This action might not be possible to undo. Are you sure you want to continue?
has been prepared by Wyeth vvith the hope that it vvill be
useful to students in various fields of medicine vvhose responsibilities vvill ultimately injections.
include the giving of intramuscular For those vvhose training complished fact
is already an acbooklet vvill
vve hope the
act as a refresher. Everyone agrees that intramuscular injec-
tions should avoid major nerves and vessels, but there is no universal agreement on specifically preferred sites and procedures. This
booklet presents a selected cross section of thinking on those sites and procedures most generally accepted for Illustrations in this adults booklet and children. are intended
primarily as an aid to general site orientation. Specific procedures as described in the text of the booklet are recommended in administration of intramuscular We vvish to express injections. our appreciation to
Daniel .J. Hanson, M.D., Department of Pathology and Research Institute, Mercy Hospital, Toledo, Ohio, for permission to reprint a
portion of his article, "Intramuscular
Injuries and Complications," to Philip S. Barba, M.D., Adjunct Professor of Pediatrics, Temple University School of Medicine, for his helpful comments on pediatric intramuscular injec-
tions, and to Alice C. Cook, R.N., Senior Instructor at The Memorial Hospital School of Delavvare, for her tech-
nical assistance and advice.
Table of Contents
in General .. Injections. and Recommendations Injection Area Sites . for Intramuscular Injections .
Intramuscular Precautions Intramuscular
Gluteus Medius Ventrogluteal Area
Vastus Lateralis ... Intramuscular Pediatric Injections in Infants and Children Injection Sites
Intramuscular Gluteal Region .. Vastus Lateralis. Deltoid .
20 22 24 25
With Prefilled TUBEX Sterile . .
for the Injection.
Orders for Medication Preparation Steps for Injection
26 27 28
Steps for Injection ..... ...
With Reusable Syringe
Giving the Injection
After the TUBEX Injection After the Injection Bibliography
TUBEX in the Hospital TUBEX Closed Injection
30 31 32
With a Reusable Syringe ... .
. Inside back cover
Giving injections is a serious and important part of medical treatment. In a very real sense the same kind of preparation and caution employed in an operating exercised in giving injections. ing introduced procedure must be Two foreign objects are beneedle and the
into the body, a hypodermic
medication, and this should be done with as much precision as a surgeon employs when using a scalpel. The accuracy of the choice of injection site and the excellence of the technique of injection help control the effectiveness of the medication. A misdirected administering arable damage. A physician orders an injection for a patient only when most injection or improper technique in the injection may prevent medication from
acting most efficiently or, more important,
may cause irrep-
it is absolutely necessary or the manner of treatment suited to the existing circumstances. to as parenteral therapy) are: advantages for giving injections of medication
Some of the reasons and (also referred
1. To administer
medication when the mental
or physical state of the patient may make any other route difficult or impossible. 2. To achieve a quick response to the medication. 3. To guarantee the accuracy of the amount
of medication received. 4. To obtain a sure response from the patient. 5. To prevent irritation of the digestive system, loss of medication through involuntary ejection or destruction by digestive acids. 6. To anesthetize a specific area of the body. 7. To concentrate medication at a specific lo-
cation in the body.
are given when a quick but proto an immediate effect of short
longed action is preferred
duration. By injecting medication into the muscle a deposit of medicine is formed which is gradually absorbed into the blood stream. When given properly, the intramuscular several types of injections. Generally speaking, large quantities be adequate for most treatments. Medications for many intramuscular Injections are in an aqueous solution or in a suspension, while a few are in an oil solution or suspension. When an aqueous suspension or oil solution or suspension is administered, sary to give the injection thicker liquid. it is generally necesat a slower rate because of the of medication are selinjection is probably the easiest, safest, and best tolerated of the
dom injected into the muscles and a 2- or 2.5-cc. syringe will
Precautions and recommendations
with the permission
oj the author, Daniel J. and Research
of well-defined H the vertical
landmarks is drawn
line. to the
Hanson, M. D., Department
only slightly medial
Institute, Mercy Hospital, Toledo, Ohio jrom "I ntramuscular Injection Injuries and Complications" published in GP January, 1963.
proper location, the intersection with the horizontal will be located medial to the sciatic nerve. This will expose the nerve to injection may be assumed quadrant." to be given although the injection outer in the "upper
RecornluendatioJJs A local lesion of greater or lesser extent, depending
upon the material injected, is produced in the tissues each time an injection is given. The operator must be aware of the differences the substance in tissue toleration when choosing to be injected and he must area.
