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Purpose
Intramuscular injection is used for the delivery of certain drugs not recommended for other routes of administration, for instance intravenous, oral, or subcutaneous. The intramuscular route offers a faster rate of absorption than the subcutaneous route, and muscle tissue can often hold a larger volume of fluid without discomfort. In contrast, medication injected into muscle tissues is absorbed less rapidly and takes effect more slowly that medication that is injected intravenously. This is favorable for some medications.
Description
Intramuscular (IM) injections are given directly into the central area of selected muscles. There are a number of sites on the human body that are suitable for IM injections; however, there are three sites that are most commonly used in this procedure.
Deltoid muscle
The deltoid muscle located laterally on the upper arm can be used for intramuscular injections. Originating from the Acromion process of the scapula and inserting approximately one-third of the way down the humerus, the deltoid muscle can be used readily for IM injections if there is sufficient muscle mass to justify use of this site. The deltoid's close proximity to the radial nerve and radial artery means that careful consideration and palpation of the muscle is required to find a safe site for penetration of the needle. There are various methods for defining the boundaries of this muscle.
Vastus lateralis muscle
The vastus lateralis muscle forms part of the quadriceps muscle group of the upper leg and can be found on the anteriolateral aspect of the thigh. This muscle is more commonly used as the site for IM injections as it is generally thick and well formed in individuals of all ages and is not located close to any major arteries or nerves. It is also readily accessed. The middle third of the muscle is used to define the injection site. This third can be determined by visually dividing the length of the muscle that originates on the greater trochanter of the femur and inserts on the upper border of the patella and tibial tuberosity through the patella ligament into thirds. Palpation of the muscle is required to determine if sufficient body and mass is present to undertake the procedure.
Gluteus medius muscle
The gluteus medius muscle, which is also known as the ventrogluteal site, is the third commonly used site for IM injections. The correct area for injection can be determined in the following manner. Place the heel of the hand of the greater trochanter of the femur with fingers pointing towards the patient's head. The left hand is used for the right hip and vice versa. While keeping the palm of the hand over the greater trochanter and placing the index finger on the anterior superior iliac spine, stretch the middle finger dorsally palpating for the iliac crest and then press lightly below this point. The triangle formed by the iliac crest, the third finger and index finger forms the area suitable for intramuscular injection.
Determining which site is most appropriate will depend upon the muscle density at each site, the type and nature of medication you wish to administer, and of course the preferred site for injections.
Preparation
Before administering medication, verify the medication order for accuracy and prepare the medication from the vial or ampule.
* First, assist the patient into a position which is comfortable and practical for access to the injection site you have chosen.
* Locate the correct area for injection using the above guidelines or those taught during medical training. Clean the site with an alcohol swab or other cleansing agent.
* Wipe the top of the vial with an alcohol swab before the needle enters.
* Prepare the syringe by removing the needle cover, draw in the same volume of air as you plan to inject, then inject the air into the vial and draw your medication into the syringe.
* Safely change your drawing needle for your fresh injecting needle.
* Invert the syringe, and expel any excess air. Approximately 0.1?€“0.2 ml of air should be left in the syringe so that the air in the top of the syringe chamber, when the syringe and needle are pointing down, forces the entire amount of medication to be delivered. This also prevents medication residue from being left in the needle, where it can leak into the subcutaneous and dermal layers when the syringe and needle are removed from the muscle.
* When ready to inject, spread the skin using the fingers of the non-dominant hand. Holding the syringe with the thumb and forefinger of the dominant hand, pierce the skin and enter the muscle. This process should be done quickly with sufficient control so as to lessen the discomfort of the patient.
* Aspirate at the injection site (while syringe and needle are within the muscle) by holding the barrel of the syringe with the non-dominant hand and pulling back on the syringe plunger with the dominant hand. If blood appears in the syringe, it is an indication that a blood vessel may have been punctured. The needle and syringe should be immediately withdrawn and a new injection prepared. If no blood is aspirated, continue by slowly injecting the medication at a constant rate until all medication has been delivered.
* Withdraw the needle and syringe quickly to minimize discomfort. The site may be briefly massaged, depending on the medication given. Some medication manufacturers advise against massaging the site after injection, as it reduces the effect and intention of the medication by dispersing it too readily or over too large an area. Manufacturers' recommendations should be checked.
* Discard the used syringe and needle intact as soon as possible in an appropriate disposal receptacle.
* Check the site at least once more a short time after the injection to ensure that no bleeding, swelling or any other signs of reaction to the medication are present. Monitor the patient for other signs of side effects, especially if it is the first time the patient is receiving the medication.
Aftercare
Monitor for signs of localized redness, swelling, bleeding, or inflammation at injection site. Observe the patient for at least 15 minutes following the injection for signs of reaction to the drug.
Complications
Most complications of intramuscular injections are a result of the drug injected and not the procedure. However, it is possible that localized trauma of the injection site may result as part of the process. Minor discomfort and pain is common for a short period following the injection, but usually resolves within a few hours.
