What actions should the nurse perform when administering an IM injection?
Good injection technique can mean the difference between less pain and injury. Angela Cocoman and John Murray explain Show The administration of intramuscular injections is a common nursing intervention in clinical practice.1 This article aims to, raise awareness in relation to the injection sites used for intramuscular injection and, to highlight best practice in relation to IM injection administration. The importance of good injection technique cannot be understated. It should not be forgotten that among potential complications of IM injection are abscess, cellulites, tissue necrosis, granuloma, muscle fibrosis, contractures, haematoma and injury to blood vessels, bones and peripheral nerves.2 Although IM injection is a commonplace nursing practice, there is a dearth of guidelines for nursing staff in this area.3,4 It has been outlined that there are no working policies or procedures on administering injections to which nursing staff can refer.3 Furthermore, the technique and preparation by certain staff may not be substantiated by evidence.4 Sites of the thigh (Rectus femoris and Vastus lateralis)
The thigh may be utilised when other sites are contraindicated or by clients who administer their own medication, as it is readily available in the sitting or lying back position. However, the main disadvantage is that injections in the Rectus femoris site may cause considerable discomfort.6 This site can be used for infants, children and adults. Needle length used is usually 2.5cm or less. The dorsogluteal site
The presence of major nerves and blood vessels, the relatively slow uptake of medication from this site compared with others and the thick layer of adipose tissue commonly associated with it, makes this site problematic.7 The sciatic nerve and superior gluteal artery lie only a few centimetres distal to the injection site, thus great care needs to be taken to identify landmarks accurately. Palpating the ileum and the trochanter is important; using visual calculations alone can result in injection being placed too low and injuries to other structures.8 Risks associated with an IM injection to the dorsogluteal site
The deltoid site
It is important to limit volume of medication based upon size of muscle, ie. 0.5-2ml. The ventrogluteal site The ventrogluteal site has come to attract significant attention in the nursing literature and there is wide agreement that this site is the preferable site for intramuscular injection.2 There is a dearth of research in this area in Ireland as to the extent to which the ventrogluteal site is used.
Administrating an IM injection
It has been suggested4 that the following points should be incorporated into clinical guidelines:
These measures should ensure optimal nursing care for patients. Angela Cocoman is mental health lecturer at DCU and John Murray is a community mental health nurse for Water ford Mental Health Services (HSE South Eastern Area) References
All rights reserved by INMO. Please don't use without permission What are the steps for administering a proper IM injection?Your thumb should point to the person's groin and your fingers point to the person's head. Pull your first (index) finger away from the other fingers, forming a V. You may feel the edge of a bone at the tips of your first finger. Put the injection in the middle of the V between your first and middle finger.
What should you do before administering an injection?Before starting the injection session, and whenever there is contamination with blood or body fluids, clean the preparation surfaces with 70% alcohol (isopropyl alcohol or ethanol) and allow to dry. Assemble all equipment needed for the injection: –
When giving an IM injection Do you aspirate?Aspiration is most commonly performed during an intramuscular (IM) or subcutaneous (SC) injection, and is meant to ensure that the needle tip is located at the desired site, and has not accidentally punctured a blood vessel.
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