Administering Intramuscular Injection

Definition An intramuscular injection is an injection given directly into the central area of a specific muscle. In this way, the blood vessels supplying that muscle distribute the injected medication via the cardiovascular system. Purpose Intramuscular injection is used for the delivery of certain drugs not recommended for other routes of administration, for instance intravenous, oral, or subcutaneous. The intramuscular route offers a faster rate of absorption than the subcutaneous route, and muscle tissue can often hold a larger volume of fluid without discomfort. In contrast, medication injected into muscle tissues is absorbed less rapidly and takes effect more slowly that medication that is injected intravenously. This is favorable for some medications. Precautions Careful consideration in deciding which injectable route is to be used for the prescribed medication is essential. The intramuscular route should not be used in cases where muscle size and condition is not adequate to support sufficient uptake of the drug. Intramuscular injection should be avoided if other routes of administration, especially oral, can be used to provide a comparable level of absorption and effect in any given individual's situation and condition. Intramuscular injections should not be given at a site where there is any indication of pain. Description Intramuscular (IM) injections are given directly into the central area of selected muscles. There are a number of sites on the human body that are suitable for IM injections; however, there are three sites that are most commonly used in this procedure. Deltoid muscle The deltoid muscle located laterally on the upper arm can be used for intramuscular injections. Originating from the Acromion process of the scapula and inserting approximately one-third of the way down the humerus, the deltoid muscle can be used readily for IM injections if there is sufficient muscle mass to justify use of this site. The deltoid's close proximity to the radial nerve and radial artery means that careful consideration and palpation of the muscle is required to find a safe site for penetration of the needle. There are various methods for defining the boundaries of this muscle. Vastus lateralis muscle The vastus lateralis muscle forms part of the quadriceps muscle group of the upper leg and can be found on the anteriolateral aspect of the thigh. This muscle is more commonly used as the site for IM injections as it is generally thick and well formed in individuals of all ages and is not located close to any major arteries or nerves. It is also readily accessed. The middle third of the muscle is used to define the injection site. This third can be determined by visually dividing the length of the muscle that originates on the greater trochanter of the femur and inserts on the upper border of the patella and tibial tuberosity through the patella ligament into thirds. Palpation of the muscle is required to determine if sufficient body and mass is present to undertake the procedure. Gluteus medius muscle The gluteus medius muscle, which is also known as the ventrogluteal site, is the third commonly used site for IM injections. The correct area for injection can be determined in the following manner. Place the heel of the hand of the greater trochanter of the femur with fingers pointing towards the patient's head. The left hand is used for the right hip and vice versa. While keeping the palm of the hand over the greater trochanter and placing the index finger on the anterior superior iliac spine, stretch the middle finger dorsally palpating for the iliac crest and then press lightly below this point. The

triangle formed by the iliac crest, the third finger and index finger forms the area suitable for intramuscular injection. Determining which site is most appropriate will depend upon the patient's muscle density at each site, the type and nature of medication you wish to administer, and of course the patient's preferred site for injections. Equipment needed Drawing up needle Injecting needle (size: 23g, 1 or 1 inch (0.6x25 or 32mm)) Syringe (2-5ml size) Medication Orders Cotton wool Swab Tray Procedure: 1. Draw up the medication 2. Prepare the skin 3. Pull skin taut with non dominant hand. 4. Hold syringe like a dart in the dominant hand. Bring the needle close to the skin and place one finger of the dominant hand on the skin to steady you. 5. Inject at 90 in a firm, confident and swift motion. 6. The amount of subcutaneous fat in the patient will determine how deep you will need to go, generally about of the way up the needle. 7. Use you non-dominant hand to hold the tip of the syringe or the plastic part of the needle whilst part of the hand is in contact with the patients skin. 8. Use the dominant hand to aspirate aspirate (checking to see if you are in a blood vessel or not). When using the plastic injection trainers, you will get an air bubble when you aspirate. In real life, you get nothing (as there is no spare air, only surrounding tissue) and you have to tug a bit. If you find that there is blood in the tip of your syringe, this means that you are in a blood vessel. You will need to withdraw, get rid of your needle, medication and syringe (you will need a witness if you are disposing of narcotics) and start all over again. It is much better to do this than to try to salvage your injection. 9. Use you dominant hand to slowly inject the medication into the muscle. 10. When finished injecting, swap hands so that the dominant hand is holding the syringe, ready to withdraw and in contact with the patients skin. 11. Use the non dominant hand to get the cotton wool ball and to provide the countertraction upon withdrawal. 12. Dispose of the needle immediately in the sharps container and the syringe into a normal rubbish bin. If you have a glass ampoule, dispose of it in the sharps container. If it is plastic, dispose of it in the normal rubbish bin. 13. Sign the medication orders chart. Aftercare Monitor for signs of localized redness, swelling, bleeding, or inflammation at injection site. Observe the patient for at least 15 minutes following the injection for signs of reaction to the drug. Complications Most complications of intramuscular injections are a result of the drug injected and not the procedure. However, it is possible that localized trauma of the injection site may result as part of the process. Minor discomfort and pain is common for a short period following the injection, but usually resolves within a few hours. Results The optimal outcome is a situation in which the medication is safely and effectively delivered to the patient via intramuscular injection without signs of complications or discomfort.