Transcript Aplikace intramuskulárních injekcí

IM administration of medications
Mgr.Renata Vytejčková
Ústav ošetřovatelství 3.LF UK
Intramuskular injections
Administering of a medication into a
muscle
 Volume 1 – 10 ml
 Purpose: therapeutic or prophylactic
 Effect within 10-15 min
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The advantages of IM administration
Faster absorption then s.c.
 Larger volume
 Appropriate for medications that irritate
subcutaneous tissue
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Places of administration
Musculus gluteus medius
 Musculus gluteus maximus
 Musculus quadriceps femoris
 Musculus deltoideus
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Administration into gluteus medius
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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
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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
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Administration into the musculus
vastus lateralis
Administration into the thigh muscle
The equipment
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The order sheet
Medication
Sterile syringe
Sterile needles (to
withdraw and
administer)
Swabs
Band aid
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File
 Disinfection
 Emesis basin
Needle selection
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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
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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
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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 syringe
 Spread the skin laterally approximately
3cm away from the injection site
 Hold the skin taut until you remove the
needle
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Z-track method
Medications injected i.m.
Analgesics
 Antibiotics
 Premedication in surgery
 Vaccines
 Other
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Complications
Infiltrate formation
 Vein puncture
 Hitting a bone
 Hitting a nerve
 Abscess formation
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Infiltrate formation
In absence of site rotation
 Formation of granulation tissue
 Medication easily absorbed into vascular
bed
 Mikroembolization
 Prevention – site rotation
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Vein puncture
Blood in the syringe
 Interrupt the procedure
 Take a new needle and select another
injection site
 Risk of embolism
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Hitting a nerve
Most often the nervus ischiadicus
 The cause – improper selection of
injection site (too low, too close to the
middle)
 Burning, tingling, pain radiating into the
leg
 Risk of paralysis
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Abscess formation
In case of oil substances
 Administration into fat tissue or not deep
enough into the muscle
 Short needle, inappropriate injection site
selection
 Redness, pain, mass
 Sometimes elevated temperature
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Hitting the bone
Often in very thin patients
 The needle can bend, little hook at the
tip of the needle will tear the tissues
 The needle can break, remain in the
tissue
 X-ray control, surgical removal
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