bedside curtain
4. Check that all the necessary equipments are available
5. Perform hand hygiene and Wear gloves
6. Uncover the arm completely

2. 7. Ask the patient to relax and support his/her arm below the vein to be used
8. Apply tourniquet and look for a suitable vein
9. Clean the site using alcohol swab in firm circular motion and allow the site to dry
10. Pull the cap of the needle and keep it aside
11. Stabilize the vein by pulling the skin taut in the longitudinal direction of the vein using
non-dominant hand
12. Insert the needle at an angle of around 35 degrees
13. Puncture the skin and move the needle slightly into vein (3-5 mm)
14. Aspirate, if blood appears, hold the syringe steady
15. Loosen the tourniquet and inject slowly
16. If the blood doesn't appear, try again
17. Withdraw the needle swiftly and cover it with a cap, and discard the needle
18. Press a sterile gauge over the opening and secure it with an adhesive
19. Remove the gloves and perform hand hygiene
20. Evaluate the patient for any side effects
Sites: A good vein runs straight, stands up a little, fills and empties, and is easy to splint
 Hand- Dorsal arch veins
 Wrist- Volar aspect
 Cubital fossa- Median antecubital, cephalic and basilic veins
 Foot- Dorsal arch
 Leg- Saphenous vein at the knee
Contraindications: Dialysis site, H/o mastectomy, fragile vein, H/o trauma, etc.
Examples: Bolus Injection IV Adenosine in PSVT, Slow Injection IV Calcium gluconate in
arrhythmias, Infusion of fluids- NS, RL, D5W, etc. Rapid infusion in shock.
Side effects and complications: Infiltration: pooling of fluid in tissue space due to misplaced
cannula, Hematoma- extravasation and collection of blood from severed vein, Thrombophlebitis,
Embolism (air)

3. INTRAMUSCULAR
Checklist:
1. Check the patient details
2. Communicate to the patient about what procedure you are going to do & take consent
3. Draw the bedside curtain
4. Check that all the necessary equipments are available
5. Perform hand hygiene and Wear gloves
6. Uncover the area to be injected
7. Clean the site using alcohol swab with firm circular motion
8. Allow the site to dry
9. Tell the patient to relax the muscle
10. Pull the cap from the needle
11. Insert the needle swiftly at an angle of 90 degrees
12. Aspirate briefly. If blood appears, withdraw the needle and replace it
13. If blood doesn't appear, inject slowly (0.5-2 min)
14. Withdraw the needle quickly
15. Carefully place the cap back on the needle
16. Discard the needle in the dustbin for sharp waste (White Puncture proof Container)
17. Apply a sterile gauge piece over the injection mark.
18. Press it, massage it and then apply the adhesive
19. Remove the gloves and perform hand hygiene
20. Evaluate the patient for any side effects
Sites:
- Deltoid- 3 finger-span below the Acromion process of Scapula
- Vastus lateralis- Anterolateral aspect of mid-thigh. Used in vaccination in toddlers.

4. - Dorsogluteal- upper outer quadrant of right buttock in prone position (Gluteus maximus)
- Ventrogluteal- Place the patient in side position, with the upper knee flexed. Put heel of
the palm on greater trochanter and Index finger on ASIS, with thumb pointing towards
groin and fingers pointing towards head end. The site of injection is in centre of
triangular gap in between index finger, middle finger and Iliac crest. (Gluteus medius and
minimus)
Contraindications: Gluteal muscle atrophy, Paraplegia, Quadriplegia, Marasmus, Ascending
Paralysis (GBS, Poliomyelitis), Overlying cellulitis, Coagulopathy
Examples: Antibiotics (Penicillin G, Benzathine penicillin, Streptomycin), Biologicals
(Immunoglobins, vaccines, and toxoids), Hormonal agents (Testosterone, medroxyprogesterone)
Side effects & Complications: Pain at site of injection, Abscess formation, Systemic reaction,
Nerve injury (eg. Sciatic in dorsogluteal) and Atrophy, Muscle injury and Contractures, Cellulitis
Z-track method: Technique for IM in which the doctor slightly pulls and holds pressure on the
skin when giving an injection, which leaves a zigzag path behind when they remove the needle
and release the skin. Z-track technique prevents staining of skin surface on IM Iron Injections.

5. SUBCUTANEOUS
Checklist:
1. Check the patient details
2. Communicate to the patient about what procedure you are going to do & take consent
3. Draw the bedside curtain
4. Check that all the necessary equipments are available
5. Perform hand hygiene and Wear gloves
6. Uncover the area to be injected (Abdomen)
7. Clean the site using alcohol swab with firm circular motion and allow the site to dry
8. Pull the cap from the needle
9. Using the non-dominant hand, pinch hold and pull taut the skin at the site of injection
(especially in thin patients)
10. Using the dominant hand, hold the syringe between thumb and forefinger
11. Insert needle in the base of the skin hold at an angle of 20-30 degree (normal syringe)
12. Relax the skin
13. Aspirate briefly. If blood appears, withdraw the needle and replace it. If blood doesn't
appear, inject slowly (0.5-2 min)
14. Withdraw the needle quickly
15. Carefully place the cap back on the needle
16. Discard the needle in the dustbin for sharp waste (White Puncture proof Container)
17. Apply a sterile gauge piece over the injection mark.
18. Press it, massage it and then apply the adhesive
19. Remove the gloves and perform hand hygiene
20. Evaluate the patient for any side effects

6. Sites: On abdomen- atleast 2 inches away from umbilicus, outer area of arm, upper back, upper
buttock, mid-thigh
Examples: Insulin, erythropoietin, IPV, Omalizumab (Anti IgE antibody., sumatriptan, LMWH
Side effects and complications- lipodystrophy, rash, pain, hematoma (LMWH action)
Insulin syringe for subcutaneous injection
INTRADERMAL: At an angle of 15 degrees. E.g. BCG vaccine, Tuberculin testing, fractional
fIPV, Triamcinolone injection on keloid
INTRA-ARTERIAL: E.g. thrombolysis in cases of embolism, vasodilator drugs in cases of
vasospasm
INTRA-ARTICULAR: Directly in joint. E.g. Hyaluronic acid in osteoarthritis, Steroids in
cases Rheumatoid arthritis
SUBLINGUAL: Nitroglycerin, Zolpidem, Ergotamine, Desmopressin, Apomorphine
TRANSDERMAL: Nicotine patch for smoking cessation, Estradiol to prevent menopausal
symptoms, Hyoscine for motion sickness, nitrate patches for angina