1. Dr. Kamlesh R. LalaMBBS, D PED, FCGPNARANPURAAHMEDABAD1

2. HISTORYThe first injection was given in 1920,but became popular only after second world war.Now injections are probably the most commonpercutaneous procedure practiced worldwide2 3. MAGNITUDE An estimated 12 billion injections are administered each year. The average no of injections range from 0.9 to 8.5 per person per year. 3 4. DEFINITIONIntramuscular injections are a common yet complextechnique used to deliver medication deep into the largemuscles of the bodyIt may be for curative, diagnostic or recreational purpose 4 5. SURVEY An Indian survey found that 96% of all injections given by private doctors were of antibiotics, vitamins, analgesics and chloroquine. Surprisingly 70 to 95 % of such injections were unnecessary.5 6. WHY INJECTIONS ??? Injections are stronger medication Injections work faster and drug is more effective Patients non compliance Financial incentives If I wont give my colleague will give6 7. COMPLICATIONSGiving IM injection is not a benign procedure. It is with risk of disease, disability and even deathThe most common one is transmission of blood borne infections mainly Hepatitis B, Hepatitis C and HIVThese infections may be passed to HCW and even in societyDo you know how ???7 8. Others are Abscess Muscle or fat necrosis Muscle fibrosis and contracture Gangrene Nerve Injury8 9. WHAT IS SAFE INJECTION Does no harm to recipient Does not expose the HCW to any risk Does not result in waste that is dangerous for the community Do you know two third of injections given in our country are UNSAFE !! By reuse of syringe and needle9 10. Indications of injection 10 11. Severe and life threatening illness Inability to swallow Profuse vomiting Non availability of effective oral agent 11 12. So before giving any injection just ask yourself Is it necessary Is it justified And if YES then see that it is SAFE 12 13. GIVING IM INJECTION13 14. It can be discussed under following heads Site Selection Preparation of Injection Procedure Post Injection Care 14 15. Site Selection The most common injection site is anterolateral thighinto Vastus Lateralis muscle Never use gluteal muscle in children The other site in adult and in older children is deltoidmuscle 15 16. Anterolateral Thigh16 17. Deltoid17 18. Selecting Gluteus Muscle 18 19. REMEMBERFor giving vaccines including anti rabies vaccinenever selectgluteal muscle. They are ineffective if injected so.19 20. RISKS OF GLUTEUS INJECTION Injury to sciatic nerve If medication is in fatty tissue then it may result intonecrosis and abscess Chloroquine, Diclofenac and oily, viscous or depotinjections are always to be injected into gluteus muscle 20 21. PREPARATION OF INJECTION 21 22. Injection medication may be Available in prefilled syringe Available in liquid form Has to be reconstituted Either in single dose or multidose vial22 23. MULTIDOSE VIAL Where possible use single dose vial rather than a multidose one Never make multiple withdrawals from a single dose vialWhy ???23 24. Chances of infection are more common with MD vialBecause of Reuse of same syringe for filling medication Permanent insertion of needle into the vial Storage of reconstituted vial Opened vial kept submerged in water or ice Rubber stopper wiped with antiseptic Lack of proper hand hygiene24 25. EQUIPMENT SELECTION Use only new disposable syringe and needle every time Changing only the needle on the same syringe is alsonot safe Use wide bore needle rather than a narrow one For oily or viscous injection use 20 or 21 no. needle Use longer possible needle For gluteus injections always use 1 needle25 26. Skin preparation Avoid site with oozing dermatitis or infection If the skin is clean than no use of disinfection Clean the site with single use spirit or alcohol swab in acircular motion in an area 5-8 cms Pre wetted cotton swabs are better to be avoided If spirit is not available normal saline can be used Never use Savlon or Dettol Let the site be dry before injection 26 27. Preparing Syringe The area for preparing injection should be clean Clean your hands with alcohol based hand wash If you have cut or injury on fingers, cover it with waterproof adhesive No need to use gloves routinely27 28. Preparing syringe Remember to use new equipment Observe aseptic precautions No need to change the needle after withdrawing medication Do not ever wipe the needle with swab Do not keep the air bubble inside the syringe 28 29. Giving injection We have found giving injection necessary We have selected the site We have prepared the syringeSo now comes giving injection 29 30. Giving injection Make the patient comfortable and give him a properposition so as to identify the proper site for injection Properly hold the child Hold the syringe in your hand as if holding a pen Remove needle cap immediately before givinginjectionnot earlier 30 31. Giving injection Ensure smooth and steady insertion of the needle at90 degree with a dart technique No need to aspirate Slowly push the medication allowing muscle fiber tostretch and accommodate the injected volume Wait for a while and remove the needle in the samedirection as it was pushed Apply gentle pressure with a dry gauze31 32. Z technique32 33. Preventing Needle Stick Injury Anticipate abrupt movement of the patient and takecare More the used needle is handled or carried, the greateris the risk of sharp injury Never try to recap, bend or manually remove needlefrom syringe Do not move around with used equipment in hand Keep needle destroyer near by only Properly dispose it33 34. Multiple injections Some times multiple injections are to be given in asingle visit especially for vaccines Any no of injections can be given in a single visit Use different anatomical site If same limb is to be used than separate two injectionsby 1-234 35. Post Injection Syncope This is known side effect especially inadolescents. So it is better to observe the patientfor 10-15 minutes35 36. According to WHOUse injections only when necessary oralmedicines are effective in most cases.36