We recommend a minor modification for the location of the injection site, using definite anatomic landmarks. lateral A line drawn from the posterior trochanter with the course superior iliac spine to the greater to and parallel of the femur is of the sciatic
control the site of the resultant needle tip in a relatively Many cases of 'generalized reactions predicted. accidents technique. With the previously in avoiding injection described after However,
lesion by locating the
silent intramuscular anaphylactic injection
and related cannot be are reoccur, injection
nerve. Any injection lateral and superior to this line will be removed from the course of the sciatic nerve and will be within the region of the greatest gluteal mass, as recommended by Hochstetter and others. The deltoid and posterior triceps area should be
lated to tissue damage are preventable. they usually
at the injection
When complications to faulty
avoided irritating available
in adults substance
when anything is injected.
but the most nonThe muscle masses are generally may involve are
can be attributed
in these areas
facts in mind, several important
not as large as those in the gluteal areas and an injection which is only slightly misplaced the radial nerve. In addition, pain and tenderness more noticeable to the patient in this area. Infants present a different small and problem.
points will be listed which are particularly complications.
Select the Agent. When a choice is possible, select the agent which demonstrates the greatest tissue toleration. In the case of antibiotic injections, it has been shown that procaine penicillin and oxytetracycline cause the least extensive Chloramphenicol reactions succinate at the injection and tetracycline sites. provoke
The gluteal area primarily of close small muscle child in-
is composed developed,
fat. There is only a poorly mass. An y injection
in this area is dangerously fighting
to the sciatic nerve. A squirming,
the most severe necrotic
creases the danger of injecting into or adjacent to the nerve. In such patients, the lateral or anterior thigh is recommended for intramuscular nerves. injections. Nathan, develops These muscles are better developed moved from any major reasons, used the deltoid at birth and are far refor similar with good with loco-
Choose the Proper Site. In adults, the recommended site of intramuscular injection is the upper outer quadrant of the gluteal area. The gluteal area is not synonymous with the buttocks. A review of the anatomy of the area will reveal that the term "buttocks" includes a zone of fat tissue inferior to the gluteal musculature adjacent to the posterior thigh.
area in infants
results. The gluteal musculature
motion and, therefore, may be used for injection when the child has been walking for a year or more (usually at the age of 2 or 3). Individual evaluation of the musculature should be made and may indicate pain
site in the gluteal zone perpendicular in the hands of of the absence
... the classic method nonprofessional
of intersecting especially because
the use of the thigh at an even older age. This location may also be used safely in adults although is more noticeable than in the gluteal area.
lines may be dangerous, personnel,
Intramuscular injection sites/the
A site often chosen for its ease of access is the deltoid area which can be employed when the patient is in either a standing, sitting, orJprone position. While the deltoid muscle forms a fairly large triangle on the shoulder prominence, area available to a shoulder injection the actual is limited, bounda-
axilla or armpit boundaries
on the bottom.
