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Intramuscular Injection

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Page 1: Intramuscular Injection

Intramuscular Injection

Page 2: Intramuscular Injection

Learning Objectives

Identifies the parts of a syringe and the needle gauge suggested for IM injection with 90% accuracy.

Given a certain patient situation, the students distinguish the appropriate site for the administration of medication.

Explains why the medication should be administered intramuscularly.

Follows the Z-track Technique for iron preparation Medications.

Reports to her Instructor any adverse reaction to the drug administered to the patient.

Volunteers himself in assisting Medical Mission organized by the school.

Administers IM injection properly by selecting the appropriate injection site and follows the 90° rule.

Page 3: Intramuscular Injection

Intramuscular Injection A method of administering medications parenterally

into the muscles with the use of syringe and a needle.

Suggested needle gauge: 22, 23, 25 Needle = 1 1/2

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Parts of a Syringe

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Purposes:

•To promote RAPID ABSORPTION of the drug

•To provide an ALTERNATE ROUTE when drug is irritating to subcutaneous tissues

•To provide a LESS PAINFUL ROUTE for parenteral medication

•When a LARGER AMOUNT is to be administered

•When an OIL Y PREPARATION is to be avoided of

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SITES OF IM INJECTION

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ANTEROLATERAL ASPECT OF THE THIGH- Vastus Lateralis

VENTROGLUTEAL SITE- Gluteus minimus

UPPER ARM- Deltoid

ANTERIOR ASPECT OF THIGH- Rectus femoris

DORSOGLUTEAL- Gluteus maximus

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Points to Remember:

The nurse should administer the maximum volume to inject on the basis of the site and the client's muscle development: 2.5-3 ml for a large muscle (gluteus medius) in a well-

developed adult 1-2 ml for less developed muscles in children, elderly

and thin clients 0.5-1 ml for the deltoid muscle

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Vastus Lateralis

The thigh is used often for children, especially children under 3. It is also a good place for an adult. The thigh area is especially useful if you need to give yourself a Intramuscular injection because it is easy to see.

Look at the thigh that will get the Intramuscular injection. In your mind, divide the thigh (the area between the knee and the hip) into three equal parts. The middle third is where the Intramuscular injection will go.

This muscle is called the vastus lateralis. It runs along the top of the thigh (the front) and a little to the outside. Put your thumb in the middle of the top of the thigh, and your fingers along the side. The muscle you feel between them is the vastus lateralis.

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Ventrogluteal site

The hip is an area with good bone landmarks and very little danger of hitting blood vessels or nerves. It is a good place for a Intramuscular injection for adults and children over 7 months old. The person getting the Intramuscular injection should be lying in his or her side.

To find the correct place to give a Intramuscular injection in the hip to another person: Place the heel of your hand on the hip bone at the top of the thigh. Your wrist will be in line with the person’s thigh. Point your thumb at the groin, fingers point to the person’s head. Form a “V” with your fingers by opening a space between your pointer finger and the other three fingers. Your little finger and ring finger will feel the edge of a bone along the fingertips. The place to give the Intramuscular injection is in the middle of the V-shaped triangle.

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Deltoid

The person getting the Intramuscular injection can be sitting, standing or lying down. Start with a completely exposed upper arm. You will give the Intramuscular injection in the center of an upside down triangle. Feel for the bone that goes across the top of the upper arm. This bone is called the acromion process. The bottom of it will form the base of the triangle. The point of the triangle is directly below the middle of the base at about the level of the armpit. The correct area to give a Intramuscular injection is in the center of the triangle, 1 to 2 inches (2.5 to 5 cm) below the bottom of the acromion process.

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Rectus Femoris

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Dorsogluteal site

The upper rear end area is the area where most people have gotten Intramuscular injections. Expose one entire cheek of the rear-end. With an alcohol wipe draw a line from the top of the crack between the cheeks to the side of the body. Starting in the middle of the same side, draw another line across the first one with the alcohol wipe. Start from about 3 inches above the first line to about half way down the middle of the cheek. You should have drawn a cross. In the upper outer square you will feel a curved bone. The Intramuscular injection will go in the upper outer square below the curved bone.

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Z-TRACK TECHNIQUE

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Z-track method of intramuscular injection is used to administer drug in a large muscle that prevents the leakage of the medication into the layers of subcutaneous tissues.

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Essential Procedures Identify the patient. Explain the procedure. Provide privacy by closing the doors and providing

drapes. Position the client in either his abdomen (prone) or his

side (lateral). ventrogluteal muscle Expose the gluteal muscle. Ventrogluteal muscle is

usually used. Prepare the site with an antiseptic swab. The principle of

this method is to start from the inner to the outer surface. Don gloves. Perform the Z-track technique.

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Preparation Verify doctor’s order on the patient’s chart. Hand washing. Use a proper needle. Rule of thumb in needle selection for

IM injection are as follows: 200 lb (90.7 kg) – 2” needle 100 lb (45 kg) – 1 1/4” to 1 ½” needle Aspirate the prescribed medication into the syringe. Draw

0.2-0.5 cc of air (depending on the hospital policy) to create an air lock. (Air-lock technique is used with this procedure.)

Replace the needle with a new one after preparing the drug so that no drug remains outside the needle shaft. This prevents tracking the drug into the subcutaneous tissue during injection.

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Place gloved fingers on the skin surface and pull the overlying skin and subcutaneous tissue approximately 2.5-3.5 cm (1 to 1 ½ inches) laterally to the side. (See Figure A)

Holding the skin taut with the nondominant hand, insert the needle at a 90 degree angle at the spot where the finger was initially placed before displacing the skin laterally. (See Figure B)

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Aspirate for blood return with the dominant hand only (practice of nurse makes this step easy). If there is no blood return on aspiration, inject the drug slowly, followed by the air. Air clears the clears the needle of the medication and prevents tracking of the medication through the subcutaneous layers upon needle withdrawal. (Air-lock technique)

Wait for 10 seconds before withdrawing the needle to allow the medication to disperse evenly.

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Slowly remove the needle.Release the skin taut. A zigzag needle track is

created (by sliding of the tissue planes across each other) preventing the escape of medication from the muscle tissue. (See Figure C

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