Intramuscular Injection -common sites, procedure, complications

Presented by Ganga Tiwari, Bsc. Nursing Fourth Year
TU, IOM,MNC, Kathmandu Nepal

1. INTRMUSCULAR INJECTION Presented by: Ganga Tiwari Bsc Nsg 4 th year, T eaching learning TU, IOM, MNC, Kathmandu Nepal

2. Introduction It is a form of parenteral administration of medication. Where a drug is injected into the deep muscle tissue, in the form of solution. Medication administered in IM injection usually is absorbed intermediately Muscle tissue having a large blood supply promotes quick absorption.

3. Contd.. Longer and heavier gauge (20 to 22) needle is required to reach deep muscle tissue. An obese patient requires 3 inch and a thin patient require ½ to 1 inch needle. Amount: Up to 3 ml of medication can be given by this route . Angle of injection is 72 to 90 degrees.

4. Common sites Ventro gluteal Vastus lateralis Rectus femoris Deltoid ventrogluteal

5. Ventrogluteal site

6. Vastus lateralis and rectus femoris .

7. Vastus lateralis Lacks major nerve and blood vessels. Rapid drug absorption. Preferred site for infants( less than 1 year) and children receiving immunization. Also used for adults.

8. Rectus femoris It is also the site of choice for infants and children. It can be used for adults.

9. D eltoid

10. Deltoid Easily accessible but muscles not well developed in most patient. Used for small amount of drugs( up to 1 ml) Not used for infants and children with underdeveloped muscle. Potential for injury to radial ulnar , brachial nerve and artery. Recommended side for site for hepatitis , tetanus and rabies vaccines.

11. Dorsogluteal site

12. Dorsogluteal site This site has been associated with significant injury. causing pain ,temporary and permanent paralysis . M ainly due to sciatic nerve injury. Also there is chance of subcutaneous tissue irritation.

13. Articles required Cardex Medication tray Kidney tray Medication ( ampule / vial/ prefilled syringe) ampule cutter or opener Sterile syringe and needle Disposable gloves Spirit swab Dry gauze piece or cotton.

14. Procedure Check the medication instructions, Identify the patient. Explain the procedure to the patient the purpose of medication, the site of injection, expected effects and how to co- operate. Wash hands Prepare the necessary articles prepare the necessary medication from vial or ampule) and bring the articles in the patient bed site.

15. Contd.. Maintain the privacy. Select the appropriate site by inspecting muscle size and integrity consider volume of medication to be injected. Position the patient according to the site selected (supine, lateral, prone, sitting depending upon the site). Locate the exact site for injection.

16. Contd.. Wear gloves. Clean the area around the injection site with a spirit swab. Allow antiseptic to dry. Confirm the medication and the dose is correct . Remove the needle without contaminating the needle by pulling it straight off.

17. Contd.. Ensure that medication is not dripping on the needle prior to injection. If it is dripping change the needle. Medication on outside the needle can cause pain and irritation of subcutaneous tissue when it passes into the muscle.

18. Contd.. Grasp and pinch the area surrounding the injection site or spread skin at the site as appropriate. Hold the dry cotton in between third and fourth finger. Hold on syringe between thumb and the fore finger in a pen holding manner and pierce skin at 90 degree angle and insert the needle.

19. Contd.. Aspirate by holding barrel steady with non-dominant hand and pulling back the plunger with the dominant hand. Aspiration helps in checking if the needle is in blood vessel. Withdraw needle if blood appears in the syringe, discard it and prepare new injection. Inject the medication slowly and steadily if blood does not appear in the syringe on aspiration

20. Contd.. Withdraw the needle slowly and steadily while supporting the hub of the syringe with non-dominant, Support the skin surface using cotton swab for applying counter traction at the site. Apply gentle pressure at the site with dry cotton. If bleeding is continue applying pressure till the bleeding stops.

21. Contd.. Discard the uncapped needle and syringe into the puncture proof container. And other soiled articles in the appropriate container. Remove gloves and wash hands. Document the medication. Assess effectiveness of medications

22. Z track method This method is used for intramuscular injection while administering medications which irritates the skin and subcutaneous tissue. It minimizes irritation as it seals the medication in muscle tissue.

23. Contd.. To use z- track method Apply a new needle to the syringe after preparing the medication so that no medication remains on the needle shaft. Then choose an IM site preferable in larger and deep muscle such as ventrogluteal muscle.

24. Contd.. Pull the overlying skin and the subcutaneous tissue approximately 2.5 to 3.5 (1 to 1 ½ inches) laterally to the side with the ulnar site of the non-dominant. Hold the skin in this position until you administer the injection.

25. Contd.. After preparing the site with antiseptic swab .Inject the needle deep into the muscle. Slowly inject the medication if no blood appears on aspiration. Keep the needle inserted for 10 seconds so the medication disperses evenly. This leaves the zig – zag path that seals the needle track. The medication can’t escape from the muscle tissue.

26. Z track method

27. Z track method

28. C omplications Fibrosis Nerve damage(mainly sciatic ,brachial, radial and ulnar nerve damage leading to the paralysis) Abscess Tissue necrosis Infection. Periostitis Injury to the blood vessels and bone Cellulitis. Allergic reaction Hemorrhage in case of bleeding disorders.

29. Fibrosis

30. Abscess

31. Allergic reaction

32. C ellulitis

33. Questions ???? 1.What is i ntramuscular injection? 2.What are the purposes of intramuscular injection? 3.What are the common sites for IM injection? 4.What are the articles required for IM injection? 5. What are the complications of IM injection?

34. References Basvanthappa,B.T .(2004). Fundamentals of Nursing. New Delhi : Jaypee Brothers. Perry, A.G. and Potter, P.A. (2007).Basic Nursing Essentials For Practice .(sixth edition): Mosby Giri , M. and Sharma,P . (2013). Essential Fundamental Of Nursing.(first edition).Kathmandu: Medhavi Publication .

35. References Pathak , S.and Devkota ,R.(2011).A Textbook Of Fundamentals of Nursing.(second edition). Kathmandu:Vidyarthi Prakashan . Taylor,C.R . and Lillis,C .(2008). Fundamental Of Nursing.(Volume1): Lipincott William and Willikins Health learning material center. Institute Of Medicine,Tribhuvan University.Fundamental Of Nursing (Second Edition ,reprint,2010).Kathmandu Dillibazar . Heidel Press. Skidmere,L .(2009).Nursing Drug Referance:Mosby

36. THANK YOU !!