The two side
are lines parallel to the arm one-third
and two-thirds of the way around the outer lateral aspect of the arm. Care should be taken to avoid not only the acromion, clavicle and humerus, but also the brachial veins and arteries and the radial nerve. It is recommended that the number and size of injections made at this site be limited. The area is small and cannot quantities tolerate repeated injections and large of medication.
since there are major bones, blood vessels and nerves to be avoided. The recommended by the lower edge of the acromion ries of the injection area form a rectangle bounded on the top to a point on the lateral side of the arm opposite the
Intramuscular injection sites/the
the most commonly is the posterior injections
site for be of a
The patient should be lying face down. A "toe-in" position should stances correct relaxes should technic. the muscles. exposed. Do not there The injection Under hurry, site with let be clearly no circumdo not
gluteal area. purposes
this site for injection given to restrict gluteus diagonal Extreme medius
to that portion
be any compromise
which is above and outside superior
line drawn from the greater caution should be observed
trochanter iliac spine. to ensure avoiding the
modesty tempt you to give this injection
to a persite. penecourse.
of the femur to the posterior that the boundary
son who is bending over a table or with his clothing only partially removed from the injection The needle is inserted perpendicular surface on which the patient is lying-needle tration should be on a direct back-to-front to the flat
line is maintained, gluteal artery.
hazard of possibly injecting nerve or the superior
into either the sciatic
injection sites /
The ventrogluteal area (von Hochstetter's site) has been accorded growing recognition as a site removed from major nerves and vascular structures. The subcutaneous fatty layer is relatively shallow and there is good gluteal muscle density. Because anatomical landmarks are easily identifiable around the ventral area of the gluteal muscles, this site is also recommended for injections in children. Although especially suitable for a patient lying on his back, this site is also accessible with the patient lying prone, on his side, or standing. The patient should always be sufficiently exposed to enable adequate identification of anatomical landmarks.
Palpate to find the greater trochanter, ing into the left side of the patient, index finger on the anterior (Use the left hand injecting middle into the patient's finger posteriorly
the anterior injectand the place the palm iliac spine.
superior iliac spine and the iliac cresLWhen of the right hand on the greater trochanter superior to delineate
the site when the index
right side.) Spread the away from
finger as far as possible along the iliac crest, as shown in the straight-line space or triangle finger is formed. center between drawing below. A "V" the index and middle is made in the directed
of the triangle
with the needle
slightly upward toward the crest of the ilium.
Ventrogluteal area (in triangle)
Iliac crest (not illustrated)
Greater trochanter of the femur
injection sites /
the Vastus Lateralis
Another is the
site recommended vastus lateralis.
for its relative This injection
safety area is
it is easier to give an injection
when the patient The entire
and freedom from major nerves and blood vessels bounded by the mid-anterior the leg, the mid-lateral breadth mal end and another knee at the distal end. thigh on the front of at the proxiabove the
vastus lateralis a sitting exposed landmarks
is lying on his area should be
back, it is acceptable position. to permit pertinent
to use this site when he is in identification patients. of anatomical See pages 20
thigh on the side, a hand's hand's breadth
below the greater trochanter
to this site. This site may
also be used for pediatric
and 21 for specific recommendation.
vastus latera lis
in infants and children
Every precaution muscular children-with Current which applies when administering to adults also applies for infants intraand injections
one added precaution-the abounds
margin for error
is critically narrower! medical literature with recommendations permits inference of stressing correct technic and proper site selection. Close examination of this literature these basic guidelines for pediatric intramuscular injections:
Some notes to underscore
1. No injection casual
should ever be given with the attitude or mechanical routine. for every injection-
attention to detail is mandatory no matter who gives it.
2. Proper injection technic requires a sound knowledge of
the anatomy injection involved. The terms used to describe landmarks the site and pertinent must be under-
3. Major nerves and blood vessels must be avoided and
injection among necessary. sites should useable sites be selected when accordingly. Rotate are repeated injections
4. The entire injection area should be fully exposed to permit an unobstructed overall view of the injection site.
5. The target muscle should be large enough to accommodate the medication to be injected. Medication permits deposited into the belly of the muscle optimal
A relaxed muscle is highly desirable. to deposit the
6. The needle length should be adequate
into the belly of the target muscle. allows the relaxed muscle the medication deposit. to A into and
7. A slow rate of injection distend and accommodate too-rapid rate of injection in expulsion surrounding tissues,
into a taut muscle can result from the muscle severe irritation
of the medication causing discomfort.
