im injection presentation slide ........

Intra muscular

1. ADMINISTRATION OF IM INJECTION

2. Define Intramuscular injection Enlist the indications& contraindications of IM injection Enumerate the sites of IM injection Discuss the technique in IM injection Explain the procedure in administering IM injection OBJECTIVE

3. A method of administering medications directly into muscle tissues. DEFINITION

4. INDICATIONS CONTRAINDICATIONS Administration and absorption of large doses (up to 5 ml) in appropriate sites Medications that irritate subcutaneous tissues Cannot locate an appropriate vein Drugs that are altered by digestive juices Un cooperative /cannot take medications orally Active infection near the injection site A known allergy or hypersensitivity to the material or to the lidocaine Acute myocardial infarction Shock Coagulation disorders

5. Areas to be avoided Inflamed Edematous Moles Birthmarks Scar tissues Other lesions

6. SITES Deltoid muscle Feel for the bone at the top of the upper arm ( Acromion process) . Two finger-widths below this, there is a inverted triangular muscle. The needle should enter the centre of triangle. The maximum amount of medication for a single injection is 1 ml.

7. SITES Vastus lateralis muscle of the thigh Commonly used for immunizations in children. This muscle is located on the anterior lateral aspect of the thigh and extends from one hand’s breadth above the knee to one hand’s breadth below the greater trochanter. The middle third of the muscle is used for injections. The maximum amount of medication for a single injection for adult is 3 ml and Children is 0.5ml to 1 ml

8. SITES Ventrogluteal muscle of the hip Locate the greater trochanter of the femur with the palm of the hand. Spread index and middle fingers posteriorly from the anterior superior iliac spine to the furthest area possible Position the index and middle fingers into a ‘V’ then administer in the middle of the V. The maximum amount of medication for a single injection for adult is 2.5 to 5 ml

9. The ventrogluteal site is free from blood vessels and nerves, and has the greatest thickness of muscle when compared to other sites Advantages of ventrogluteal site

10. SITES Dorsogluteal muscle of buttocks Due to the potential injury to the sciatic nerve this site is not recommended.

11. SITES Rectus femoris muscle in thigh Used occasionally for adult Self administration is possible May cause discomfort for some clients. This muscle is located on the anterior middle aspect of the thigh and extends from one hand’s breadth above the knee to one hand’s breadth below the greater trochanter . The maximum amount of medication for a single injection is 5 ml.

12. In an adult, the most commonly used needles are 1 or 1 ½ inch long and 18 to 25 Gauge thick . An aqueous solution : 20 to 25 gauge needle. Viscous or oil-based solutions :18 to 21 gauge needles. Children: 1 – 1 ¼ inch long and 22 to 25 Gauge thick Needle size Safety needles should be used for IM injections to reduce the risk of needle-stick injury

13. The Z-track method is a type of IM injection technique used to prevent tracking (leakage) of the medication into the subcutaneous tissue. Z-Track Injection Sites Thigh (vastus lateralis muscle) Hip (ventrogluteal) Technique

14. Purpose of Z-Track Injection It helps to prevent medication from seeping into the subcutaneous tissue and ensures a full dosage. Some medications are dark colored (iron preparation) and can cause staining on the skin. This technique is to prevent injection site discoloration or lesions.

15. Procedure Skin and tissue are pulled and held firmly while a long needle is inserted into the muscle. Pulling the skin and tissue before the injection causes the needle track to take the shape of the letter “Z,” This zigzag track line prevents medication from leaking from the muscle into surrounding tissue.

16. Create Z-track .  Keep the needle in place for about 10 seconds before taking it out. After removing the needle, release the hold on the skin and tissue. Apply pressure to the site .  Use gauze to apply gentle pressure to the site for a moment. Never massage the site . This may cause the medication to leak and irritate the skin.

17. Prescription sheet Tray containing: Prescribed medication Sterile syringe and needle Alcohol swabs Gauze /cotton balls Container for waste Sharp disposal box Small tray (to keep the prepared medication). EQUIPMENTS

18. 1.Confirm doctor’s prescription 2.Hand hygiene 3.Assemble equipments PROCEDURE

19. 4.Calculate drug dosage Inj.Rocephin (ceftriaxone) 1000 mg ( 1 gram) –powdered form Diluent – Lidocaine 1% ( 3.5ml) After reconstitution the volume is 4 ml Formula Dose ordered × Volume Dose available Eg . Dose ordered is 500 mg Dose Available is 1000 mg Volume is 4 ml 500mg × 4 ml = 2 ml 1000 mg PROCEDURE (CONTD…)

20. 5.Withdraw the drug From a vial: Expose and clean the rubber stopper of the vial with the alcohol swab Prepare the appropriate syringe and needle Dissolve and mix the drug ,if required Inject air equal to the amount of medication needed into the vial and withdraw the correct dosage of the drug. From ampoule : Ensure that the medicine in the lower part of an ampoule Prepare the appropriate syringe and needle File the ampoule, if necessary Break the neck of the ampoule protecting the fingers with gauze and withdraw the correct dosage. PROCEDURE (CONTD…)

21. Withdrawing medication from Vial 1 2 3 4 5 6

22. Withdrawing medication from Ampoule

23. 6. Expel air and change the needle. 7. Place the loaded syringe in the small tray with alcohol swab and cotton balls along with the prescription sheet and take to the patient. 8. Identify the patient and explain the procedure 9. Provide privacy 10.Position the patient comfortably on bed 11.Select and clean the site PROCEDURE (CONTD…)

24. 12. Taut (stretch) the skin as required 13. Insert the needle at 90 degree angle into the muscle 14. Withdraw the plunger. if no blood is aspirated, inject the medicine slowly ( if blood is aspirated, remove and change the needle then select another site) 15.Withdraw the needle quickly and apply pressure over the injected site using dry cotton ball. PROCEDURE (CONTD…)

25. 16.Make the patient comfortable 17.Observe and report any untoward reactions 18.Discard waste (sharp items in to the sharp disposal box) 19.Clean and replace reusable equipment 20.Wash and dry hands 21.Document necessary information PROCEDURE (CONTD…)

26. Complications Immediate Severe pain at the injection site Redness, swelling, or warmth at the injection site Prolonged bleeding Late Tissue necrosis, or tissue death Injury to blood vessels and nerves Tingling or numbness Sterile abscess Muscle atrophy, injury to bone, & cellulitis.