Intramuscular Injection(IM) injection
- 1. WELCOME
- 2. Intramuscular injection With drug calculation
- 3. Introduction Since the 1920s,the health professionals have been aware of the fact the intramuscular injection,which seems to be easy to be administered,may lead to preventable complications. Intramuscular injection, which was first administered by the doctors and then the nurses with the start of the use of penicillin in the 1940s is a frequently administered nursing application. This is the most common way of injecting medication directly into a patient. For rapid absorption of the medicine this is a very useful process because the medicine from this injection is inserted directly into the muscle. This allows the medicine to gain easy access to the blood stream and quickly begin its healing work. Intramuscular injection are the best and safest way of injecting medication into a patient.
- 4. Definitionof intramuscular injection An intramuscular injection is when medication is injected deep into muscles. or, Intramuscular injection is the injection of a substance directly into muscle.
- 5. Purposesof intramuscular injection 1) It is simple and accessible. 2) Adsorption of drug is more rapid. 3) Slightly irritant drug can be given. 4) Moderately large volume can be given(but not more than 5 ml). 5) Intramuscular injection work faster and systemic effect of the drug.
- 6. Sitesofintramuscular injection 1. Deltoid:- 2 finger widths down from the acromion process; the bottom edge is at an imaginary line drawn from the axilla.
- 7. 2.Ventrogluteal:- With thumb toward the umbilicus, place palm of hand on the greater trochanter, index finger on the anterior superior iliac & the middle finger on the iliac crest.
- 8. Continue… 3.Vastus lateralis:- Place one hand below the greater trochanter & one hand above the lateral femoral condyle; mid-lateral thigh.
- 9. Continue… 4.Dorsal gluteal(greatest risk of injury):- Draw an imaginary line between the greater trochanter & the posterior superior iliac spine; at the middle of the imaginary line; go up about one inch.
- 10. Continue… 5.Others:- Quadricep site Rectus femoral site Tricep muscle
- 11. Anglesof intramuscular injection Intramuscular at 90 degree angle. Subcutaneous at 45 degree angle. Intradermal at 10-15 degree angle.
- 12. Intramuscular injection needle lengthPatient age Injection site Needle size New born(0-28days) Anterolateral thigh muscle 5/8’’ (22-25gauze) Infant(1-12months) Anterolateral thigh muscle 1’’(22-25guaze) Toddler(1-2years) Anterolateral thigh muscle Alternate site: Deltoid muscle of arm if muscle mass is adequate. 1-1 ¼’’(22-25gauze) 5/8 -1’’(22-25gauze) Children(3-10 years) Deltoid muscle(upper arm) Alternate site: Anterolateral thigh muscle 5/8-1’’(22-25gauze) 1-1 ¼’’(22-25gauze) Children &adults(11years & older) Deltoid muscle(upper arm) Alternate site: Anterolateral thigh muscle 5/8-1’’(22-25gauze)s 1-1 ¼’’(22-25guaze)
- 14. Calculating dose The nurse must be prepare the dose accurately.The quantity for administration can be easily calculated using a standard formula. D X Q Drug calculation formula: ----------- H Here, D=Desired dose Q=Quantity H=dose on hand(supplied dose)
- 15. Exampleofdrug calculation A physician order Tranal 50 mg given intramuscularly to a patient. How will you give it? We know that, Drug calculation formula is = DXQ H = 50 X 2 100 = 100 100 = 1 ml Here D=50 mg H=100 mg Q=? 50 mg = 1 ml 1 mg = 1 ml 50 100 mg = 1 x 100 ml 50 =2 ml
- 16. Advantagesof intramuscular injection i. Rapid onset of action. ii. Uniform absorption. iii. Long duration of action. iv. Suitable for vaccine.
- 17. Disadvantagesof intramuscular injection i. Painful. ii. Chance of hematoma. iii. Chance of neurovascular bundle injury. iv. Large volume can not be administered.
- 18. Precautionsof intramuscular injection 1) Never use the same needle & syringe to inject more than one person. 2) It is important to know what reactions a medicine can produce & to take the recommended precautions before injecting. 3) If any signs of allergic or poisonous reaction appear, never give the same or similar medicine again. 4) Select the proper site & needle size according to age, weight of the patient & medication viscosity. 5) Maintain sterile technique properly.
