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Allow the skin to dry completely. If the gluteal muscle must be used, care should be taken to define the anatomic landmarks. Aspiration refers to the action of pulling back on the plunger for 5 seconds prior to injecting medication (Ipp, Sam, & Parkin, 2006). Current practice in the acute care setting is to aspirate IM injections to check for blood return in the syringe. Distraction, such as blowing bubbles and applying pressure at the injection site before giving the injection, may help alleviate the childs anxiety. With IMs, there is an increased risk of injecting the medication directly into the patients bloodstream. Encourage questions and answer them as they arise. Document procedure as per agency policy. For screening, the HI assay was performed by thestandard Clarke and Casals technique using dengue referencestrains.11A test dilution 1:10 (a) If the gluteal muscle is chosen, injection should be administered lateral and superior to a line between the posterior superior iliac spine and the greater trochanter or in the ventrogluteal site, the center of a triangle bounded by the anterior superior iliac spine, the tubercle of the iliac crest, and the upper border of the greater trochanter. 7.4: Intramuscular Injections - Medicine LibreTexts The skin is held in this position until the injection has been administered. Historic concerns about exposure to vaccine components are limited to non-parenteral vaccines in which some degree of environmental exposure is unavoidable (5, 8), or situations in which self-inoculation is likely due to the nature of the vaccine microbe [e.g. Avoid moving the syringe. Ensuring the sharps container is close by allows for safe disposal of the needle. reduced attenuation of smallpox vaccine virus (9)]. 17. The concern should be explored, the practitioner notified, and the order verified. Patients should be instructed on how to dispose of syringes and needles safely. However, the immunogenicity for persons aged 65 years is inadequate, and varying the recommended route and dose either with the intradermal product licensed through 64 years of age or with other influenza vaccines is not recommended (24). Once medication is completely injected, remove the needle using a smooth, steady motion. For a well-developed adult, no more than 3 ml of medication should be administered in a single IM injection because the muscle tissue does not absorb it well in larger volumes.5 For smaller adults or those with less muscle mass, the volume injected may need to be adjusted. Options for safe sharps disposal at home include allowing patients to transport their own sharps containers from home to collection sites (e.g., practitioners office, hospital, pharmacy), mailing their used syringes to a collection site (mail-back programs), participating in syringe exchange programs, or using special devices that destroy the needle on the syringe, rendering it safe for disposal. Chapter 4: Vaccine safety. 6. Review medication information, such as purpose, action, side effects, normal dose, rate of administration, time of onset, peak and duration, and nursing implications. There is no evidence the cream interferes with other vaccines (46-49). St. Louis: Elsevier. Monitor the patient for adverse and allergic reactions to the medication. Can 70% isopropyl swab for 30 For injection dosage form: For pain: Adults (patients 16 years of age and older)15 or 30 mg, injected into a muscle or a vein four times a day, at least 6 hours apart. A separate needle and syringe should be used for each injection. A smaller gauge needle (22 to 25 gauge) should be used with children. For women under 60 kg (130 lbs), a 16 mm (5/8 inch) Using the Z-track technique, the skin is pulled laterally, away from the injection site, before the injection; then the medication is injected, the needle is withdrawn, and the skin is released. Keep a sheet or gown draped over body parts not requiring exposure. (a) For the majority of infants, a 1-inch needle is sufficient to penetrate the thigh muscle. This is to prevent inadvertent contamination of the vial through direct or indirect contact with potentially contaminated surfaces or equipment that could then lead to infections in subsequent patients (3). Always wear gloves to administer injections. Sep 17, 2010 In the case of having no other site to inject, and with 1.0 ml being the maximum that is recommended in the deltoid, you would be well advised to The injection site is generally three finger widths below, in the middle of the muscle. 10. up to 3mL Deltoid injection Explain the risks related to the procedure, including hematoma formation, nerve injury, and allergic reaction to the medication. Don appropriate PPE based on the patients need for isolation precautions or the risk of exposure to bodily fluids. A quick injection is less painful. WebA single injection can be given into each deltoid muscle in children, adolescents and adults. Collaboration with the practitioner helps determines which methods will help best reduce pain before injection. 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. and I've been using various different books I've borrowed from friends to study. Nakajima, Y. and others. 21. ), Centers for Disease Control and Prevention (CDC). Occupational Safety and Health Administration (OSHA). 