intramuscular injections topic 8. administering injections intramuscular – given deep into...
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Intramuscular injectionsIntramuscular injections
Topic 8 Topic 8
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Administering injectionsAdministering 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 injectionsAdministering 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 InjectionEquipment – IM Injection
What needle should I use for IM injections?21G or 23G
Green or blue hub
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Administering injectionsAdministering 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 injectionsAdministering 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 SitesIntramuscular Sites
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Deltoid MuscleDeltoid 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 injectionsAdministering injections
Intramuscular- The ventrogluteal muscle – avoids
major nerves & blood vessels- has consistent thickness - is the preferred injection site for adults &
children > 7 months of age
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Old MethodOld Method
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Current MethodCurrent Method
The ‘Double Cross’
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Underlying StructuresUnderlying Structures
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Administering injectionsAdministering injections The vastus lateralis muscle in the thigh
– is the preferred site for infants < 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 TechniqueThe 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 TechniqueThe Z-track Technique
Pull skintaut then
Insertneedle
Remove needle and release skin
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Administering injectionsAdministering injections Intramuscular
What equipment do you need?
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ProcedureProcedure
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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ProcedureProcedure
- 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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ProcedureProcedure
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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ProcedureProcedure
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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ProcedureProcedure
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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ProcedureProcedure
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…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 SITEVOLUME PER MUSCLE SITE
Ventrogluteal - Up to 4ml in a well Ventrogluteal - Up to 4ml in a well developed muscledeveloped muscle
Vastus lateralis - Up to 4ml in a well Vastus lateralis - Up to 4ml in a well developed muscledeveloped muscle
DeltoidDeltoid - Up to 1ml in a well - Up to 1ml in a well developed muscledeveloped muscle