Transcript Slide 1

Intramuscular Injection
June Levine RN MSN
National Consultant AmbulatoryNursing
Ben Hudnall Memorial Trust
Which Site Should I Use?
Consider:
 age of the client
 medication to be injected
 client’s general condition
Sites
 Vastas Lateralis
 Deltoid
 Ventrogluteal
SITES OF THE THIGH
Vastus lateralis muscle preferred
Rectus femoris muscle rarely used except
for infants & self-administered injections
Vastas Lateralis
 Safe, rapid absorption
 Can be used for infants, children
& adults
 Needle length usually 1 inch or less
Location:
 one handbreadth above the knee
 one handbreadth below the greater
 medial lateral portion of the thigh
Vastas Lateralis
 Look at the thigh that will get the shot. In your mind,
divide the thigh (the area between the knee and the
hip) into three equal parts. The middle third is where
the shot will go.
 This muscle is called the vastus lateralis. It runs along
the top of the thigh (the front) and a little to the
outside. Put your thumb in the middle of the top of
the thigh, and your fingers along the side. The muscle
you feel between them is the vastus lateralis
Vastas Lateralis
Vastas Lateralis
Vastis Lateralis
 The infant’s diaper must be undone to ensure the
injection site is completely exposed and the
anatomical markers easily identified.
 Position the leg so that the hip and knee are flexed
and the vastus lateralis is relaxed
 Draw an imaginary line between the 2 markers down
the front of the thigh. The correct site for IM
vaccination is lateral to the midpoint of this line, in
the outer (anterolateral) aspect
 Do not inject into the anterior aspect of the thigh
where neurovascular structures can be damaged
Vastis Lateralis
Deltoid (DEL-toyd) Muscle (Upper
arm muscle) Site
 Used for immunizations, nonirritating
medications
 Risk of injury to the brachial artery &
radial nerve
 Limit volume of medication based upon
size of muscle - 0.5 - 2 ml / cc
Deltoid – Locating the Site
 The person getting the shot can be sitting, standing or
lying down
 It is essential to expose the arm completely from the top
of the shoulder to the elbow when locating the deltoid
site. Roll up the sleeve or remove the shirt if needed.
 Place fingers on the patient’s shoulder
 Feel for the bone that goes across the top of the upper
arm This bone is called the acromion process
 The bottom of it will form the base of the triangle
 Place index & middle finger on landmark, creating an
inverted triangle
 The point of the triangle is directly below the middle of
the base at about the level of the armpit.
 You will give the shot in the center of an upside down
triangle, 1 to 2 inches (2.5 to 5 cm) below the bottom of
the acromion process
Deltoid
Deltoid Site
Deltoid and Ventrogluteal Sites
Ventrogluteal (ven-trow-GLUEtee-ull) Muscle (Hip):
The hip is an area with good bone
landmarks and very little danger of
hitting blood vessels or nerves. It is a
good place for a shot for adults and
children over 7 months old. The
person getting the shot should be
lying on his or her side.
Ventrogluteal Site
 First you must determine which hand you will use to
locate the IM injection site by the position the patient is
in, for example if the patient is on their right side you
would use your right hand to find the landmarks.
 So using the example, a person is lying on their right
side so you would take your right hand and place it on
their greater trochanter, depending on the length of your
fingers you would then place your index finger on the
anterior superior iliac spine or point your finger in that
direction with the thumb pointed at the groin, all other
fingers should be pointed at the patient's head.
 Once your hand is in position move your middle finger
back along the iliac crest towards the buttock as far as
you are able to go. This forms the triangle with the index
and middle finger and the center of that triangle is the
injection site for a ventrogluteal injection.
Ventrogluteal Site
To find the correct place to give a shot in the hip to another
person:
 Place the heel of your hand on the hip bone at the top of
the thigh. Your wrist will be in line with the person's
thigh.
 Point your thumb at the groin, fingers point to the
person’s head.
 Form a “V” with your fingers by opening a space
between your pointer finger and the other three fingers.
 Your little finger and ring finger will feel the edge of a
bone along the fingertips.
 The place to give the shot is in the middle of the Vshaped triangle.
Ventrogluteal Site
 The volume of drug that can go the ventrogluteal
route is 1.0 - 4.0 ml for well developed muscles, but a
child under 2 years old should receive no more than 1
ml in the ventrogluteal site.
 The gauge of needle can be 21-25, with a length of
1.5 inches for the average sized adult; the needle
would be much shorter for skinny individuals and
children. Larger patients may require a needle that is
larger than 1.5 inches to make sure the needle makes
it through the adipose tissue (fat).
 Be sure that the angle of all ventrogluteal injections is
90 degrees.
Ventrogluteal Site
Ventrogluteal Site
Ventrogluteal Site
Ventrogluteal Site
Ventrogluteal Site
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The child’s nappy must be undone to ensure the injection site is
completely exposed and the anatomical markers easily identified
by sight and palpation. Anatomical markers are the anterior
superior iliac spine (ASIS), the greater trochanter of the femur and
the iliac crest (see Figure 1.4.7).
Place the child in a prone position (face-down) on parent/carer’s
lap or on the clinic table/bed with arms tucked against the child’s
chest. Allow the child’s legs to dangle towards the floor (see Figure
1.4.8).
The knee and hip should be turned inwards to encourage muscle
relaxation at the injection site.
The injection site should be that which is closest to the
immunization service provider.
Place the palm over the greater trochanter (the uppermost bony
prominence of the thigh bone) with the thumb pointing towards
the umbilicus. The index finger points to the anterior superior iliac
spine, and the middle finger is spread so that it aims at the iliac
crest, thus creating a ‘V’ outlining the ventrogluteal triangular
area. The injection site is at the centre of this area
Dorsogluteal
Dorsogluteal (door-so-GLUE-tee-ull) Muscle (rearend): The upper rear end area is the area where
most people have gotten shots. Expose one entire
cheek of the rear-end. With an alcohol wipe draw a
line from the top of the crack between the cheeks to
the side of the body. Starting in the middle of the
same side, draw another line across the first one with
the alcohol wipe. Start from about 3 inches above the
first line to about half way down the middle of the
cheek. You should have drawn a cross. In the upper
outer square you will feel a curved bone. The shot will
go in the upper outer square below the curved bone.
Read more: http://www.drugs.com/cg/how-to-givean-intramuscular-injection.html#ixzz0xr4fKzGc
IM Injections
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Spread the skin to ensure firmness
90°angle
Insert needle quickly, dart-like fashion
ALWAYS aspirate prior to injection
 Remove needle quickly in the same
direction as insertion
ACTIVATE NEEDLE SAFETY
References
 www.health.gov.au The Australian
Immunization Handbook. 3/26/2008 Images
downloaded august 36, 2011
 academic.cuesta.edu/desmith/iminject.pdf
 Lippincott’s Nursing Procedures, 5th Ed.
Williams & Wilkins 2009
 http://www.drugs.com/cg/how-to-give-anintramuscular-injection.htmal