Intra Muscular Injection

Subject: Fundamentals of Nursing

Overview

Intra Muscular Injection

Intra muscular injection is defined as introduction of medicine into the muscle in the form of solution. It is a form of parenteral administration of medication, where a drug is injected into a deep muscle tissue.

Medications administered to IM injection usually are absorbed intermediately, slower than IV administration but more rapidly than SC injection. Muscle tissue having large blood supply promotes quick absorption.

Purposes

  • To obtain a quicker effect of medicine than is obtained by oral administration and subcutaneous administration.
  • Assume that the total dosage will be administered and some will be absorbed for the systemic action of the drug.
  • The medicines that is not suitable for intravenous administration.

Advantages

  • Absorption is rapid than subcutaneous route.
  • Oily preparations can be used.
  • Irrigative substances might be given
  • Slow releasing drugs can be given by this route.

Disadvantages

Using this route might cause nerve or vein damage.

Site for IM Injection

Various sites may be used for intramuscular injection. To avoid complication, the nurse must be able to identify anatomic landmarks and site boundaries and use accurate, careful when administering intramuscular injection. The age of the client, medication to be injected amount of medication and client's general condition influence site choice. Injections should not be given into abnormal muscle tissue, such as tissue underneath burns, scars or inflamed areas.

Deltoid: The deltoid muscle is located in the lateral aspect for the upper arm. It is not often used because it is a small muscle and is not capable of absorbing a large amount of solution. Damage to the radial nerve and artery is a risk with use of the deltoid site.

The deltoid muscle can be located by palpating the lower edge of the acromion process. A triangle is formed at the mid-point in line with the axilla on the lateral aspect of the upper arm, with the base of the triangle at the acromion process. It is used only for adults and can accommodate about 1 ml of solution. The deltoid site is located at the lateral site of the humorous from two three finger widths (2.5 to 5 cm) below the acromion process in adults or one finger widths below the acromion process in children. The injection is given into the thickest area of the muscle that lies over the mid auxiliary line.

Ventrogluteal Site: This involves the gluteus medius and gluteus minimus muscles in the hip area. This site offers a large muscle mass that is relatively free from major nerves and blood vessels and fat. It is considered the safest and least painful site for delivering IM infection.

To locate the ventrogluteal site, place the palm of your hand over the greater trochanter with your fingers facing the patient's head. The right hand is used for the patient's left hip or the left hand for the right hip, to identify landmarks. The index finger is placed on the anteriosuperior iliac spine and the middle finger extends dorsally, palpating iliac crest. A triangle is formed, and the injection is given in the center of the triangle.

Dursogluteal Site: Because of its proximity to the sciatic nerve and superior gluteal artery and the possibility of administering the injection subcutaneously into the thick layer of fat over the dorsal gluteal muscle, the routine use of this site for IM injections is not recommended.

To locate the dorsoglutal site, use the index fingers to find the greater tronchanter and the posterior superior iliac spine. Draw an imaginary straight line between these landmarks and give the injection with the needle at 90° angle lateral and superior to the midpoint of this line.

Second method: To locate this site, divide the buttock into four parts with an imaginary line. The crest of the illium can be palpated for the superior aspect, the gluteal fold is the inferior aspect; the medial aspect is medial fold and lateral is the side of the buttock. From these land marks, the outer quadrant is located. Then the upper outer aspect of the quadrant is located.

Rectus Femurus Site: It is the site of choice for infants and children and it also may be used for adults. The rectus femurus is located one third of the distance from the knee to the greater trochanter of the femur in the center of the anterior thigh. An injection is administered into this site by lying the muscle away from the bone and inserting the needle at a right to the muscle.

Vastus Laterials: The vastus lateral site is used for IM injections for infants, children and adults. It is located along the anteriolaterial aspect of the thigh. To locate the site, the thigh is divided into thirds horizontally and vertically and injection is given in the outer middle third. This site is particularly desirable for infants and children, whose gluteal muscles are poorly developed.

Complications of Intramuscular Injections

  • Abscess
  • Hematoma
  • Injury to blood vessels and peripheral nerves
  • Pain at the injection site
  • Tingling or numbness
  • Infection
  • Bleeding
  • Allergic reaction

Subcutaneous Injection

Subcutaneous injection means introducing of medicine into the subcutaneous tissues. This route is used for administering insulin, Heparin and certain immunizations.

Purposes

  • To administer the medication that is in-effective in the gastrointestinal tract by the action of the digestive juice.
  • To administer smaller doses.
  • To slow drug absorption.
  • To obtain a prompt action of a medicine that is not obtained by oral administration.

Advantages

Absorption is slow and constant

Disadvantages

  • It might lead to abscess formation
  • Absorption is limited by blood flow

Common Sites

  • Outer aspect of the upper arm.
  • Posterior chest wall below the scapula.
  • Anterior abdominal wall from below the breast to illiac crests.
  • Anterior and lateral aspect of the thigh.

Intradermal Injection

Intradermal injection is administration of medication into the dermal layer of skin. The useful sites for intradermal injection are upper arm, inner aspect of forearm and upper back beneath scapula.