needless patient 8. Few children adequate
are completely be taken requires physician
Since they that still
may struggle when least expected, measures often during the actual injection. tive patient possible a trained
it is important
to keep the child two persons. or nurse
the uncooperaWhenever assist. should
Office assistants else is available
or parents to help.
may be used when no one
Pediatric intramuscular injection sites/Gluteal
The gluteal onymous.
region and the buttock
are not synthe
the buttock superior adequately the gluteal
and extends developed region
to the anterior is for is used, area
Each must be defined to establish
the musculature suitable
proper injection sites. Buttock refers strictly to the gluteal prominence. The buttocks gluteal "seat." are confined nates, to one area clunes, of the or region-the "rump"
and proper technic is a very
injection. The gluteal region includes sites: (1) the ventrogluteal terolateral
Injections should never be given into any than
area and (2) the pos-
quadrant of the buttock. The gluteal region is much more expansive
aspect of the gluteal region.
Ventrogluteal or von Hochstetter's site This site has been described in detail on pages 12 and 13. Those same technics cedures. apply for pediatric injection pro-
Posterolateral aspect of the gluteal region
1. The patient lies prone on a flat table surface.
A "toe in" position relaxes the muscle. superior iliac and the
2. Palpate to locate the posterior
The lateral injection to the site must imaginary
spine and the head of the greater trochanter. be superior line
Gluteal region Buttock
these two landmarks. head of the trochanter crest is most remote and vessels.
The area above from major
and below the iliac nerves
3. The syringe is held perpendicular
table surface on which the patient The needle is directed on a straight front course.
to the flat is lying. back-toSciatic N.
Post. sup. iliac spine
Sup. gluteal A. Gluteus maximus M.
Inf. gluteal A.
Greater trochanter of femur
quadriceps in the
lateral is is the major muscle of this group and is located on the most lateral of the thigh a suitaway from major nerves and vessels. The anterior surface of the mid-lateral able site for intramuscular needle insertion infants, will penetrate thigh is therefore injections in this area. In very small depth
Survey the overall size of the thigh and plan the depth accordingly. into the muscle belly. needle insertion to just a one-inch
The infant lies on his back. Grasp the thigh and compress the muscle tissue as shown. This helps to stabilize the extremity and concentrates shown, patient. muscle This mass is reVastus lateralls M.
muscle mass. Using the position arm helps to restrain The needle penetrates on the lateral portion directed the struggling
the gathered of the anterior course.
thigh and is
on a front-to-back
moved from the medial portion of the thigh where major nerves and vessels are located deeper layers of the muscle tissue. An alternate anterolateral injection surface site in this area of the upper thigh. is the When among the
this location is used, the needle is directed distally and inserted obliquely at an approximate to the horizontal needle should not penetrate amasses the musculature 45° angle ,
I I I I
and long axes of the leg. The deeper than one inch. at the site of injection.
Compressing the muscle tissues between the fingers
,, ,I , ,
Sciatic N. Femoral A. & V.
Rectus femoris Vastus lateralis
The deltoid muscle in infants and young children is shallow and can accommodate volume limiting factor is that repeated only a very small Another in this injections of the more fluid medications.
area are painful. The patient entire can sit, stand or lie down and this site Whatever position is used, the landmarks. and arm area should be exposed should be given in the densest porthe armpit and area, line and of axillary in the posterolateral is still accessible. shoulder to permit
full view of all pertinent
tion of the deltoid muscle-above below the acromion mid-way between an imaginary the upper injection and the posterior
the lateral surface between is inserted
arm. Grasp The
mass at the the thumb pointing
site and compress needle
slightly upward toward the shoulder.
Median & Ulnar N. Deep brachial A. Radial N. Brachial A.
Preparing for the injection
Cartridge-Needle and gIVIng an injection the
Unit or where a reusable syringe is necessary. First,
is used, additional preparation
nurse should be thoroughly familiar with the written medication order and any special instructions or precautions necessary. As in any other medical procedure, medication are "musts".
