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Administering Intramuscular Injection

Administering Intramuscular Injection

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Published by: bwester2222 on Jun 23, 2009
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12/01/2012

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Administering Intramuscular InjectionDefinition
An intramuscular injection is an injection given directly into the central area of aspecific muscle. In this way, the
blood vessels
supplying that muscle distributethe injected medication via the
cardiovascular system
.
Purpose
Intramuscular injection is used for the delivery of certain drugs not recommendedfor other routes of administration, for instance intravenous, oral, or subcutaneous.The intramuscular route offers a faster rate of absorption than the subcutaneousroute, and muscle tissue can often hold a larger volume of fluid without discomfort.In contrast, medication injected into muscle tissues is absorbed less rapidly andtakes effect more slowly that medication that is injected intravenously. This isfavorable for some medications.
Precautions
Careful consideration in deciding which injectable route is to be used for theprescribed medication is essential. The intramuscular route should not be used incases where muscle size and condition is not adequate to support sufficient uptakeof the drug. Intramuscular injection should be avoided if other routes ofadministration, especially oral, can be used to provide a comparable level ofabsorption and effect in any given individual's situation and condition.Intramuscular injections should not be given at a site where there is any indicationof
pain
.
Description
Intramuscular (IM) injections are given directly into the central area of selectedmuscles. There are a number of sites on the human body that are suitable for IMinjections; however, there are three sites that are most commonly used in thisprocedure.
Deltoid muscle
The deltoid muscle located laterally on the upper arm can be used for intramuscularinjections. Originating from the Acromion process of the scapula and insertingapproximately one-third of the way down the humerus, the deltoid muscle can beused readily for IM injections if there is sufficient muscle mass to justify use of thissite. The deltoid's close proximity to the radial nerve and radial artery means thatcareful consideration and palpation of the muscle is required to find a safe site forpenetration of the needle. There are various methods for defining the boundaries ofthis muscle.
 
Vastus lateralis muscle
The vastus lateralis muscle forms part of the quadriceps muscle group of the upperleg and can be found on the anteriolateral aspect of the thigh. This muscle is morecommonly used as the site for IM injections as it is generally thick and well formedin individuals of all ages and is not located close to any major arteries or nerves. It isalso readily accessed. The middle third of the muscle is used to define the injectionsite. This third can be determined by visually dividing the length of the muscle thatoriginates on the greater trochanter of the femur and inserts on the upper border ofthe patella and tibial tuberosity through the patella ligament into thirds. Palpationof the muscle is required to determine if sufficient body and mass is present toundertake the procedure.
Gluteus medius muscle
The gluteus medius muscle, which is also known as the ventrogluteal site, is thethird commonly used site for IM injections. The correct area for injection can bedetermined in the following manner. Place the heel of the hand of the greatertrochanter of the femur with fingers pointing towards the patient's head. The lefthand is used for the right hip and vice versa. While keeping the palm of the handover the greater trochanter and placing the index finger on the anterior superior iliacspine, stretch the middle finger dorsally palpating for the iliac crest and then presslightly below this point. The triangle formed by the iliac crest, the third finger andindex finger forms the area suitable for intramuscular injection.Determining which site is most appropriate will depend upon the patient's muscledensity at each site, the type and nature of medication you wish to administer, andof course the patient's preferred site for injections.
Preparation
Before
administering medication
, a health care practitioner verify themedication order for accuracy and prepare the medication from the vial or ampule.
First, ensure you have identified the patient and assist them into a positionwhich is comfortable and practical for access to the injection site you havechosen.
Locate the correct area for injection using the above guidelines or thosetaught during medical training. Clean the site with an alcohol swab or othercleansing agent.
Prepare the syringe by removing the needle cover, inverting the syringe, andexpelling any excess air. Approximately 0.1–0.2 ml of air should be left in thesyringe so that the air in the top of the syringe chamber, when the
syringeand needle
are pointing down, forces the entire amount of medication tobe delivered. This also prevents medication residue from being left in theneedle, where it can leak into the subcutaneous and dermal layers when thesyringe and needle are removed from the muscle.
 
When ready to inject, spread the skin using the fingers of the non-dominanthand. Holding the syringe with the thumb and forefinger of the dominanthand, pierce the skin and enter the muscle. This process should be donequickly with sufficient control so as to lessen the discomfort of the patient. Ifthere is little muscle mass, particularly in infants or the elderly, then you mayneed to pinch the muscle to provide more volume of tissue in which to inject.
Aspirate at the injection site (while syringe and needle are within the muscle)by holding the barrel of the syringe with the non-dominant hand and pullingback on the syringe plunger with the dominant hand. If
blood
appears in thesyringe, it is an indication that a blood vessel may have been punctured. Theneedle and syringe should be immediately withdrawn and a new injectionprepared. If no blood is aspirated, continue by slowly injecting the medicationat a constant rate until all medication has been delivered.
Withdraw the needle and syringe quickly to minimize discomfort. The sitemay be briefly massaged, depending on the medication given. Somemedication manufacturers advise against massaging the site after injection,as it reduces the effect and intention of the medication by dispersing it tooreadily or over too large an area. Manufacturers' recommendations shouldbe checked.
Discard the used syringe and needle intact as soon as possible in anappropriate disposal receptacle.
Check the site at least once more a short time after the injection to ensurethat no bleeding, swelling or any other signs of reaction to the medicationare present. Monitor the patient for other signs of side effects, especially if itis the first time the patient is receiving the medication.
Document all injections given and any other relevant information.
Aftercare
Monitor for signs of localized redness, swelling, bleeding, or inflammation atinjection site. Observe the patient for at least 15 minutes following the injection forsigns of reaction to the drug.

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