Steps for Administering a Intramuscular Injection:

Procedure for administering intramuscular injection:
1. Review the order and check patient allergies.
2. Wash hands and put gloves on.
3. Identify the patient (remember six rights).
4. Position patient and locate site using appropriate anatomical landmarks.
5. Wipe site with alcohol in a circular motion to cleanse, allow to dry.
6. Spread skin taut and insert needle at a 90 degree angle.
7. Aspirate and observe for blood in syringe. If blood appears remove and
discard needle.
8. Inject medication slowly, remove needle quickly and gently apply
pressure to site with dry 2x2 gauze.

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Z-Track Method of Intramuscular Injection

The Z-Track method of IM injection is used to administer a drug into a large muscle, it prevents leakage of a irritating medication into the subcutaneous tissues. When using this method the skin is pulled to the side, the medication is injected and the skin is released. Here a seal is formed over the IM site which prevents seepage of the medication into the tissue. Z-Track method pictured above.

Sites For Intramuscular Injection

Video demonstrating sites of injection.

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Needles for Intramuscular Injections:

The syringe size for intramuscular injections ranges from 3 to 5 ml. The needle size and length vary according to factors such as the muscle to be used, the type of solution, how much adipose tissue is covering the muscle and the age of the patient.
The gauge (or opening diameter) of the needle varies from #18-#28. For intramuscular injections a longer needle is used to reach the muscle, commonly the length is 1-1 1/2 inches. The gauge for intramuscular injections is larger, from #20-#22. Some examples of situations that may alter the choice of needle length and gauge would be the slender adult or child that would require a shorter needle or a more viscous solution that would require a larger gauge.

Questions:

1. What is the preferred site for intramuscular injections?

2. True or false, The dorsogluteal site is the preferred site for children under three?

3. True or false, It is safe to administer less than 1 ml of solution into the deltoid area?

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Intramuscular Injection Sites

 Intramuscular Injection Sites and Their Landmarks

1.      Ventrogluteal site: Is the most comfortable and safest for IM injections. This site is not close to any major blood vessels or nerves. The landmarks for this site include the greater trochanter, anterior superior iliac spine and iliac crest. With the patient on their side place the palm of your hand on the greater trochanter, the index finger on the anterior superior iliac spine and the middle finger pointing toward the iliac crest. View diagram below:

                               

2.      Deltoid site: This site is most common for small volumes. To inject into this site you must first locate the acromion process, place a finger on the process and measure 3 fingerbreadths down. The injection is given into the fullest part of the deltoid. View diagram below:

              

    

3.       Vastus Lateralis: Is located on the lateral aspect of the thigh, it is the number one site for newborns and infants who have not developed any of the gluteal muscles or the deltoid muscle. Have patient assume a supine position, divide the thigh into thirds. Place one hand next to the head of the trochanter and the other hand just above the patella. The area between your hands is the middle third; this is where the injection is given into the fullest portion of the muscle. View diagram below:

       

4.      Dorsogluteal site: This site is never used in infants and small children. Because of the proximity to the sciatic nerve it is only used as a last resort in adults. The landmarks for this site are the posterior superior iliac spine and the greater trochanter. An imaginary line is drawn between the two landmarks. Find the center of the line and move one inch above the line. View the diagram below:

            

Hope this helps!

Dorsogluteal Injection

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