THE INSTRUMENTS AND MEDICATION
the empty syringe must be assembled. After the vial of medication has been selected and the seal sterilized with alcohol, the needle is then inserted through the seal, the plunger of the syringe depressed to expel the air into the vial, and the correct amount of medication withdrawn into the syringe. The needle is then withdrawn from the vial and, in the case of an empty TUBEX Sterile sterility. an Cartridge-Needle
washing of hands before preparing and the use of sterilized equipment
When giving an injection with a prefilled TUBEX@ Sterile Cartridge-Needle required premeasured, Unit, the only equipcartridgement preparation the correct is as follows: Select prefilled name and room
Unit, the rubber needle-sheath
is replaced in order to maintain When preparing
needle unit. Mark the patient's on the medication
the patient for the injection,
envelope before enclosing the
attitude of confidence and quiet efficiency in what you are doing will generally help to set patients at ease and instill a greater degree of cooperation. Screening and keeping the patient covered as much as possible will prevent both uneasiness and
TUBEX.Place envelope, the TUBEX@ Hypodermic Syringe and a disposable TUBEX@ Isopropyl Alcohol Sponge on a tray to take to the patient's room. In instances where an empty TUBEX Sterile
Orders for medications
DOSAGE AND APPLICATION: Abbreviation aa ad lib . . Derivation ana ad libitum cum cubic centimeter Gram g ra n u m gutta minim quantum sufficit rec ipe sine drach ma uncia . . . . . . . . . . . . . English of each freely as desi red with cubic centimeter Gram grain drop minim a sufficient take without dram ounce amount
ce Gm. (use capital G)
gtt m q.s
. . .
TIME OF ADMINISTRATION: Abbreviation Derivation English . . .
b.i.d H h.S o.d D.n. p.c p.r.n qh (q3h, q4h, etc.) q.i.d. (or 4i.d.) si op. sit stat t.i.d
. . . . . . . . . . .
ante ci bum bis in die hora h 0 ra ni ~ omni d ie om ni nocte post cibum pro re nata quaque hora quater in die si opus sit stati m te r in die .
before meals twice a day hour bed time daily or once daily every night after meals whenever necessary (dose may be repeated) every hour (3, 4, etc.) fou r ti mes a day if necessa ry immediately three times a day
. . . . . . . . .
HOURS: Abbreviation Usual Times
b.i.d o.d D.n. p.c q.i.d q.2.h q.3.h qA.h t.i.d
one-half hour before a meal 10 A.M. and 4 P.M. 10 A.M. 8 P.M. one hour after a meal 8 A.M. ,12 noon, 4 P.M., 8 P.M. 6 A.M. and on even hours day and night 6- 9. 12- 3, etc., day and night 8. 12- 4- 8, etc., day and night usually keyed to meals or specifically designated
. . . . . .
steps for injection with ~
Prefilled TUBEX@ St en.1 C ar t.d ge- N ee dl e U n .t e n I
1. Read the medication
2. Select the TUBEX unit required. 3. Write patient's
name and room number Cartridge-Needle on envelope Unit, and enclose TUBEX cartridge. Syringe and TUBEX@Isopropyl
4. Place TUBEX Sterile
Alcohol Sponge on tray to take to patient.
TO LOAD THE TUBEX HYPODERMIC
5. Grasp barrel of syringe in one hand. With the
other hand, pull back firmly on plunger downward and swing the entire handle-section so that
it locks at right angle to the barrel.
6. Insert TUBEX Sterile Cartridge-Needle
needle ferrule end first, into the barrel. by rotating it clockwise
in the threads
front end of syringe. 7. Swing plunger back into place and attach end to the threaded shaft of the piston. Hold the metal the glass cartridge-with one syringe barrel-not
hand and rotate plunger until both ends of TUBEX Sterile Cartridge-Needle engaged. To maintain Unit are fully, but lightly, sterility, leave the rubber
sheath in place until just before use.
TO ADAPT 2.CC. SYRINGE TO I.CC. TUBEX
The 2-cc. syringe can be used for a l-cc. TUBEX. Engage both ends of TUBEX and push through TUBEX. so the number automatically the slide After use,
itself for 2-cc.
