Intramuscular Injections

1. Intramuscular Injections UAM College of Technology- McGehee Practical Nursing

2. The Injection Method Topics covered will include: Correct injection technique Correct needle length Correct needle gauge Correct injection locations Max dose for each injection site Examples of “Injections Gone Bad”

3. What is an Intramuscular Injection? • Intramuscular injections are absorbed more quickly because of the greater blood supply to the body muscles. Muscles can also take a larger volume of fluid without discomfort. Although the amount varies among individuals, it is chiefly based on muscle size and condition and the site used. Several factors indicate the size and length of the needle to be used: • The muscle • The type of solution • Amount of adipose tissue covering the muscle • The age of the patient

4. Administering an IM Injection • ACTION: Plan the site that the injection will be given • RATIONALE: The deltoid, ventrogluteal, vastus lateralis, or rectus femoris sites may be used. • ACTION: Perform hand hygiene and don gloves. Select and expose the injection site so that the view is unobstructed. • * For the ventrogluteal site, the patient may be supine or turned to the side • RATIONALE: The ventrogluteal site is the safest site. The IM site chosen must be with defined landmarks; a good view is necessary to inject the correct location. • ACTION: Remove the alcohol swab and cleanse the area of injection 2 inches in diameter in a firm circular motion. Place the swab to the side or in the non-dominant hand for later use. Allow the area to dry. • RATIONALE: Prevent the transfer of microorganisms. Cleanses the site. Makes the swab available after the injection. Wet alcohol on the skin may cause stinging on injection.

5. Administering an IM Injection • ACTION: Pick up the syringe and verify that the correct dose is in it. If an air bubble is to be used as a lock, add 0.2mL of air. Invert the syringe so that it is perpendicular to the floor and the bubble rises to a position behind the fluid in the syringe. • RATIONALE: An air bubble is thought to seal the needle track, keeping the medicine from leaking out. • ACTION: Spread the skin at the site with the non-dominant hand, pressing firmly around the site to compress the subQ and muscle tissue. • RATIONALE: Taut skin reduces resistance to the needle when it enters the tissues and causes less pain. • ACTION: Grasp the barrel of the syringe firmly between the thumb and index finger, like a dart, and plunge the needle firmly into the muscle at a 90º angle, with a quick firm forward thrust until desired depth is reached. • RATIONALE: Holding the skin taut and the syringe steady while introducing the needle to the desired depth with one stroke causes the least discomfort to the patient.

6. Administering an IM Injection • ACTION: Steady the barrel of the syringe with the non-dominant hand and pull the plunger back with the dominant hand to ASPIRATE for blood. If blood returns in the syringe, withdraw the needle and dispose of the syringe and medicine. Prepare for a new injection. • RATIONALE: A medication prepared for IM injection can be harmful if it is injected intravenously. Blood should not be reinjected into tissue • ACTION: Inject the medication by pushing the plunger into the barrel with a slow, continuous motion. Be careful not to displace the needle from its original position as you inject. • RATIONALE: Injecting slowly is less painful because the tissue has more time to absorb the medication. A medication prepared for IM absorption may cause local tissue reaction if left in the fatty subcutaneous or intradermal tissue. • ACTION: Quickly remove the needle, drawing it straight up with a quick motion. Activate the needle guard. Apply pressure swab at the injection site. • RATIONALE: Removing the needle with a quick motion is less painful than removing it slowly. Enclosing the needle in the guard prevents needle sticks. Pressure helps prevent the medicine from leaking back up the needle track.

7. Administering an IM Injection • ACTION: Massage the injection site with a gentle, firm circular motion, if not contraindicated. Apply an adhesive bandage if there is superficial bleeding. • RATIONALE: Massage increases the circulation and helps to disperse the medication so that it is absorbed more quickly. Blood should be contained; apply an adhesive bandage as needed. • Dispose of syringe, remove gloves, and perform hand hygiene. • Determine how the patient tolerated the injection.   • Document the dose and site of injection.

9. IM Injection Sites for Children The vastus lateralis site is the preferred site of injection in children and infants and may be used for adults. The area extends from the anterior lateral aspect of the thigh to the midlateral thigh, and hands width below the proximal end of the greater trochanter and a hands width above the upper knee. The middle third of the muscle is the best site for injection. The maximum amount of medication injected into the vastus lateralisin the infant is 0.5ml, in the toddler 1ml and in the school age/adolescent is 2ml.

10. IM Injections for Children Cont. The area for the deltoid muscle injection is triangular, with the base of the triangle beginning about 2 finger breadths below the lower edge of the acromion process and extending down to just about the axilla fold. The deltoid injection site is used in children 13 months of age and older if the muscle mass is well-developed. The maximum amount of medication injected into the deltoid muscle is 1mL for the school age child.

12. Adult Intramuscular (IM) Injection Guidelines

13. Intramuscular Injections Given Improperly

14. Intramuscular Injections Given Improperly

15. Intramuscular Injections Given Improperly

16. Intramuscular Injections Given Improperly

17. Intramuscular Injections Given Improperly

18. Intramuscular Injection In-Service Presentation Created by: 2013 Practical Nursing Students Tyler Clavet, LPN Katie French, LPN Megan Prosser, LPN Angela Wash, LPN Instructor: Kim Ray, RN

19. Sources • Fundamental Concepts & Skills for Nursing 3rdEdition