Purposes

  • To perform sensitivity test.
  • To perform tuberculin test.
  • To administer vaccination.
  • To obtain a local effect at the site of injection of local anesthesia such as xylocaine.

Intra-venous Injection

Introduction of drug directly into the blood stream is called intravenous injection.

Purposes

  • To a fast action of the medications as in emergency.
  • To give medicines those are irritating or ineffective when given by other route.
  • To introduce large amount of medication e.g. IV fluid, blood.
  • To introduce a drug into the direct circulation for diagnostic purpose e.g. IVP.
  • To increase the volume of circulating fluid in the treatment of shock or haemorrhage.
  • To have the action of medicines on the blood stream or the blood vessels.

Advantages

  • Immediate action takes place
  • This route is preferred in emergency situations
  • This route is preferred for unconscious patients.
  • Large volume of fluids might be injected by this route
  • Diluted irritant might be injected
  • Absorption is not required
  • Blood plasma or fluids might be injected.

Disadvantages

  • This method is more risky
  • Sepsis-Infection, Phlebitis (Inflammation of the blood vessel) might occur
  • This method is not suitable for oily preparations
  • This method is not suitable for insoluble preparations

Types of IV Administration

Adding the medicine in a intravenous solution bottle.

Existing intravenous line for continuous infusion.

Bolus - direct intravenous push for immediate or fast action.

Intravenous Push

Introducing a single dose of concentrated medication directly into the systemic circulation is intravenous push. IV push technique is used to administer medications that can be given rapidly for desired therapeutic effects.

Procedure for Injection

S.N. Nursing Action   Rationale
1 Check patient's identification by asking name and compare medication card.   Ensures that drug is administered to the correct patient.
2 Explain the purpose of medication, the site of  injection, expected effect and allow the patient to  clarify doubts.   Explanation encourages cooperation and reduces anxiety.
3 Check the patient's history of drug allergies.    
4 Wash hands and wear gloves if needed.   Reduces spread of microorganisms.
5 Prepare needed articles and arrange in bed side.   Facilitate orderly performance of procedure and save the times.
6 Prepare medication from ampoule/vial.    
7 Don gloves if needed.   Prevents from transmission of microorganism.
8

Select the appropriate injection site Asses the area. Check for lumps, nodules, tenderness, hardness, swelling, scaring, itching, burning sensation and localized inflammation in the area.

For intramuscular injection

  • Select the appropriate injection site inspecting muscle size and integrity.

  • Position the patient: Assist the patient to a supine, lateral or prone position depending on the site chosen. If ventrogluteal, have the patient in the supine position with knees flexed or lateral position with the upper leg flexed or prone with the toe in position.

  • Locate the exact site for injection.

For subcutaneous injection

  • Outer aspect of upper arm- arm relaxed and at the sides of the body.
  • Anterior thigh - sitting or lying down with muscles relaxed.
  • Abdomen the patient in semi recumbent position.

For intradermal injection

Inner aspect forearm, upper chest or upper back beneath scapulae.

  

Consider the volume of medication to be injected.

An average adult's deltoid muscle by can absorb 0.5-1 ml and gluteal muscle can absorb 1-4 ml.

Ensures free access to injection site.

Forrarm is the most convinent and easily located sothat the commonly used site.
9 Clean with an antiseptic swab in circular motion moving from the center to periphery, moving outward up to 5cm.   Friction helps to clean the skin. Pathogens in the skin can be introduced into skin.
10 Transfer and hold the swab between 3rd and 4th  fingers of the non-dominant hand or place in a tray. Allow the site to dry.   Cotton swab is kept in readiness for removal of needle. 
11 Remove the needle's cover without contaminating the needle by pulling it straight off.   Reduces risk of accidental needle prick.
12 Confirm that medication and dosage are correct. Ensure that medication is not dripping on the needle prior to injection; if it is dripping change the needle.   Medication outside of the needle can cause pain and irritation of tissue when passes into the skin and muscle.
13

Inject the medicine.

For IM injection

  • Grasp and pinch the area surrounding the injection site or spread skin at the site as appropriate.
  • Hold the syringe between the thumb and forefingers in a pen-holding manner and pierce the skin at the site at a 90 degree angle and insert the needle.
  • After insertion, release the tissue and immediately move your non-dominant hand to the steady lower end of the syringe. Slide your dominant hand to the top of the barrel.
  • Aspirate by holding the barrel steady with the non-dominant hand and pulling back the plunger with your dominant hand.
  • Withdraw the needle if blood appears in the syringe, discard and prepare a new injection.
  • Inject the medication slowly and steadily if blood does not appear in the syringe on aspiration.

Z-track technique

Pull skin to one side,downward or laterally about an inch using non dominant hand. Inject medication with airlock at 90 degree angle. Hold needle in place for 10 seconds.

Withdraw the needle and release the skin.

For subcutaneous injection

 

For subcutaneous injection

Grasp and pinch the area surrounding the injection site or spread skin at the site.