. Prepara tIon steps
f or InJee Ion WI .. t. 'th/ S' Reusable .ynnge
I. Read the medication order.
2. Obtain multiple-dose vial of medication. 3. Using forceps remove the syringe barrel and plunger from the sterile boats. 4. Insert plunger into the syringe barrel. 5. Using forceps remove needle from the sterile tray and attach securely to the syringe. 6. Using alcohol-saturated swab, clean the seal of the multiple-dose vial of medication. which corresponds to the amount of
7. Pull syringe plunger out to the graduation medication ordered. 8. Penetrate
the vial seal with needle and invert syringe and vial so that the vial is on top,
taking care that the needle tip is still in the medication. 9. Depress the plunger on syringe all the way in order to expel the air into the vial. 10. Pull out on syringe plunger until the desired amount of medication has been withdrawn.
II. Withdraw the needle from the vial.
12. Return multiple-dose vial to cabinet. 13. Write patient's name and room number on card. 14. Place card, reusable syringe, and alcohol swab on a sterile tray to take to the patient's room.
IS. Cover tray to maintain sterility.
Units are used with multiple-dose is merely secured into the
vials, the syringe
steps of preparation
are similar to those for reusable syringes. Assembly is not as time concartridge
suming or complicated, since the
and the rubber sheath removed. Sterility is maintained after the cartridge-needle unit has been filled by replacing the rubber needle-sheath until about to give the injection.
Giving the intramuscular
Giving medication by means of the TUBEX@ Closed Injection System or a reusable syringe is basically the same. These illustrations show the technic site 3. Holding the barrel of the syringe in the right
hand in a dart or pencil grip, introduce the needle into the skin with a quick thrust.
of injection with the draped ventrogluteal used as an example.
Using an alcohol sponge or swab, cleanse an area approximately two inches square around the proposed injection site.
4. Once the surface of the skin has been punctured by the needle, the remainder of the penetration of the needle through the skin and into the muscle should be with a firm and steady pressureo In the case of average or heavy patients it is preferable to retain the pressure on the skin around the injection site with the thumb and index fingers of the left hand for the entire time the needle is being inserted. In thin patients, on the other hand, it is often preferable to release the pressure of the left hand once the puncture has been made, and change to a slight pinching grip in order to firm the injection site and avoid the possibility of going too deep and striking a
2. With the index and thumb of the left hand
spread or tense the skin in the injection area.
bone, nerve or blood vessel.
Once the desired depth of insertion
reached, steady the syringe tip with the left hand and with the right hand pull back or out on the plunger approximately seconds, one-quarter inch for a few 7. After the medication pressure against has been injected, site with apply the
to see if any blood
can be aspirated the injection
back into the syringe. syringe,
Should blood appear in the be withdrawn and a
the needle should
new injection site selected.
alcohol sponge in the left hand as the needle is withdrawn by the right leaking hand; this reduces the
risk of medication
into the subcutaneous
tissues and possibly forming abscesses.
the injection that
has been given,
it is imon
all the information
chart. This should include: name of the medication, of administration, side of the body,
If no blood appears, the position of the fingers right hand can be shifted so that the
of injection, strength, including
amount and specific site
on the thumb
covers the head of the plunger fingers are hooked
and the under the
any unusual is com-
index and middle
reaction and your signature. plete until this has been done.
side grips on the syringe barrel. With a firm pressure on the thumb move the plunger downward
into the syringe as far as it will go. (The small air bubble that is last to disappear part of the injection, medication, is an important
by massaging the area with the sponge to remove any blood or medication If rapid absorption that might the be present. massaging is desired,
since it helps to spread the from the needle, of the
clear the medicine
should be continued for about two minutes. 29
seal the injection
site and prevent tracking
medication as the needle is withdrawn.)
