Intramuscular injectionsIntramuscular injections

Topic 8 Topic 8

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

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

Equipment – IM InjectionEquipment – IM Injection

What needle should I use for IM injections?21G or 23G

Green or blue hub

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

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

Intramuscular SitesIntramuscular Sites

Deltoid MuscleDeltoid Muscle

The deltoid – should be used for infrequent injections (limited muscle mass)

Located 2-3 finger widths

below the acromion

process

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

Old MethodOld Method

Current MethodCurrent Method

The ‘Double Cross’ 

Underlying StructuresUnderlying Structures

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

Vastus lateralis muscle

‘Bunch up’ in elderly, emaciated or infants

Divide thigh into thirds

Inject into the middle third

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

The Z-track TechniqueThe Z-track Technique

Pull skintaut then

Insertneedle

Remove needle and release skin

Administering injectionsAdministering injections Intramuscular

What equipment do you need?

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

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

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

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.

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

ProcedureProcedure

Apply pressure to the site if bleeding but do not massage the site

Complete the standard protocol for ending the procedure

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

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