Intramuscular injections
Topic 8
Administering injections
 Intramuscular
-
-
– given deep into muscle
tissue
muscles are highly vascular = rapid drug
absorption, usually in 10 – 30 minutes
(aqueous soln.)
Risk of injecting into a blood vessel ...
plunger of syringe is drawn back a little to
see if any blood returns before injecting
Administering injections
 Intramuscular
-
-
usually a 21 –23G needle is used
Depth of injection depends on the amount
of body fat to pass through the sc layer &
penetrate the muscle layer
Needle should be inserted at a 900 angle to
the skin
Rotate sites to avoid hypertrophy
Equipment – IM Injection
What needle should I use for
IM injections?
21G or 23G
Green or blue hub
Administering injections
 Intramuscular
-
-
muscle is less sensitive to irritating &
viscous drugs ... as much as 4ml can be
administered into larger muscles
Small children & older infants should
receive no more than 1ml IM
Administering injections
 Intramuscular
- 3 most common sites
are:
 The deltoid muscle in the arm
 The ventrogluteal in the buttocks
 The vastus lateralis in the thigh
Intramuscular Sites
Deltoid Muscle
deltoid – should be used for
infrequent injections (limited muscle mass)
 Located 2-3 finger widths
below the acromion
process
 The
Administering injections
 Intramuscular
-
The ventrogluteal muscle – avoids
major nerves & blood vessels
has consistent thickness
is the preferred injection site for adults &
children > 7 months of age
Old Method
Current Method
The ‘Double Cross’
Underlying Structures
Administering injections
 The
-
vastus lateralis muscle in the thigh
– is the preferred site for infants < 7
months of age
is commonly used for adults
Muscle is well developed & thick
Offers ease of access
Vastus lateralis muscle
‘Bunch up’ in elderly,
emaciated or infants
Divide thigh into
thirds
Inject into the middle
third
The Z-track Technique
 Recommended
for IM injections, particularly
when the med. is irritating to the tissue e.g.
iron-dextran complex
 Involves pulling the skin either downward or
laterally before injection (creates a disjointed
pathway & locks med. into the muscle)
 Decreases leakage of med. & minimises
pain at the site
The Z-track Technique
Pull skin
taut then
Insert
needle
Remove
needle and
release
skin
Administering injections
 Intramuscular
What equipment do you
need?
Procedure
 Perform
the standard protocol for beginning
the procedure
 Attach the drawing up needle to the syringe
If using a vial – swab top of vial with an alcohol
wipe
If using an ampoule – gently tap to dislodge
any med. above the neck of the glass
Procedure
snap open the ampoule – may use a
gauze square to protect fingers; may
need to use a file to snap open the
ampoule
Draw up the correct amount of
medication
Remove the needle & dispose in sharps
container
Attach the administration needle
-
Procedure
 Expel
air & any surplus med.
 Transport all equipment to the client using
a kidney dish or suitable tray
 Select an appropriate site
 Cleanse the area with an alcohol swab &
allow to dry for 10 sec.
 Pull the skin sideways if using the Z-track
technique
Procedure
 Insert
the needle quickly & smoothly at a
900 angle to skin (in very thin clients,
inserting the needle at 450 may be more
appropriate)
 Pull back on the plunger & if no blood
appears, inject the med. slowly.
Procedure
 If
blood appears withdraw the needle &
discard. Repeat the whole procedure
 Smoothly
& steadily withdraw the
needle, releasing the skin
 Clean
the site with an alcohol swab
Procedure
 Apply
pressure to the site if bleeding but
do not massage the site
 Complete
the standard protocol for ending
the procedure
Things to consider…
 Observe
client for any reaction to the
medication
 Inspect the site for bruising, redness, or
heat
 Prior to injecting, palpate the muscle for
any tenderness or hardness & avoid
injecting into such an area
VOLUME PER MUSCLE SITE
 Ventrogluteal
- Up to 4ml in a well
developed muscle
 Vastus
lateralis - Up to 4ml in a well
developed muscle
 Deltoid
muscle
- Up to 1ml in a well developed