- 19. Procedureof intramuscular injection Equipment:- 1) Sterile container/kidney tray. 2) Cotton. 3) Gloves. 4) Antiseptic solution. 5) Sterilized syringe & needle-3cc,5cc,10cc according amount of medication. 6) Required medicine(in vail or ampoule). 7) Ampoule of sterile water. 8) Gauze pieces if needed. 9) Forceps.
- 20. Continue… Procedure:- 1) Check patients name & medication order, including rights of administration of oral medication to the patient:- i. Right patient. ii. Right dose. iii. Right drug. iv. Right time. v. Right route. vi. Right assessment. vii. Right approach.
- 21. Continue… vii. Right education. viii.Right prescription. ix. Right nurse clinician. x. Right principle of care. xi. Right evaluation. xii. Right documentation.
- 22. Continue… 2)Explain procedure to the patient. 3)Perform hand washing. 4)Withdraw medication from an ampoule or vial. 5)Do not add air to the syringe. 6)Provide for the privacy. Have the patient assume a position appropriate for the site selected. 7)Ensure that the area is not tender & is free of lumps or nodules. 8)Clean the area thoroughly with an alcohol swab, using friction. Allow alcohol to dry. 9)Quickly dart the needle into the tissue at a 90 degree angle.
- 23. Continue… 10)As soon as the needle is in place, use non-dominant hand to hold the lower end of the syringes. Slide dominant to the tip of the barrel. 11)Aspirate by slowly(for last 5 seconds)pulling back on the plunger to determine whether the needle is in a blood vessel. If blood is aspirated, discard the needle, syringes & medication, prepare a new sterile set up & inject at another site. 12)If no blood is aspirated, injected the solution slowly. 13)Remove the needle slowly & steadily. 14)Assist the patient to a position of comfort. 15)Remove gloves & dispose of the properly. Perform hand hygiene.
- 24. Continue… 16)Chart the administration of the medication, include the site of administration. 17)Evaluate the patients response to the medication within an appropriate time frame. Assess the site, if possible, within 2 to 4 hours after administration.
- 25. Complicationof intramuscular injection Early(days to weeks) Swelling Redness Pain Bruising/ecchymosis Itching Infections Allergic reaction/hypersensitivity Inflammation Solid nodules Lumps caused by misdistribution Tissue necrosis Embolism with blindness
- 26. Continue…. Delayed(weeks to years) Granulomatous inflammation/foreign body reaction Nodules, erythematous or not Migration of the implanted filler Scarring Asymmetry
- 27. Nursingcareplan Nursing diagnosis Goal Nursing intervention Evaluation 1) Fear & anxiety due to administration of intramuscular injection. To reduce fear & anxiety. i. Explain the procedure to the patient. ii. Psychological support to the patient. iii. Maintain patient privacy. Minimize fear & anxiety. 2) Risk for developing complication. To prevent complication. i. Proper hand washing. ii. Put sterile gloves. iii. Use sterile needle. iv. Pushing injection in the safe area. Gradually reduce complication.
- 28. Continue…. Nursing diagnosis Goal Nursing intervention Evaluation 3) Deficit knowledge about intramuscular injection. Increase knowledge by providing information about intramuscular injection. i. Encourage the patient. ii. Explain the patient about complication of intramuscular injection. Patient acquire knowledge about intramuscular injection.
- 29. Summary Intramuscular injection is the injection of a substance directly into muscle. In medicine, it is one of the several alternative methods for the administration of medications. Intramuscular injection is a parenteral technique that maintains several advantages over enteral techniques, making it potentially useful in the management of pain & anxiety.When giving intramuscular injection a nurse must be remembered that----- ‘’Save one life you are a hero, Save one hundred lives & You are a nurse’’ So responsibility is the vital points for giving intramuscular injection.
- 30. References Dr.Md.Mokbul Hossain MMBS;M phil(pharmacology),A handbook of easy pharmacology. Hesperian Foundation,1993,516p;WhereThere Is No Doctor-A village Health Care Handbook. Sk-Md.ZahirulAlam;RN(BNC),BSN(DU),MPH-Hospital management & Nutrition; Fundamental of nursing and Health Assessment. Correspondence to: • www.alfa.saddle.back.edu • www.immunize.org/catd/p2020.pdf • www.sciencedirect.com • www.pharmatips.in • Knowledge concering.com
- 31. Thanks