Administration of intramuscular injection.pptx

intramuscular

1. Administering an Intramuscular Injection Presented By Mrs.Usha Rani Kandula , MSc(N), Assistant professor in Adult health nursing, Department of Clinical nursing, Arsi University, College of health sciences, Asella , Ethiopia, Institutional email: [email protected].

2. Intramuscular Injection -Intramuscular (IM) injections are used to promote rapid drug absorption and to provide an alternate route when the drug is irritating to subcutaneous tissue . -The IM route enhances the absorption rate because there are more blood vessels in the muscles than in subcutaneous tissue ; - however , the absorption rate may be affected by the client’s circulatory status . -The medication volume and appropriate size of the syringe and needle for administering an IM injection to a particular site.

3. -4 ml for a large muscle (gluteus medius ) in a well developed adult. - 1 to 2 ml for less developed muscles in children, elderly, and thin clients. -0.5 to 1.0 ml for the deltoid muscle. -When more than 4 ml is ordered, the medication can be divided into two different sites . -There are four common sites for administrating IM injections (see the accompanying display). - Injection sites are identified by using appropriate anatomic landmarks .

4. -The primary site for administering an IM injection in clients over 7 months old is the ventro gluteal ( VG) site . - The gluteus medius is a well-developed muscle, free of major nerves and large blood vessels. - Research shows that injuries—including fibrosis, nerve damage, abscess , tissue necrosis, muscle contraction, gangrene, and pain—have been associated with all the common sites ( dorso gluteal , deltoid, and vastus lateralis , for example) except the VG site.

5. -The nurse should avoid using the deltoid and dorso -gluteal sites in infants and children. - There is a risk of striking the sciatic nerve when using the dorso -gluteal site . -The deltoid muscle is not well developed in infants and children.

6. -The nurse will need to decide on the gauge and length of the needle on the basis of the consistency of the solution, the site, and how far the needle must be injected to reach the muscle. - A 21- to 23-gauge needle will accommodate the consistency of most drugs and will minimize tissue injury and subcutaneous leakage . The needle’s length is determined by the site: • 1 1/2-inch needle, VG site for average-sized adults • 1-inch needle, VG site for children • 1-inch needle, deltoid or vastus lateralis

7. -An obese client usually requires a 2-inch needle to ensure that the needle will reach a large muscle such as the gluteal muscle . -The nurse should administer an IM injection at a 90° angle .

8. Z-Track Injection - The Z-track (zigzag) technique refers to a method used in administering IM injections . -This technique was traditionally used when administering imferon , an iron preparation, which can cause permanent discoloration in the subcutaneous tissue. -Today, the technique is used commonly when administering ventrogluteal and dorsogluteal injections.

9. Equipment Medication administration report (MAR) Sterile 3-ml syringe and long bevel, 20 to 22 gauge, 1- to 2-inch needle (average-sized, adult client receiving a drug in an aqueous solution) Medication as prescribed Alcohol swab Nonsterile gloves Sterile 2 × 2 gauze pad

10. Sl.No Action Rationale 1 Check with client and the chart for any known allergies. Prevents the occurrence of hypersensitivity reactions. 2 Wash hands. Reduces the transmission of microorganisms. 3 Follow the five rights. Promotes client safety. 4 Prepare the medication from an ampule or vial; refer to Procedure 29-2 or 29-3 as appropriate. Add 0.1 to 0.2 ml of air to the syringe. Ensures that all the medication is expelled from the needle’s shaft. Take medication to the client’s room and place on a clean surface.

11. Sl.No Action Rationale 5 Check the client’s identification armband. Accurately identifies the client. 6 Explain the procedure to the client; provide for privacy. Reduces the client’s anxiety and enhances cooperation. 7 Place the client in an appropriate position to expose the site. Provides access to the site, promotes relaxation of muscles, and decreases the discomfort from the injection. Deltoid: sitting position.

12. Sl.No Action Rationale Ventrogluteal : Side-lying: flex the knee, pivot the leg forward from the hip about 20° so it can rest on the bed. Supine: flex the knee on the injection side. Prone: point toes inward toward each other to internally rotate the femur. 8 Don nonsterile gloves. Decreases contact with blood and body fluids.

13. Sl.No Action Rationale 9 Select and clean the site. Avoids potential problems that may decrease the rate of the drug’s absorption. Assess the client’s skin for redness, scarring, breaks in the skin, and palpate for lumps or nodules. Select site using the anatomic landmarks. Avoids tissue containing large nerves and blood vessels. Cleanse the area with an alcohol swab, cleanse from inside outward using friction; wait 30 seconds to allow to dry. Removes the surface microorganisms and prevents the introduction of alcohol into subcutaneous tissue to avoid irritation. 10 Prepare for the injection.

14. Sl.No Action Rationale Remove the needle cap by pulling it straight off, and expel any air bubbles from the syringe. Maintains the sterility of the needle; ensures the correct dosage in the syringe. Pull the skin down or to one side (Z-track technique) with nondominant hand. Decreases the risk of medication’s leaking into needle track and the subcutaneous tissue; reduces complications and discomfort. 11 Administer the injection. Ensures that the needle is injected into the muscle. Ventrogluteal : quickly insert the needle using a dartlike motion and steady pressure at a 90° angle to the iliac crest in the middle of the V (Figure 29-24).

15. Sl.No Action Rationale Aspirate by pulling back on the plunger, and observe for blood. If blood appears, remove the needle and discard. If blood does not appear, inject the medication slowly, about 10 sec/ml. Promotes comfort and allows time for the tissues to expand and begin absorbing the medication. Wait 10 seconds after the medication has been injected, then smoothly withdraw the needle at the same angle of insertion. Allows the medication to diffuse through the muscle. Apply gentle pressure at the site with a dry, sterile 2 × 2 gauze; do not massage the injection site. Swab using gentle pressure. Decreases tissue irritation.

16. Sl.No Action Rationale Discard the needle and syringe in a sharps container; do not recap the needle. Prevents needlesticks . 12 Position client for comfort ; encourage client receiving ventrogluteal injections to perform leg exercises (flexion and extension). Promotes the absorption of the medication. 13 Remove gloves, wash hands. Prevents transmission of microorganisms. 14 Record on the MAR the dosage, route, site, and time. Provides documentation that the medication was administered. 15 Inspect the injection site within 2 to 4 hours and evaluate the client’s response to the medication. Alerts the nurse to hypersensitivity reactions; the peak plasma level is dependent on the drug’s half-life.

17. Thanking you