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”
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
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.
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.
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.
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. o Dispose of syringe, remove gloves, and perform hand hygiene. o Determine how the patient tolerated the injection. o Document the dose and site of injection.
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 lateralis in the infant is 0.5ml, in the toddler 1ml and in the school age/adolescent is 2ml.
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.
Injection Procedure : *Spread the skin taut, (except in the vastus lateralis which requires lifting the muscle) and inset the needle at a 90º angle, unless patient is emaciated then inject at a 45º angle. *Pull back the plunger slightly. If blood appears, remove the needle. Properly dispose of the needle and prepare for a new injection. *If blood is not present, then inject the medication at a slow, steady rate. 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 lateralis is 3mL. The area for the deltoid muscle injection is triangular, with the base of the triangle beginning about 2 finger breadths (2.5-5cm) below the lower edge of the acromion process and extending down to just about the axilla fold. The maximum amount of medication injected into the deltoid muscle is 1mL. The ventrogluteal site is the safest injection site. It involves the gluteus medius and minimus muscles. To locate the site of injection, place the palm over the greater trochanter, form a ‘V’ with the middle finger toward the iliac crest and the index finger toward the anterior superior iliac spine. Move your hand, and inject within the center of the ‘V,’ below the anterior superior iliac crest. The maximum amount of medication injected into the ventrogluteal muscle is 3mL. The rectus femoris belongs to the quadriceps muscle group. It is located on the anterior aspect of the thigh. This site is used in adults and when other sites are contraindicated. The rectus femoris site is used by clients that administer their own injections because it is easy to reach. The maximum amount of medication injected into the rectus femoris muscle is 3mL.