INTRAMUSCULAR INJECTION

IM injection introduction of larger amounts of drugs (as much as 3 mL) into muscles, using needle & syringe. Therapeutic Uses: [5] IM Route preferred over Oral Route when: 1. Client > wont/cant swallow a drug 2. Client > vomiting/having gastric suction 3. Drug Action > hampered/destroyed by GI secretions 4. Drug Action > Quicker action needed compared to Oral route 5. Drug > irritating to GIT [B] IM Route preferred over SQ Route when: 1. Substance > irritating to SQ tissues 2. Drug Action > more rapid action desired 3. Amt. Of Drug (to be injected) > is more than what SQ tissues can absorb 12 Equipment/Supplies common for 3 types of Injection: 2C3D HK 2M NSS Cotton Balls Disposable soaked in 70 % alcohol dry Gloves Container for sharps Container for glass (ampules/vials) Hypodermic Tray w/ Sterile Towel Kidney Basin Medication Needle Solvent Syringe Needles Age Adults Children Infants lined w/ waste receptacle in ampule/vial Card size depending on route for medication in powder form 2.5 or 3 mL depending on amt of drug 5 Considerations for IM Site Selection: 1. (-) Infection/necrosis? 2. (-) Bruising/abrasions? 3. Location of underlying anatomical structures 4. Volume of med to be administered? 5. Advantages & Disadvantages of Site Selected? INTRAMUSCULAR INJECTIONS ADVANTAGE Provides faster med absorption b/c of greater vascularity of muscle Less danger of causing tissue damage when entering deep muscle Muscle is less sensitive to irritating & viscous meds 3 mL injected into larger muscle tolerable w/o severe muscle discomfort DISADVANTAGE Risk of accidental injection into blood vessels

4 Considerations for IM Injection: 1. Needle - Use longer & heavier gauge to pass thru SQ tissue & penetrate deep muscle tissue 2. Fat/Obese Clients may require 3 in long needle 3. Thin Clients - may require only - 1 in long needle 4. Small Children & Infants - Give max of 1 mL only Assessment before IM injection: 1. (-) Masses? 2. (-) Swelling? 3. (-) Tenderness? 4. (-) Hardened Lesions? 5. (-) Edema?

Length (in) 1 1 -1 3/8

Gauge 19 23 25 27

3 things Nurse should know before injecting a medication: 1. Volume to administer 2. Characteristics & Viscosity of medication 3. Location of anatomical structures underlying injection sites 4 negative consequences of incorrect injection administration: MISTAKES RESULT 1. Incorrect Site Nerve/Bone damage during needle insertion 2. Trembling Hand Pain & Tissue Damage 3. Failure to aspirate Accidental injection of syringe before injecting air into artery or vein 4. Too large volume for Extreme Pain & Tissue site selected Damage

7 ways in w/c Nurse may minimize clients discomfort: 1. Choice of Needle Use sharp-beveled & in smallest suitable length & gauge 2. Positioning Client most comfortable to reduce muscular tension 3. Injection Site correct selection using anatomical landmarks 4. Conversation diverts clients attention 5. Inserting Action quickly & smoothly to minimize tissue pulling 6. Holding Syringe steady while needle remains in tissues 7. Injecting slowly & steadily ANGLES OF INJECTION

4 Usual IM Injection Sites: QVDD 1. Quadriceps a. rectus femoris b. vastus lateralis 2. Ventrogluteal a. gluteus medius b. gluteus minimus 3. Dorsogluteal 4. Deltoid

VENTROGLUTEAL MUSCLE Safe for all clients > situated deep & away from major nerves & blood vessels Preferred site for adults & anyone over 7 months old Injuries associated w/ all the common IM sites except ventrogluteal: 1. Fibrosis 2. Nerve damage 3. Abscess 4. Tissue necrosis 5. Muscle contraction 6. Gangrene 7. Pain

Route of Injection IM SQ ID

Angle of Insertion 90 0 45 0 15 0

INTRAMUSCULAR INJECTION
LOCATING VENTROGLUTEAL MUSCLE LOCATING THE DELTOID MUSCLE

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Place heel of hand over greater trochanter of clients hip w/ wrist perpendicular to femur. Right Hand used for left hip Left Hand used for right hip Point thumb toward clients groin Point fingers toward clients head Point index finger to the anterosuperior iliac spine Extend middle finger (back along iliac crest) toward the buttock Index finger, Middle finger & Iliac crest form a V-shaped triangle Center of Triangle is Injection site Client Position > lying on his/her side Client > Flex knee & hip to relax ventrogluteal muscle

1. 2. 3.

