im administration of medications mgr.renata vytejčková Ústav ošetřovatelství 3.lf uk
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IM administration of medications
Mgr.Renata Vytejčková
Ústav ošetřovatelství 3.LF UK
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Intramuskular injections
Administering of a medication into a muscle
Volume 1 – 10 mlPurpose: therapeutic or prophylacticEffect within 10-15 min
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The advantages of IM administration
Faster absorption then s.c.Larger volume Appropriate for medications that irritate
subcutaneous tissue
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Places of administration
Musculus gluteus mediusMusculus gluteus maximusMusculus quadriceps femorisMusculus deltoideus
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Administration into gluteus medius
Middle finger palpates crista iliaca Thumb palpates spina iliaca anterior superior Thumb into position between trochanter major
and crista iliaca Insert needle into the space between thumb
and index finger, 60° appr. 5 cm deep Not appropriate in children below 3 years of
age and very thin patients The patient is lying on either side, the upper
leg bent in hip and knee, lower leg straight
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Administration into musculus gluteus medius
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Gluteus muscles
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Administration into musculus deltoideus
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Administration into the musculus deltoideus
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Administration into the gluteus maximus
Palpate crista iliaca, spina iliaca anterior superior a spina iliaca posterior superior
Make a vertical line between the two spinas The lateral (outer) space is the proper injection
site Use 90° angle The four quadrants methods is possible
alternative Patient is in prone position, toes turned inward
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Administration into the musculus gluteus maximus
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Administration into the musculus gluteus maximus
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Administration into the thigh muscle
The lateral (outer) middle third of the thigh
Place one hand just below the trochanter and the other just above the patella, the space between the thumbs can be used for administration
Supine position, lower extremity slightly flexed and relaxed
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Administration into the musculus vastus lateralis
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Administration into the thigh muscle
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The equipment
The order sheet Medication Sterile syringe Sterile needles (to
withdraw and administer)
Swabs Band aid
File Disinfection Emesis basin
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Needle selection
In thin patients use shorter needle (4-5cm)
In well developed muscles or obese patients use longer needle (5-6cm)
In case of oily substances or antibiotics use needle with large diameter
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The procedure
Inform the patient, ask him to position himself properly
Palpate the injection site Disinfect the skin Hold the syringe
perpendicularly, support the needle
Use the thumb and the index finger to taut the skin
Gently but quickly insert the needle between the two fingers 3-5 cm deep, use 90° angle
Use 60-70° angle in thin patients
Aspirate Slowly inject the medication If there is blood in the syringe
do not proceed and change the medication
Sometimes appropriate to aspirate again during the injection
Remove the needle quickly Cover the injection site with
band aid Document the procedure
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Z-track method
For medications that may irritate subcutaneous tissues
Leave a small bubble in the syringeSpread the skin laterally approximately
3cm away from the injection siteHold the skin taut until you remove the
needle
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Z-track method
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Medications injected i.m.
AnalgesicsAntibioticsPremedication in surgeryVaccines Other
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Complications
Infiltrate formationVein punctureHitting a bone Hitting a nerveAbscess formation
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Infiltrate formation
In absence of site rotation Formation of granulation tissue Medication easily absorbed into vascular
bed MikroembolizationPrevention – site rotation
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Vein puncture
Blood in the syringeInterrupt the procedureTake a new needle and select another
injection site Risk of embolism
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Hitting a nerve
Most often the nervus ischiadicusThe cause – improper selection of
injection site (too low, too close to the middle)
Burning, tingling, pain radiating into the leg
Risk of paralysis
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Abscess formation
In case of oil substances Administration into fat tissue or not deep
enough into the muscleShort needle, inappropriate injection site
selectionRedness, pain, massSometimes elevated temperature
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Hitting the bone
Often in very thin patientsThe needle can bend, little hook at the
tip of the needle will tear the tissues The needle can break, remain in the
tissueX-ray control, surgical removal
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Děkuji za pozornost