After the injection with/
1. Return used TUBEx and tray to nursing station.
2. Replace sheath, using a twisting motion to avoid snagging. To disengage plunger from piston hold the glass cartridge and rotate the plunger counterclockwise. When plunger is disengaged, pull back firmly on plunger and swing the entire handle section downward. Do not pull plunger back before disengaging or syringe will jam. Rotate TUBEx Cartridge-Needle Unit counterclockwise to disengage at front end of syringe and remove from synnge. 3. Before discarding, the sheath-covered needle
should be bent to seal the lumen in order to discourage pilferage or reuse. The syringe, never having come in contact with patient or medication, is returned to storage.
Used TUBEx Cartridge-Needle Units should
not be employed for successive injections or as multiple-dose containers. They are intended to be used only once and discarded.
After the injection witya
I. Return used syringe and tray to nursing station.
2. Fill, eject and rinse syringe with tap water. 3. Disassemble needle from syringe.
4. Fill syringe with detergent or blood solvent and let stand for at least 30 minutes.
5. Place needle in sterilizer for 30 minutes at 250 degrees Fahrenheit to decontaminate and
render safe for handling.
6. Brush syringe barrel interior, plunger and tip with low-sudsing, nonetching detergent.
7. Rinse syringe parts twice in tap water and once in a tray of distilled water. 8. Clean inside of needle hub with a water-saturated
cotton swab containing blood solvent or detergent.
9. Pass a stylet through the interior of the needle to remove any skin tissue, rubber vial
stopper cores, blood or foreign matter. 10. Check needle for sharpness and, if needed, resharpen properly and repeat cleaning process.
II. Rinse entire needle with tap water, including ejecting through the needle with a syringe. 12. Repeat the flushing of the needle with a syringe filled with distilled water. 13. Place syringe and needle in individual paper wrappers and then into a tray ready for sterilizing. 14. Put tray into steam sterilizer, close sterilizer door and set the temperature at 250 degrees
Fahrenheit for 30 minutes.
15. At the end of 30 minutes open the sterilizer door slightly and allow the needle and syringe
to cool and dry for 15 minutes before removing.
16. Store sterile injection equipment in sterile tray or "boats" until required for use.
1. American Academy of Pediatrics: Report of the Committee on the Control of Infectious Diseases 1966 (Red Book), Ed. 15, Evanston, Ill., p. 4. 2. Broadbent, T. R.; Odom, G. L., and Woodhall, B.: Peripheral nerve injuries from administration of penicillin; report of four clinical cases, 1. Am. Med. Assoc. 140:1008 (July 23) 1949. 3. Brown, L. B., and Nelson, A. R.: Postinfectious intravascular
thrombosis with gangrene, Arch. Surg. 94:652 (May) 1967. 4. Butters, A. G.: Intramuscular injections (Correspondence), Brit.
Med. J. 2:1362 (Nov. 18) 1961. 5. Cates, H. A.: Primary Anatomy (Basmajian, J. V., [ed.]), Ed. 4, Baltimore, Williams and Wilkins Co., 1960. 6. Combes, M. A.; Clark, W. K.; Gregory, C. F., and James, lA.: Sciatic nerve injury in infants; recognition and prevention of impairment resulting from intragluteal injections, J. Am. Med. Assoc. 173:1336 (July 23) 1960. 7. Curtiss, P. H., Jr., and Tucker, H. l: Sciatic palsy in premature infants; a report and follow-up study of ten cases, J. Am. Med. Assoc. 174:1586 (Nov. 19) 1960. 8. Gellis, S. S. (ed.): Year Book of Pediatrics, 1965-66, Chicago,
Year Book Medical Publishers, pp. 374, 375; 433-435. 9. Gilles, F. H., and French, J. H.: Postinjection sciatic nerve pal-
sies in infants and children, J. Pediat. 58:195 (Feb.) 1961. 10. Gray, H.: Anatomy of the Human Body (Goss, C.M. [ed.]), Ed. 27, Philadelphia, Lea and Febiger, 1959. 11. Hanson, D. l: Intramuscular injection injuries and complica-
tions, GP 27:109 (Jan.) 1963. 12. Hanson, D. 1.: Acute and chronic lesions from intramuscular injections, Hosp. Formulary Management 1:31 (Sept.) 1966. 13. Hill, L. F.: Sites for intramuscular 1. Pediat. 70:158 (Jan.) 1967. 14. Hill, L. F.: Complication resulting from an intramuscular injection (Letters to the Editor [reply]), 1. Pediat. 70:1012 (June) 1967. 15. Hughes, W.: Pediatric Procedures, Philadelphia, W. B. Saunders Co., 1964, pp. 87-98. injections (Editor's Column),
16. Hughes, W. T.: Complication resulting from an intramuscular injection (Letters to the Editor), J. Pediat. 70:1011 (June) 1967. 17. Intramuscular 16) 1961. 18. Knowles, J. A.: Accidental intra.arterial injection of penicillin, injections (Editorial), Brit. Med. J. 2:758 (Sept.