Sources:
Intramuscular Injection: Encyclopedia of Nursing & Allied Health
http://www.spotinjections.com
Injections 101
How to do your 1st injection
Intramuscular injection is used for the delivery of certain drugs not recommended for other routes of administration, for instance intravenous, oral, or subcutaneous. The intramuscular route offers a faster rate of absorption than the subcutaneous route, and muscle tissue can often hold a larger volume of fluid without discomfort. In contrast, medication injected into muscle tissues is absorbed less rapidly and takes effect more slowly that medication that is injected intravenously. This is favorable for some medications.
Description
Intramuscular (IM) injections are given directly into the central area of selected muscles. There are a number of sites on the human body that are suitable for IM injections; however, there are three sites that are most commonly used in this procedure.
Deltoid muscle
The deltoid muscle located laterally on the upper arm can be used for intramuscular injections. Originating from the Acromion process of the scapula and inserting approximately one-third of the way down the humerus, the deltoid muscle can be used readily for IM injections if there is sufficient muscle mass to justify use of this site. The deltoid's close proximity to the radial nerve and radial artery means that careful consideration and palpation of the muscle is required to find a safe site for penetration of the needle. There are various methods for defining the boundaries of this muscle.
Vastus lateralis muscle
The vastus lateralis muscle forms part of the quadriceps muscle group of the upper leg and can be found on the anteriolateral aspect of the thigh. This muscle is more commonly used as the site for IM injections as it is generally thick and well formed in individuals of all ages and is not located close to any major arteries or nerves. It is also readily accessed. The middle third of the muscle is used to define the injection site. This third can be determined by visually dividing the length of the muscle that originates on the greater trochanter of the femur and inserts on the upper border of the patella and tibial tuberosity through the patella ligament into thirds. Palpation of the muscle is required to determine if sufficient body and mass is present to undertake the procedure.
Gluteus medius muscle
The gluteus medius muscle, which is also known as the ventrogluteal site, is the third commonly used site for IM injections. The correct area for injection can be determined in the following manner. Place the heel of the hand of the greater trochanter of the femur with fingers pointing towards the patient's head. The left hand is used for the right hip and vice versa. While keeping the palm of the hand over the greater trochanter and placing the index finger on the anterior superior iliac spine, stretch the middle finger dorsally palpating for the iliac crest and then press lightly below this point. The triangle formed by the iliac crest, the third finger and index finger forms the area suitable for intramuscular injection.
Determining which site is most appropriate will depend upon the muscle density at each site, the type and nature of medication you wish to administer, and of course the preferred site for injections.
Preparation
Before administering medication, verify the medication order for accuracy and prepare the medication from the vial or ampule.
* First, assist the patient into a position which is comfortable and practical for access to the injection site you have chosen.
* Locate the correct area for injection using the above guidelines or those taught during medical training. Clean the site with an alcohol swab or other cleansing agent.
* Wipe the top of the vial with an alcohol swab before the needle enters.
* Prepare the syringe by removing the needle cover, draw in the same volume of air as you plan to inject, then inject the air into the vial and draw your medication into the syringe.
* Safely change your drawing needle for your fresh injecting needle.
* Invert the syringe, and expel any excess air. Approximately 0.1?€“0.2 ml of air should be left in the syringe so that the air in the top of the syringe chamber, when the syringe and needle are pointing down, forces the entire amount of medication to be delivered. This also prevents medication residue from being left in the needle, where it can leak into the subcutaneous and dermal layers when the syringe and needle are removed from the muscle.
* When ready to inject, spread the skin using the fingers of the non-dominant hand. Holding the syringe with the thumb and forefinger of the dominant hand, pierce the skin and enter the muscle. This process should be done quickly with sufficient control so as to lessen the discomfort of the patient.
* Aspirate at the injection site (while syringe and needle are within the muscle) by holding the barrel of the syringe with the non-dominant hand and pulling back on the syringe plunger with the dominant hand. If blood appears in the syringe, it is an indication that a blood vessel may have been punctured. The needle and syringe should be immediately withdrawn and a new injection prepared. If no blood is aspirated, continue by slowly injecting the medication at a constant rate until all medication has been delivered.
* Withdraw the needle and syringe quickly to minimize discomfort. The site may be briefly massaged, depending on the medication given. Some medication manufacturers advise against massaging the site after injection, as it reduces the effect and intention of the medication by dispersing it too readily or over too large an area. Manufacturers' recommendations should be checked.
* Discard the used syringe and needle intact as soon as possible in an appropriate disposal receptacle.
* Check the site at least once more a short time after the injection to ensure that no bleeding, swelling or any other signs of reaction to the medication are present. Monitor the patient for other signs of side effects, especially if it is the first time the patient is receiving the medication.
Aftercare
Monitor for signs of localized redness, swelling, bleeding, or inflammation at injection site. Observe the patient for at least 15 minutes following the injection for signs of reaction to the drug.
Complications
Most complications of intramuscular injections are a result of the drug injected and not the procedure. However, it is possible that localized trauma of the injection site may result as part of the process. Minor discomfort and pain is common for a short period following the injection, but usually resolves within a few hours.
Sources:
Intramuscular Injection: Encyclopedia of Nursing & Allied Health
http://www.spotinjections.com
Injections 101
How to do your 1st injection
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