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Im and IV Injections-1

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14 views31 pages

Im and IV Injections-1

Uploaded by

doctor.pavanreddi
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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INTRAMUSCULAR AND

INTRAVENOUS INJECTIONS

KAVITI.SRI CHANDINI
INTRAMUSCULAR
INJECTIONS
INTRODUCTION
• Intramuscular injection is the method of installing medications into the depth of the bulk of specifically selected
muscles.

• The basis of this process is that the bulky muscles have good vascularity, and therefore the injected drug
quickly reaches the systemic circulation and thereafter into the specific region of action, bypassing the first-
pass metabolism.

• It is one of the most common medical procedures to be performed on an annual basis.

• Drugs may be given intramuscularly both for prophylactic as well as curative purposes, and the most common
medications include _

- Antibiotics- penicillin g benzathine penicillin, streptomycin

- Biologicals- immunoglobins, vaccines, and toxomedroxyprogeste

- Hormonal agents- testosterone, medroxyprogesterone


ANATOMICAL
LANDMARKS
• There are specific landmarks to be taken into consideration while giving im injections so
as to avoid any neurovascular complications. the specific landmarks for the most
commonly used sites are
• DORSOGLUTEAL REGION
5 to 7.5 cm below the iliac crest.
Upper outer quadrant of the upper outer quadrant within the buttocks
• VENTROGLUTEAL REGION
The heel of the opposing hand is placed in the greater trochanter, the index finger in
the anterior superior iliac spine and the middle finger below the iliac crest. the drug is
injected in the triangle formed by the index, middle finger, and the iliac crest
• DELTOID
2.5 to 5 cm below the acromion process
• VASTUS LATERALIS
The middle third of the line joining the greater trochanter of the femur and the lateral
femoral condyle of the knee
INDICATIONS
IM is commonly indicated for patients who are
• Noncompliant
• Uncooperative
• Reluctant
• Unable to receive drugs through other commonly utilized routes
CONTRAINDICATIONS
• Active infection, cellulitis or dermatitis at the site of administration
• Known allergy or hypersensitivity to the drug
• Thrombocytopenia
• Coagulation defects
• Hypovolemic shock- the absorption of the drug may be hampered owing to
compromised vascularity to the muscle
• Myopathies
• Associated muscular atrophy- leads to delayed drug absorption as well as adds up the
risk of neurovascular complications
EQUIPMENT

• 20-25 gauge syringe with a needle length of 16-38 mm


• Filter needle
• Alcohol-based antiseptic solution
• The correct drug in an appropriate dose
• Dry cotton swab
• Self-adhesive bandage
• Needle disposal unit
PREPARATION
counseling regarding the procedure and preparing the patient- to calm them down and
also to minimize the pain associated with the procedure
consent
Prerequisite- ensure the 'rs’
• Right patient
• Right drug
• Right dose
• Right site
• Right timing
• Ask for any adverse reactions in previous such procedures
Site selection
• Infants- vastus lateralis
• Children- vastus lateralis and deltoid
• Adults- ventrogluteal and deltoid

Drug volume
• 2 ml or less- deltoid injection
• 2 to 5 ml - ventrogluteal injection

Needle length
• Vastus lateralis -16 to 25 mm
• Deltoid-16 to 32 mm (children), 25 to 38 mm(adults)
• Ventrogluteal-38 mm
TECHNIQU
E
• Thorough cleaning of the hands
• Application of sterile gloves
• Thorough cleansing surrounding the site of injection with an alcohol-based antiseptic
solution
• Perpendicular insertion of a needle of appropriate sized length
• Prepare the drug and then aspirate it from the filter needle
• Insure intramuscular positioning of the needle via confirming restricted side to side
movement of the needle as opposed to when the needle is in the subcutaneous plane
• Aspirate to rule out any egress of blood especially in cases of dorsogluteal injection due
to inadvertent vascular puncturing of the gluteal artery during the procedure
• Slow injection of the drug at 10 sec/ml
• Slow withdrawal the needle and then apply gentle pressure over the injected site with a
dry cotton swab
• Proper disposal of all the equipment used during the procedure
• Assessment of the injected region for probable early and late complications
COMPLICATIONS
• Muscle fibrosis and contracture
• Abscess at the injection site
• Gangrene
• Nerve injury -the sciatic nerve in gluteal injection, the femoral nerve in vastus lateralis
injection
• Vascular injury
• Skin slough
• Periostitis
• Transmission of HIV, Hepatitis virus
• Persistent pain at the site of injection
ADVANTAGES
• Rapid and uniform absorption of the drug especially those of the aqueous solutions
• Rapid onset of the action compared to that of the oral and the subcutaneous routes
• IM injection bypasses the first-pass metabolism
• It also avoids the gastric factors governing the drug absorption
• Has efficacy and potency comparable to that of the intravenous drug delivery system.
• Highly efficacious in emergency scenarios such as acute psychosis and status
epilepticus
• Depot injections allow slow, sustained and prolonged action
• A large volume of the drug can be administered compared to that of the subcutaneous
route
DISADVANTAGES
• Expert and a trained person is required for administrating the drug by im route
• The absorption of the drug is determined by the bulk of the muscle and its vascularity
• The onset and duration of the action of the drug is not adjustable
• In case of inadvertent scenarios such as anaphylaxis or neurovascular injuries, intravenous (iv)
assess needs to be secured
• IM injection at the appropriate landmarks may be difficult in a child as well as in patients requiring
physical restrain
• Inadvertent injection in the subcutaneous plane of the fascia can lead to delayed action of the drug
• Painful procedure
• Suspensions, as well as oily drugs, cannot be administered
• Can lead to anxiety to the patient especially in children
•
INTRAVENOUS
INJECTIONS
SITES
PROCEDURE
• Select a suitable vein for venipuncture
• Apply tourniquet above 2 inch from venipuncture site
• Select and palpate a prominent vein
• Cleanse the skin with alcohol swab and allow it to dry
• Wear gloves
• Under aseptic conditions , introduce needle into vein
• Aspirate and now introduce the drugs
• Remove the tourniquet
• Attach tubings
ADVANTAGES

• Quickly sends medication directly into bloodstream


• Can administer large amounts
• More reliable
• Quick access
DISADVANTAGES

• Infection
• Pain
• Requires supervision
• Price high
THANK YOU

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