Hold the syringe in the dominant hand between the thumb and the forefinger. Inject the needle quickly at an angle of 45-90 degree, depending on the amount of tissue, turgor of tissue and length of needle. A 900 degree angle is normally used with a 5/8 inch needle for obese patients. A 45 degree angle is used with a 3/4 inch longer needle for an average patient or in a thin patient. After insertion, release the tissue and immediately move your non-dominant hand to the steady lower end of the syringe. Slide your dominant hand to the top of the barrel.

Aspirate by holding the barrel steady with the non-dominant hand. Withdraw the needle if blood appears in the syringe, discard and prepare a new injection. Do not aspirate for heparin. Heparin is anticoagulant and can cause bruising on aspiration. 

Inject medication slowly if no blood appears.

For intradermal injection

Use the non-dominant hand to spread skin taut over the injection site.

Place the needle almost against the patient's skin at 10-15 angles and insert the needle into the skin so that the point of the needle can be seen through the skin. Insert the needle only about 1/8 inch.

Slowly inject the drug, watching for a bleb/blister bto develop. If not present, withdraw the needle slightly and inject medication. 

For Intravenous injection

Select a site suitable for the route of administration, quantity of medication to be given and characteristics of medication.

Apply a tourniquet on the upper arm. Ask the patient to clench and unclench the hand.

Clean the skin of the site with alcohol.

Pull the skin taut and place the needle in line with

vein at a 15 to 450 angle. Insert the needle a bit below the point where the needle will pierce the vein.

When the back flow of blood occurs into the syringe, release the tourniquet and inject the medicine very slowly.

As you remove the needle, press the vein with swab at the puncture site to prevent bleeding.

For intravenous push

Select the injection part of IV tubing closest to the patient.

Connect the syringe to IV line.

Occlude the intravenous line by pinching tubing just above the injection port.

Pull back gently on the syringe's plunger to aspirate for blood return. 

Observe IV site during injection for sudden swelling.

After noting blood return, inject medication slowly over several minutes.

Release tubing after injecting medication, withdraw the syringe and recheck the fluid infusion rate.

After noting blood return, inject medication slowly over several minutes.

Release tubing after injecting medication, withdraw the syringe and recheck the fluid infusion rate.

  

Provide easy and less painful entry into muscle.

Injectinh solution into compressed  tissue results in pressure against nerve fibers and creates discomfort.

The nondominant hand secures the needle and allows for smooth aspiration.

Aspiration helps in checking if the needle is in a blood vessel.

Injecting medication slowly helps the dispersal of medication into muscle tissue thus decreasing patient's discomfort.

This leads to zig-zag path that seals the needle track wherever tissue planes slide across each other. Drugs cannot escape from the muscle tissue.

Provide easy and less painful entry into subcutaneous tissue

Subcutaneous tissue is abundant in well nourished, well hydrated people and sparse in emaciated, dehydrated or very thin people.

Injectinh solution into compressed tissue results in pressure against nerve fibers and creates discomfort. The nondominant hand secures the needle and allows for smooth aspiration.

Aspiration helps in checking if the needle is in a blood vessel. Heparin is an anticogulent and can cause bruising on aspiration.

Taut skin provides as easy entrance into skin.

Needle position faciliates insertion into intradermal tissue.

Appearance of a bleb indicate that needle into intradermal tissue.

Ensures that medicine is being delivered in the blood stream. 

Flush solution keeps intravenous line the patientafter drug is administered.  

 
14 Withdraw the needle slowly and steadily at the same angle as it was inserted while applying counter traction around the injection site with the non-dominant hand and support the skin surface using the cotton swab for applying counter traction at the site.   Supporting the skin surface with the cotton swab helps to reduce discomfort. Applying counter  traction prevents pulling of tissues when needle is withdrawn. 
15

Apply gentle pressure at the site with a dry sponge and if bleeding is present continue applying pressure till bleeding stops.

Do not massage the area for intradermal injection.

Do not massage a heparin / insulin injection site. 

 

Massaging helps to distribute the medication and absorption. 

Massaging the area in intradermal injection will lead to spread of medication to subcutaneous tissue 
16 Discard the uncapped needle and syringe into appropriate receptacles. Do not recap the needle.    Reduces risk of accidental puncture with needles.
17

If intradermal injection is given for investigation purpose, draw a circle using a blue/black pen around injection site.

Check reaction within specified time period. Instruct the client when to return for reading of response 15-16 minutes after injection for allergy testing and usually 48 to 72 hour after injection for tuberculin skin testing.

   Helps to identifying exact site for checking reaction to medication.
18 Assist the patient to a comfortable position.   Restores comfort.
19 Replace medication and articles.    
20 Remove gloves. Wash hands.   Reduces spread of microorganisms.
21

Assess effectiveness of medication.

Observe the patient for any allergic reaction.

   Adverse reaction after medication may necessitate emergency measures.
22 Record the procedure including the name of medication, dose, site and response of the patient.   Timely documentation reduces chances of medication errors and 

 
Things to remember

© 2021 Saralmind. All Rights Reserved.