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PRINCIPLES OF INJECTION TECHNIQUE (CHOICE (Solubility duration of action…
PRINCIPLES OF
INJECTION TECHNIQUE
INFECTION CONTROL
Hand hygiene
wash properly
P
ersonal
P
rotective
E
quipment
gloves
mask
gown
Sharps
safe use
safe disposal
Hepatitis B
vaccination
AIM
resolve pain
improve mobility
improve function
4 Step Plan
2. Treatment plan
When to inject
Discuss options
Contraindications?
Warn - side effects
Record above
Inform patient
diagnosis & nature of condition
proposed treatment & alternatives
drug action & effects
risk of side effects
benefits
plan for follow-up care
3. Drug choice & dose
4. Injection & follow-up
Problems if
Inaccurate
diagnosis
Inappropriate
underlying cause
not addressed
Inappropriate
drug
wrong dose
too large
Poor technique
wrong tissue/structiure
too frequent
poor aftercare
1. Diagnosis
Anatomy
Pathology
Observe
Touch
See
List - differential diagnosis
Narrow down via history & physical
Re-visit if required
Further investigations to confirm
CONTRAINDICATIONS
Soft Tissue
infection
cellulitis
dermatitis
viral infection
COVID-19?
chickenpox
shingles
herpes
TB
previous
Bacteremia
Co-pharmacy
coumarins
anti-bacterial
anti-fungal
anti-viral
Elderly
Young
Pregnant
Breast feeding
Severe
coagulopahty
anticoagulant drugs
No response to
2 injections
Intra-articular
As Soft tissue plus
Osteochondral fracture
Unstable joints esp. 2 MPJ
Inaccessible joints
Joint prothesis
No more than
3 injections/year
RARE RISK
blurred vision
Serous
Chorioretinopathy
refer to
ophthalmologist
CHOICE
Soft Tissue
Methylprednisolone +- Lidocaine
hydrocortisone
Joints
Triamcinolone
Solubility
duration of action
inversely proportional
Phosphates
short acting (dex)
Acetates
long acting (demo-med)
soluble
reduce flare?
Flourination
increases anti-inflammatory effect
decreases mineralocorticoid activity
less of a more potent drug
more of a less potent drug
MIXING
component parts
appear stable
& safe to use
MHRA advice 2010
allowed by
Independent Prescriber
not under PGD
with LA
Diagnosis
helps confirm
placement of sol
& diagnosis
Analgesia
less painful process
Dilution
spreads active drug
Distention
may help
break adhesions
INJECTION TECHNIQUE
Prepare
site
position patient
mark site
swab skin & allow to dry
plaster ready
Prepare
drugs
decide dose & vol
wash & dry hands
open vials
draw up steroid
dilute with LA
change needle
Give injection
Syringes
Luer slip
lock
right length needle
skin tension
angle of needle
distraction
Proper aftercare & follow-up
Record everything
drug
name
dose
batch No
Expiry date
advice
written post op plan
next appointment date
technique used