Am. J. Diseases Children 111 :552 (May) 1966. 19. Kolb, L. C., and Gray, S. J.: Peripheral neuritis as complication of penicillin therapy, J. Am. Med. Assoc. 132:323 (Oct. 12) 1946. 20. Lachman, E.: Applied anatomy of intragluteal injections, Am.
Surgeon 29:236 (March) 1963. 21. Lloyd.Roberts, G. C., and Thomas, in children, T. G.: The etiology of
quadriceps contracture 46B:498 (Aug.) 1964.
J. Bone and Joint Surg.
22. Matson, D.: Early neurolysis in treatment of injury of peripheral nerves due to faulty injection of antibiotics, New Eng!. J. Med. 242:973 (June 22) 1950. 23. Morris, H.: Human Anatomy (Schaeffer, J.P. [ed.]) , Ed. 11, New York, Blakiston Div. McGraw-Hill, 1953. 24. Scheinberg, infants (Feb.) 1957. 25. Shaw, E. B.: Transverse myelitis from injection Am. J. Diseases Children, 111 :548 (May) 1966. 26. Spinal cord damage from injection of penicillin of penicillin, L., and Allensworth, to antibiotic M.: Sciatic neuropathy in
Am. Med. Assoc. 196:730 (May 23) 1966. 27. Talbert, J. L.; Haslam, R. H. A., and Haller, J. A., Jr.: Gangrene of the foot following intramuscular injection in the lateral thigh: a case report with recommendations for prevention, J. Pediat. 70:110 (Jan.) 1967. 28. Turner, G. G.: The site for intramuscular injection, Brit. Med.
J. 2:56 (July 8) 1944. 29. Wolf, 1. J.: A two-stage "controlled" intramuscular technic, Clin. Pediat. 7:230 (April) 1968. 30. Zelman, S.: Notes on techniques avoidance of needless 241 :563 (May) 1961. of intramuscular injection
pain and morbidity,
Am. J. Med. Sci.
Closed Injection System, Wyeth
Unit, Wyeth TUBEX., Hypoderrnlc Syringe, Wyeth SYRINGE
CARTRIDGE STURDY, STAINLESS, UNBREAKABLE
CONTAMINATION-PREVENTING NEEDLE SHEATH
SILICONIZED, Disposable Alcohol Sponge, Wyeth NEEDLE
PRINTED IN U.S.A.~COOE5923R5
This pamphlet on the intramuscular injection of medicines was what was called a “detail” pamphlet. Its main purpose in life was to promote the use and sale of a particular product. These had useful information in them, In fact I cannot remember if I was given these for a particular class while in school, while on rotation in a hospital so I wouldn’t be a complete klutz, while on internship, or because I was lowest in seniority and was therefore delegated to deal with the sales people. The information in this pamphlet, once one ignores the product specific verbiage, is useful and worth having. One never knows when one might just have to give an injection in an emergency situation, refer to earlier comment about not looking like a complete klutz. Also, with the advent of just about any partially trained person giving injections for allergies, Flu vaccinations and the like, maybe it would just be a good idea to know if it is being done right. These particular documents are not seen much anymore, they were well made, high quality, and durable, pretty much pricing them out of existence, particularly since they were handed out free. The cynical might say also because they were useful.