Intramuscular injections

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Intramuscular injections

• Topic 8

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Administering injections

• Intramuscular given deep into muscle tissue
• muscles are highly vascular rapid drug
  absorption, usually in 10 30 minutes (aqueous
  soln.)
• Risk of injecting into a blood vessel ... plunger
  of syringe is drawn back a little to see if any
  blood returns before injecting

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Administering injections

• Intramuscular
• usually a 21 23G needle is used
• Depth of injection depends on the amount of body
  fat to pass through the sc layer penetrate the
  muscle layer
• Needle should be inserted at a 900 angle to the
  skin
• Rotate sites to avoid hypertrophy

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Equipment IM Injection
What needle should I use for IM injections? 21G
or 23G Green or blue hub
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Administering injections

• Intramuscular
• muscle is less sensitive to irritating viscous
  drugs ... as much as 4ml can be administered into
  larger muscles
• Small children older infants should receive no
  more than 1ml IM

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Administering injections

• Intramuscular - 3 most common sites are
• The deltoid muscle in the arm
• The ventrogluteal in the buttocks
• The vastus lateralis in the thigh

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Intramuscular Sites
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Deltoid Muscle

• The deltoid should be used for infrequent
  injections (limited muscle mass)
• Located 2-3 finger widths
• below the acromion
• process

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Administering injections

• Intramuscular
• The ventrogluteal muscle avoids major nerves
  blood vessels
• has consistent thickness
• is the preferred injection site for adults
  children gt 7 months of age

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Old Method
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Current Method
The Double Cross 
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Underlying Structures
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Administering injections

• The vastus lateralis muscle in the thigh is the
  preferred site for infants lt 7 months of age
• is commonly used for adults
• Muscle is well developed thick
• Offers ease of access

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Vastus lateralis muscle
Bunch up in elderly, emaciated or
infants Divide thigh into thirds Inject into
the middle third
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The Z-track Technique

• Recommended for IM injections, particularly when
  the med. is irritating to the tissue e.g.
  iron-dextran complex
• Involves pulling the skin either downward or
  laterally before injection (creates a disjointed
  pathway locks med. into the muscle)
• Decreases leakage of med. minimises pain at the
  site

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The Z-track Technique
Pull skin taut then Insert needle
Remove needle and release skin
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Administering injections

• Intramuscular
• What equipment do you need?

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Procedure

• Perform the standard protocol for beginning the
  procedure
• Attach the drawing up needle to the syringe
• If using a vial swab top of vial with an
  alcohol wipe
• If using an ampoule gently tap to dislodge any
  med. above the neck of the glass

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Procedure

• snap open the ampoule may use a gauze square to
  protect fingers may need to use a file to snap
  open the ampoule
• Draw up the correct amount of medication
• Remove the needle dispose in sharps container
• Attach the administration needle

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Procedure

• Expel air any surplus med.
• Transport all equipment to the client using a
  kidney dish or suitable tray
• Select an appropriate site
• Cleanse the area with an alcohol swab allow to
  dry for 10 sec.
• Pull the skin sideways if using the Z-track
  technique

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Procedure

• Insert the needle quickly smoothly at a 900
  angle to skin (in very thin clients, inserting
  the needle at 450 may be more appropriate)
• Pull back on the plunger if no blood appears,
  inject the med. slowly.

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Procedure

• If blood appears withdraw the needle discard.
  Repeat the whole procedure
• Smoothly steadily withdraw the needle,
  releasing the skin
• Clean the site with an alcohol swab

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Procedure

• Apply pressure to the site if bleeding but do not
  massage the site
• Complete the standard protocol for ending the
  procedure

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Things to consider

• Observe client for any reaction to the medication
• Inspect the site for bruising, redness, or heat
• Prior to injecting, palpate the muscle for any
  tenderness or hardness avoid injecting into
  such an area

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VOLUME PER MUSCLE SITE

• Ventrogluteal - Up to 4ml in a well developed
  muscle
• Vastus lateralis - Up to 4ml in a well developed
  muscle
• Deltoid - Up to 1ml in a well developed muscle