Intramuscular Injection - StatPearls - NCBI Bookshelf Retrieved February 11, 2023, from, Lilley, L.L., Rainforth Collins, S., Snyder, J.S. To decrease risk of local adverse events, non-live vaccines containing an adjuvant should be injected into a muscle. Chapter 9: Photo atlas of drug administration. Older adults and thin patients may only tolerate up to 2 ml in a single injection. WebDeltoid injection volume . * the subcutaneous tissues are not *The anterolateral thigh may be Next, the lower edge of the acromion process, which forms the base of a triangle in line with the midpoint of the lateral aspect of the upper arm, is palpated. 2. (2023). In general, the recommended needle length for an adult is 25 mm to 38 mm (1 to 1 1/2 inch). Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted. The needle is inserted at a 90-degree angle perpendicular to the patients body, or at as close to a 90-degree angle as possible. 16. Assess the site and apply a bandage if needed. Reactions may include anaphylaxis, anaphylactic shock, and neurologic deficits.10 Vaccine adverse event reporting is monitored by the Centers for Disease Control and Prevention. WebAugmentin (amoxicillin/clavulanic acid) is an antibiotic that is available as a 150 mg/mL strength injection. Insert the needle with a dart-like motion. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. How to Administer an Intramuscular Injection in the Deltoid Allow site to dry completely. Knowledge of body mass can be useful for estimating the appropriate needle length (26). Do not massage site. The only exceptions are medications that are still in their original container or medications that are administered immediately by the person who prepared them. The doses should be administered as soon as possible after filling, by the same person who filled the syringes. Intramuscular Injection: To avoid the danger of subcutaneous fat atrophy, it is important to ensure that deep intramuscular injection is given into the gluteal site. With the dominant hand, inject the needle quickly into the muscle at a 90-degree angle, using a steady and smooth motion. The dorsogluteal site should be avoided for intramuscular injections. Vaccine recommendations and guidelines of the ACIP: Vaccine administration. After the needle pierces the skin, use the thumb and forefinger of the nondominant hand to hold the syringe barrel while still pulling on the skin. Checklist 58 outlines the steps to perform an IM injection. Children and infants will require shorter needles. For example, varicella vaccine should be discarded if not used within 30 minutes after reconstitution, whereas MMR vaccine, once reconstituted, must be kept in a dark place at 36F to 46F (2C to 8C) and should be discarded within 8 hours if not used. Apply a dry cotton ball or gauze with light pressure for several seconds over the site. PharmaCare Newsletter - Province of British Columbia ), Centers for Disease Control and Prevention (CDC). injection Assemble medication, non-sterile gloves, syringes, needles, and sharps container. Assess patients response to the medication after the appropriate time frame. Administering volumes smaller than recommended (e.g., inappropriately divided doses) might result in inadequate protection. 2. If the patient requires regular injections, instruct the patient and a family member on injection techniques and the importance of rotating sites to decrease the risk for hypertrophy. Select needle length based on age, weight, and body mass. Locate correct site using landmarks, and clean area with alcohol or antiseptic swab. However, if 2 half-volume formulations of vaccine have already been administered on the same clinic day to a patient recommended for the full volume formulation, these 2 doses can count as one full dose. Apply gentle pressure to the site; do not massage. WebLocate the deltoid injection site, as described above. Review medication reference information pertinent to the medications action, purpose, onset of action and peak action, normal dose, and common side effects and implications. Additional information about implementation and enforcement of these regulations is available from OSHA. The anterolateral thigh can also be used. Lack of blood in the syringe confirms that the needle is in the muscle and not in a blood vessel. 24. Placing sharps in appropriate puncture-proof and leak-proof receptacles prevents accidental needle-stick injuries. Intramuscular Injection Document the procedure in the patients record. 13. If a needle hits the sciatic nerve, the patient may experience partial or permanent paralysis of the leg.5 The rectus femoris is no longer considered a safe injection site because of the risk of damage to the descending branch of the lateral circumflex femoral artery and the muscle branch of the femoral nerve to the vastus lateralis.6. The deltoid muscle is located by fully exposing the patients upper arm and shoulder and asking the patient to relax the arm at the side or by supporting the patients arm and flexing the elbow. Always wear gloves to administer injections. Deltoid injection Discoloured or outdated medication may be harmful. Needle-shielding or needle-free devices that might satisfy the occupational safety regulations for administering injectable vaccines are available in the United States (12-13). ACIP discourages variations from the recommended route, site, volume, or number of doses of any vaccine. Place safety shield on needle and discard syringe in appropriate sharps container. This can lead to violation of expiration dates and product contamination (6,7). Self-administration of an IM injection is difficult. In the pediatric population, a mean volume of 365 mL of hyaluronidase-facilitated isotonic solution was infused for a mean 3.1 hours. (e) Some experts recommend a 1-inch needle if the skin is stretched tightly and subcutaneous tissues are not bunched. Vaccines 9. Perform hand hygiene before patient contact. 