INTRAMUSCULAR ADMINISTRATION
- 4. INTRODUCTION The IM route provides faster medication absorption than the subcutaneous route because of the greater vascularity of the muscle. RN is responsible to chose needle size and gauge. The angle of insertion for an IM injection is 90 degrees
- 5. CONT… A normal, well-developed adult patient tolerates 2 to 5 Ml of medication into a larger muscle without severe muscle discomfort. Children, older adults, and thin patients tolerate only 2 mL of an IM injection. Do not give more than 1 mL to small children and older infants, and do not give more than 0.5 mL to smaller infants
- 6. INDICATIONS •Muscles have more blood supply ,so quicker action of drugs. • More amount of drug can be administered than the intradermal and subcutaneous tissue.
- 7. CONTRA-INDICATIONS •Avoid sites of lesions, lumps, tissue injury, presence of nodules other pathology. •Avoid sites near to large blood vessels, nerves and bones.
- 8. Intramuscular Administration Administered into a muscle or muscle group Onset: variable Volume: up to 4ml Equipment: gloves, 1-5 ml syringe, needle (18-23 g, ⅝ to 3 inch needle), alcohol swab RN is responsible to chose needle size and gauge. Administration angle: 90°
- 9. Sites for intra muscular injections •Deltoid •Vastus Lateralis •Ventro Gluteal •Dorso Gluteal •Rectus Femoris
- 10. Deltoid administration Deltoid site is easily accessible, this muscle is not well developed in many adults. There is a potential or injury because the axillary, radial, brachial, and ulnar nerves, as well as the brachial artery, lie within the upper arm under the triceps and along the humerus. Use this site for small medication volumes (2 mL or less).
- 11. Intramuscular Administration Deltoid Palpate lower edge of acromion process. Place 4 fingers across the deltoid muscle with the top finger along the acromion process. This forms the base of a triangle. Draw an imaginary line at the axilla. This forms the apex of the triangle. • Injection site is the center of the triangle, 3 finger widths (1-2 inches) below the acromion process.
- 13. Vastus Lateralis •It is thick and well developed in both adults and children. •The area is divide into 3 parts from the greater trochanter of femur and lateral femoral condyle.
- 14. Intramuscular Administration Vastus Lateralis •One hand above the knee. •One hand below the greater trochanter. •Locate midline of anterior thigh and midline of lateral thigh. •Injection site is the middle lateral area of the thigh
- 16. VENTROGLUTEAL SITE It is the site where the gluteus medius muscle lies over the gluteus minimus
- 17. ADVANTAGES OF VENTROGLUTEAL SITE 1.No large nerves or blood vessels in this area. 2.Provides greatest thickness of gluteal muscles. 3.It is sealed off by bone. 4.Contains less consistency fat than buttock area. 5.Most suitable for adults and children over 1 yr
- 18. PROCEDURE-VENTRO GLUTEAL 1.Place patient on side-lying position, bent the knees and raise it slightly to chest.(use alternate hands for hips). 2.Place the nurses heel of hand over the greater trochanter of patient with fingers pointing towards head of patient. 3.Index finger should rest on anterior superior iliac spine, middle finger stretched dorsally. 4.Midpoint of triangle formed between index finger ,middle finger and iliac crest is the site.
- 20. DORSO GLUTEAL SITE • It is composed of the thick gluteal muscles of the buttocks. • CONTRA-INDICATION • Not used for children below 3 years ,because these muscles are developed by walking. • Most dangerous site because of sciatic nerve location
- 21. PROCEDURE FOR DORSOGLUTEAL 1.Patient is positioned in prone position with toes facing inwards or side-lying position with upper knee flexed and in front of the lower leg. 2. Palpate the posterior superior iliac spine and draw an imaginary line to the greater trochanter.(This line is parallel and lateral to the sciatic nerve ). 3.Injection site is parallel and superior to this site.
- 23. RECTUS FEMORIS • IT BELONGS TO THE QUADRICEPS GROUP OF MUSCLES.IT IS SITUATED IN THE ANTERIOR ASPECT OF THE THIGH
- 24. Intramuscular Administration RECTUS FEMORIS • One hand above the knee. • One hand below the greater trochanter. • Locate midline of anterior thigh. • Injection site is the middle anterior area of the thigh.
- 25. PROCEDURE
- 26. STEPS OF IM INJECTION • ASSESSMENT 1. Assess any drug allergy 2. Specific drug’s action, side-effects and adverse reactions 3. Client knowledge about the medication. 4. Client’s age and weight to determine the site and needle size.
- 27. • PLANNING 1. CHECK THE PATIENT FILE WITH PHYSICIAN’S ORDER. 2. GATHER ALL NEEDED EQUIPMENTS: A tray containing: • Sterile medication(ampule,vial,prefilled syringe) • Syringe and needle of appropriate size. • Antiseptic swabs and clean gloves • Kidney tray
- 29. • IMPLEMENTATION:Medicine preparation 1. PEFORM THE 3 CHECKS:-Read the label When medicine is taken from cart or cupboard. Before withdrawing the medicine . After withdrawing and before giving the medicine.
- 30. 2. Also check the expiry date of the drug. 3. Confirm the correct dose and organize the equipments near the patient.
- 31. IMPLEMENTATION:PERFORMANCE 1. Perform hand hygiene and wear a clean glove. 2. Prepare medication from the ampule or vial . 3. Change the needle after drug withdrawal. 4. Invert syringe to upside and expel the air. 5. Provide privacy to the client. 6. Introduce yourself and explain procedure
- 32. 7. Position the patient according to the site. 8. Locate and clean the site –clean site in a circular movement- start from centre and move outward about 5 cm. 9. Transfer and hold the swab between the third and fourth finger of your non-dominant hand .
- 34. 10.Remove needle cover without contaminating needle. 11.Use the Z track method if needed. 12.Holding the syringe between thumb and forefinger pierce the skin to muscles quickly and smoothly at 90* angle. 13.Aspirate by holding barrel of syringe with non-dominant hand(for 5 to 10 sec).
- 35. Cont… 14.If blood doesn’t appear inject the medicine. 15.After injection wait for 10 sec to permit the drug to disperse and remove the needle at the same angle. 16.Apply gentle pressure with dry sterile gauze/cotton. 17.Discard all items as per protocol 18.Document in drug chart and nurses notes. 19.Look for effectiveness of medication.
- 36. Z-track IM Administration Method used with irritating medications – – Vistaril Iron Used to “trap” medication in muscle and prevent “tracking” of solution through tissues.
- 37. Z-track IM Administration Prepare medication Change needle after drawing up med Gather supplies Identify site Wear gloves Cleanse site with alcohol Displace skin laterally 1-1 ½ inches from injection site While holding skin, insert needle with a darting motion, at a 90° angle.
- 38. Z-track IM Administration Stabilize needle with thumb and forefinger. Aspirate. If no blood, then inject medication slowly and steady Wait 10 seconds Quickly withdrawal needle Then release skin Cover site with swab and DO NOT MASSAGE DO NOT RECAP. Activate safety feature. Place needle in sharps container uncapped Remove gloves
- 39. ADVANTAGES • Rapid absorption, except for oily preparations and suspensions. • Pain from irritating drug is less because administration of drug is deep inside the muscle. • Allows administration of a larger volume than does in subcutaneous administration. • Allows more rapid absorption than subcutaneous and oral route of administration.
- 40. Disadvantages • It may cause irritation and local reactions. • Poses risk for tissue and nerve damage if the site is improperly located. • Cannot be used where tissue is damaged or peripheral circulation is decreased.