Intramuscular Injections

Rakesh Patidar Vice principal JCN, Bhandu,Mehsana, Gujarat

Goal:

-After giving this review session student/co-worker will be able to confidently administer an intramuscular injection, know sites used for injections, and demonstrate different techniques of giving an intramuscular injection. -Perform giving IM injections. -Demonstrate correct technique for giving IM injections. -Identify equipment used for giving IM injections. -Demonstrate and explain: Z track method and Air lock technique. -Demonstrate correct disposal of used needle. -Explain and be able to identify how the patient tolerated the IM injection.

-In this session learner will be educated in IM injections

-Where to give an IM injection. -Technique for giving IM injection -Demonstrate different method for giving an IM injection. -Equipment needed to perform an IM injection.

-Equipment needed to perform an IM injection

-Syringe 1-2 inches in length. -Medication to be administered. -Gloves -Band-Aid -Alcohol swab -Patient -Muscle where medication will be administered

-Choosing the site to administer medication-There are several different sites an IM injection can be given.Site determination -Stage of patients development. -Body build -Physical condition -Amount of the medication to be given

-Sites

Mid Deltoid- common site, upper arm, 3 fingers width. Dorsalgluteal- look out for sciatic nerve, given in the butt. Rectus femoris- right on top of the thigh. Ventrolgluteal- side of the butt, or on the hip. Vastis lateralis- outer thigh, in the middle.

How to find sites-

Mid Deltoid -Is on the upper arm. - Take 3 fingers and place them at the top of the shoulder. -At the end of the third finger in the middle of the muscle is where the injection can be made.

Dorsalgluteal

-Injection is in the butt. -Watch out for the sciatic nerve. -Have patient stand or lay face down with toes pointing inward. (relaxes muscle) -Divide the buttocks into 4 quadrants; give the injection in the outer, upper quadrant toward the hip. -DO NOT give to children who are not walking yet. (Muscles are not developed enough)

Ventrogluteal-Good for adults and small children. - Find the upper part of the hip. -Place palm on hip (greater trochater), with fingers point to the ground, and make a very large V with your pointer finger and middle finger. -In the middle of the V is where the injection can be done.

Rectus Femoris -On the anterior thigh, above the knee. -Used mostly by people who have to get themselves injections. -This is painful, because the muscles in the anterior thigh are tense when given.

Vastus Lateralis -Most preferred site. -Given to children under 5 years of age. - Patient should be sitting when this injection is to be given. -On the outer thigh about half way between the knee and the hip.

-Technique of Giving an Intramuscular Injection

-Check the 5 rights of medication administration. -Choose the site the IM injection. -Check the patient for any allergies. -Gather you supplies needed to perform IM injection. -Wash your hands. -Put on gloves. -Open alcohol swab and in a circular motion, clean area in a 2 inch diameter at the site of the intended IM injection. -Let fully dry.

Continued

-Pull skin around the clean site taut. - take needle in dominate hand between the thumb and the index finger. - At a 90 degree angle, plunge the needle into the skin in a dart like motion. -Depending on the site and the condition of the patient, determine how far the needle is going to have to go into the skin to be in the muscle. -Stabilize the needle with the non dominate hand. -Use dominate hand to pull back on the plunger and aspirate or blood. (If there is blood aspirated back into the needle, remove and dispose in a sharps container. start from the beginning.) -Push the medication at a slow and steady pace. Remember to hold the needle as steady as possible.

Continued..

To take the needle out, quickly pull up at a 90 degree angle. -Make sure to cover the needle immediately after withdrawing it from the skin. -Apply some pressure at the site with the alcohol swab that was used to clean the site. -Message the site to help disperse the medication that was just given. -Cover site with Band-Aid. -Dispose of needle into a sharps container. -Throw away gloves and wash hands. -Observe the patient for signs of any allergic reaction, N&V, or any other adverse reactions that may go along with the medication. - Always remember to document.

-Different Methods of Giving IM injections

-Just giving IM injection and massaging site- Z track - Air lock

Just giving IM injections and messaging site

-Just dose of medication given. -Message site after to help disperse medication in to the muscle.

Z track method-Used for medications that can cause irritation, can be used for all IM medications. -Pull skin at the site to the side. - Still give the injection at 90 degree angle. -When shin is let go and needle removed the needle track is cut off and the medication can not leak out. -This will decrease irritation and bruising of the skin.

Air lock Technique-Medication is drawn up. -0.2mL of air can be added to the medication. -This will ensure that all the medication has been pushed though the needle. - Still given at a 90 degree angle. -Make sure medication is given first and the air lock second. -Seals needle track so medication will not go into the subquncaneaus tissue, which can cause pain, soreness and bruising.

Review

-Always remember 5 rights of medication administration. -Right dose -Right patient -Right time -Right route -Right medication -Choosing an IM Injection site that works best for your patient. (Ex: Infants can not have injections in the dorsal gluteal (butt), In determining a site take into account the patients body build, try to avoid flabby tissue.) -Different techniques of giving an IM injection: Z track, Air lock.

Evaluation:

1.) Name the site that should not be used for children who are not walking yet?

Dorsal gluteal.

-Describe Z track method:

pulling skin to the side, then giving the shot, cutting off the needle track.

2.) How do you clean a site for injection?

Alcohol swab, 2inches around the site in diameter, let dry completely.

3.)How do you determine where to give a mid deltoid IM injection?

Upper arm, 3 fingers down from the top of the shoulder. In the middle of the arm. Use patients non dominate arm.