IM administration of medications

Mgr.Renata Vytejčková

Ústav ošetřovatelství 3.LF UK

Intramuskular injections

Administering of a medication into a muscle

Volume 1 – 10 mlPurpose: therapeutic or prophylacticEffect within 10-15 min

The advantages of IM administration

Faster absorption then s.c.Larger volume Appropriate for medications that irritate

subcutaneous tissue

Places of administration

Musculus gluteus mediusMusculus gluteus maximusMusculus quadriceps femorisMusculus deltoideus

Administration into gluteus medius

Middle finger palpates crista iliaca Thumb palpates spina iliaca anterior superior Thumb into position between trochanter major

and crista iliaca Insert needle into the space between thumb

and index finger, 60° appr. 5 cm deep Not appropriate in children below 3 years of

age and very thin patients The patient is lying on either side, the upper

leg bent in hip and knee, lower leg straight

Administration into musculus gluteus medius

Gluteus muscles

Administration into musculus deltoideus

Administration into the musculus deltoideus

Administration into the gluteus maximus

Palpate crista iliaca, spina iliaca anterior superior a spina iliaca posterior superior

Make a vertical line between the two spinas The lateral (outer) space is the proper injection

site Use 90° angle The four quadrants methods is possible

alternative Patient is in prone position, toes turned inward

Administration into the musculus gluteus maximus

Administration into the musculus gluteus maximus

Administration into the thigh muscle

The lateral (outer) middle third of the thigh

Place one hand just below the trochanter and the other just above the patella, the space between the thumbs can be used for administration

Supine position, lower extremity slightly flexed and relaxed

Administration into the musculus vastus lateralis

Administration into the thigh muscle

The equipment

The order sheet Medication Sterile syringe Sterile needles (to

withdraw and administer)

Swabs Band aid

File Disinfection Emesis basin

Needle selection

In thin patients use shorter needle (4-5cm)

In well developed muscles or obese patients use longer needle (5-6cm)

In case of oily substances or antibiotics use needle with large diameter

The procedure

Inform the patient, ask him to position himself properly

Palpate the injection site Disinfect the skin Hold the syringe

perpendicularly, support the needle

Use the thumb and the index finger to taut the skin

Gently but quickly insert the needle between the two fingers 3-5 cm deep, use 90° angle

Use 60-70° angle in thin patients

Aspirate Slowly inject the medication If there is blood in the syringe

do not proceed and change the medication

Sometimes appropriate to aspirate again during the injection

Remove the needle quickly Cover the injection site with

band aid Document the procedure

Z-track method

For medications that may irritate subcutaneous tissues

Leave a small bubble in the syringeSpread the skin laterally approximately

3cm away from the injection siteHold the skin taut until you remove the

needle

Z-track method

Medications injected i.m.

AnalgesicsAntibioticsPremedication in surgeryVaccines Other

Complications

Infiltrate formationVein punctureHitting a bone Hitting a nerveAbscess formation

Infiltrate formation

In absence of site rotation Formation of granulation tissue Medication easily absorbed into vascular

bed MikroembolizationPrevention – site rotation

Vein puncture

Blood in the syringeInterrupt the procedureTake a new needle and select another

injection site Risk of embolism

Hitting a nerve

Most often the nervus ischiadicusThe cause – improper selection of

injection site (too low, too close to the middle)

Burning, tingling, pain radiating into the leg

Risk of paralysis

Abscess formation

In case of oil substances Administration into fat tissue or not deep

enough into the muscleShort needle, inappropriate injection site

selectionRedness, pain, massSometimes elevated temperature

Hitting the bone

Often in very thin patientsThe needle can bend, little hook at the

tip of the needle will tear the tissues The needle can break, remain in the

tissueX-ray control, surgical removal

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