Expose clients upper arm & shoulder fully Relax arm at the side or Flex elbow 3 Positions: a. Sitting b. Standing c. Lying down 4. 2 Procedures: PROCEDURE # 1: a. Nurse palpates lower edge of Acromion process b. Acromion process - forms the base of a triangle in line w/ midpoint of the lateral aspect of upper arm. c. Injection site - center of triangle; about 1 2 inches below the Acromion process PROCEDURE # 2: a. Place 4 fingers across Deltoid muscle b. Place top finger along the Acromion process c. Injection site 3 fingerwidths below Acromion process

VASTUS LATERALIS MUSCLE

Thick, well developed Located on anterior lateral aspect of thigh Width of Muscle: extends from midline of thigh to midline of thighs outer side In Adults: 1. Extends from a handbreadth above the knee 2. Extends to a handbreadth below the greater trochanter of the femur Suggested Site for Injection > Middle 3rd of muscle In Young Children or Cachectic Clients: grasp body of muscle during injection to be sure that medication is deposited in muscle tissue To relax muscle, ask client to: 1. Lie flat w/ knee slightly flexed or 2. Sitting position

SPECIAL IM INJECTION TECHNIQUES 1. Air-Lock technique 2. Z-Track Method AIR-LOCK TECHNIQUE Less irritating to SQ tissues during needle withdrawal Small volume of air injected behind bolus of medication Air clears needle of medication Prevents tracking of medication thru SQ tissues Recommended for such medications as: Interferon Wyeths vaccines prepared w/ aluminum adjuvant Vaccines such as: a. Diptheria b. Tetanus toxoid c. Pertussis PROCEDURE FOR AIR-LOCK TECHNIQUE

1. 2. 3.

DORSOGLUTEAL MUSCLE ADVANTAGE Traditional IM injection site DISADVANTAGE Risk of striking underlying sciatic nerve = permanent or partial paralysis of involved leg Risk of striking underlying major blood vessels Difficult to locate > clients w/ flabby, sagging tissues Site not recommended by Potter & Perry

DELTOID MUSCLE Easily accessible Muscle is not well developed in many adults Risk > radial & ulnar nerves & brachial artery lie w/in the upper arm along the humerus Should be used only for: small medication volumes When other sites are inaccessible b/c of dressings or casts

1. 2. 3.

Prepare proper dose Nurse draws up 0.2 mL of air Inject needle downward at angle of 90 0 so air rises to top of med toward the plunger.

INTRAMUSCULAR INJECTION
4. As nurse injects into muscle, air follows med creating an air lock Risks of Injection Angle less than 90 0: 1. Air collects along barrel of syringe & enters muscle too soon. 2. Medication can then easily leak back into SQ tissues. Z-TRACK METHOD

Used to minimize irritation by sealing med in muscle tissue Nurse selects IM site, preferably in larger deeper muscles (e.g. ventrogluteal) New needle must be applied to syringe after preparing the med so that no soln remains on the outside needle shaft PROCEDURE FOR Z-TRACK METHOD Prepare site w/ antiseptic swab Pull overlying skin & SQ tissues approx 1 1 inches laterally to the side Hold skin taut w/ non-dominant hand Inject needle deep into muscle Practice holding syringe & aspirating w/ one hand No blood return on aspiration? Then inject med slowly Needle remains inserted for 10 seconds to allow med to disperse evenly Release skin after withdrawing needle Leaves a zigzag path that seals needle track where tissue planes slide across each other Medication cannot escape from the muscle tissue