13. Thanks. An IM site is chosen based on the age and condition of the patient and the volume and type of medication injected. Deviation from the recommended route of administration might reduce vaccine efficacy (14-15) or increase the risk for local adverse reactions (16-18). Once medication is completely injected, remove the needle using a smooth, steady motion. Abstract. (b) Note that prefilled syringes of High-Dose Fluzone have a volume of 0.7 cc and the recommended volume of administration is 0.7 ccs. If a needle hits the sciatic nerve, the patient may experience partial or permanent paralysis of the leg. GHGoonette, BSN, RN 1,249 Posts Specializes in PACU, OR. Label all medications, medication containers, and other solutions. Wodi, A.P., Shimabukuro, T. (2021). Only give injections that are less than 0.5 mL into the deltoid. 19. Children weighing less than 30 kgDose is based on body weight and must be determined by your doctor. However, this site is not common for self-injection because its small muscle mass limits the volume of medication that can be injected typically no more than 1 Children can be very anxious or fearful of needles. These cookies may also be used for advertising purposes by these third parties. Although the deltoid site is easily accessible, the muscle is not well developed in many adults. U.S. Food and Drug Administration (FDA). Government Appropriate needle length depends on age and body mass. Providers should address circumstances in which dose(s) of these vaccines have been administered subcutaneously on a case-by-case basis. Source: Adapted from California Immunization Branch. Assemble medication, non-sterile gloves, alcohol swabs, syringes, needles, and sharps container. For the ventrogluteal muscle of an average adult, give up to 3 ml of medication. (b) If skin is stretched tightly and subcutaneous tissues are not bunched. This prevents needle from touching side of the cap and prevents contamination. Jet injectors are needle-free devices that pressurize liquid medication, forcing it through a nozzle orifice into a narrow stream capable of penetrating skin to deliver a drug or vaccine into intradermal, subcutaneous, or intramuscular tissues (32-33). Question 10a The width of the muscle used extends from the mid-line of the thigh to the mid-line of the outer thigh. Sites for intramuscular injections include the ventrogluteal, vastus lateralis, and the deltoid site. Has 25 years experience. For women who weigh >200 lbs (>90 kg) or men who weigh >260 lbs (>118 kg), a 1.5-inch needle is recommended (table 6-2) (20). St. Louis: Elsevier. 27. WebDeltoid Muscle Administer vaccine using either a 1-mL or 3-mL syringe.5/8 in (16 mm) Use a 22- to 25-gauge needle. Variation from the recommended route and site can result in inadequate protection. 23. Providers should consult package inserts for details. Vaccine from two or more vials should never be combined to make one or more doses. When possible, IM injections should be avoided in muscles that are emaciated or atrophied because these muscles absorb medication poorly.5, Aspiration before injection and slow injection of the medication are not supported by research for vaccine administration.2 The vastus lateralis and deltoid muscle are the only two sites recommended for vaccine administration because these sites do not contain large vessels that are within reach of the needle.2 For all other medications, there is no evidence to either support or abandon the practice of aspiration before administration. in (25 mm) Men and women,Men and women, less than 60 kg* (130 Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries; final rule. 19. The location of all injection sites with the corresponding vaccine injected should be documented in each patients medical record. However, needle sizes from 22 mm to 25 mm can be used for older children. Comfort measures, such as distraction (e.g., playing music or pretending to blow away the pain), cooling of the injection site(s), topical analgesia, ingestion of sweet liquids, breastfeeding, swaddling, and slow, lateral swaying can help infants or children cope with the discomfort associated with vaccination (40-42). Hold syringe between thumb and forefinger on dominant hand as if holding a dart. Injection technique is the most important parameter to ensure efficient intramuscular vaccine delivery. Rarely, an adverse reaction occurs after immunizations. Bloodborne diseases (e.g., hepatitis B, hepatitis C, human immunodeficiency virus [HIV]) are occupational hazards for clinicians and other health-care providers. They help us to know which pages are the most and least popular and see how visitors move around the site. How and where is a deltoid IM injection given? - Drugs.com To decline or learn more, visit our cookies page. Displace skin in a Z-track manner by pulling the skin down or to one side about 2 cm (1 in.)