18. To decline or learn more, visit our cookies page. 17. Any factor that interferes with local tissue blood flow affects the rate and extent of drug absorption. Assess the patients symptoms before initiating medication therapy. (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. Explain the procedure for an IM injection, including the purpose of the injection and the reason for using the IM route. The total daily dose is 750 mg every four hours, or 3,000 mg per day. In general, the recommended needle length for an adult is 25 mm to 38 mm (1 to 1 1/2 inch). A thin adult may require a 16 mm to 25 mm (5/8 to 1 inch) needle, while an average adult may require a 25 mm (1 inch) needle, and a larger adult (over 70 kg) may require a 25 mm to 38 mm (1 to 1 1/2 inch) needle. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. When choosing a needle size, the weight of the patient, age, amount of adipose tissue, medication viscosity, and injection site all influence the needle selection (Hunter, 2008; Perry et al., 2014; Workman, 1999). Ketorolac (Oral Route, Injection Route) Proper Use The site involves the gluteus medius and minimus muscle and is the safest injection site for adults and children. 13. The deltoid muscle is the site most typically used for vaccines. What is the maximum safe and effective volume of oil that can be injected IM in to the delt. With the dominant hand, inject the needle quickly into the muscle at a 90-degree angle, using a steady and smooth motion. For women who weigh 152-200 lbs (70-90 kg) and men who weigh 152-260 lbs (70-118 kg), a 1- to 1.5-inch needle is recommended. Rarely, an adverse reaction occurs after immunizations. Data source: Centers for Disease Control, 2013, 2015; Perry et al., 2014. Self-administration of an IM injection is difficult. Use a needle long enough to reach the deep muscle. Remove needle cap by pulling it straight off the needle. 2 mL. Aspiration in injections: Should we continue or abandon the practice? Parenteral Medication Administration. Displace skin in a Z-track manner by pulling the skin down or to one side about 2 cm (1 in.) Adults-ventrogluteal and deltoid[2] Technique Sequential Method of IM Injection Thoroughly clean the hands and wear gloves. WebLocate the deltoid injection site, as described above. Intramuscular Injection Refer to the organizations formulary. Review medication reference information pertinent to the medications action, purpose, onset of action and peak action, normal dose, and common side effects and implications. injection Discard the uncapped needle (or needle enclosed in a safety shield) and the attached syringe into a puncture-proof and leakproof receptacle. Select needle length based on age, weight, and body mass. Sepah, Y. and others. Webavailable in a 1 mL, 2 mL, and 4 mL sizes containing the equivalent of 600,000, 1,200,000 and following injections into the buttock, thigh, and deltoid areas. Remove the needle at the same angle at which it was inserted. A 38mm (1 1/2 inch) length needle may be required for women over 90 kg (200 lbs) for a deltoid IM injection. PPSV23and IPV are recommended by the manufacturer to be administered by the subcutaneous or intramuscular route. Use the correct needle length based on the patients gender and weight. Begin by having the patient relax the arm. Applying a colorful adhesive bandage or sticker to the injection site should be considered. The location of all injection sites with the corresponding vaccine injected should be documented in each patients medical record. Adult patients who require frequent injections should be instructed to apply a topical analgesic to the injection site before administration. 4. Hold this position until the medication is injected. To Give A Subcutaneous Injection In this case the needle length should be 1 inch to 1.25 inches. Injection technique is the most important parameter to ensure efficient intramuscular vaccine delivery. Intramuscular injections are In E. Hall and others (Eds. The IM injection route deposits medication into deep muscle tissue, which has a rich blood supply, allowing medication to be absorbed faster than it would be by the subcutaneous route. Additional information about implementation and enforcement of these regulations is available from OSHA. Glynda Rees Doyle and Jodie Anita McCutcheon, Clinical Procedures for Safer Patient Care, LandmarkingVentrogluteal Administering an IM InjectionUsing Z-track, Landmarking Vastus Lateralus Administering IM InjectionUsing Z-track, Insertion of an Indwelling Subcutaneous Device aka subcutaneous butterfly, Next: 7.5 Intravenous Medications by Direct IV Route, Creative Commons Attribution 4.0 International License. The FDA does not license administration syringes for vaccine storage. Severely immunosuppressed persons (i.e., those who require care in a protected environment, e.g., bone marrow transplant recipients, individuals with severe combined immunodeficiency diseases) should not administer LAIV. For injection into the anterolateral thigh muscle, a 1.5-inch needle should be used, although a 1-inch needle may be used if the skin is stretched tightly and subcutaneous tissues are not bunched. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html, https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2023/npsg_chapter_hap_jan2023.pdf, https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=FEDERAL_REGISTER&p_id=16265, https://www.cdc.gov/vaccines/pubs/pinkbook/safety.html, https://www.cdc.gov/vaccines/hcp/admin/admin-protocols.html, https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html. If not using the Z-track method, follow these steps for injection. Needles and syringes used for vaccine injections must be sterile and disposable. This amount of medicine may be contained in 1 mL or in one-half (0.5) mL of the injection, depending on the strength. The deltoid muscle has a triangular shape and is easy to locate and access, but is commonly underdeveloped in adults. Avoid moving the syringe. Leaving the needle in place allows the medication to be displaced. IM .. Haemophilus influenzae type b (Hib) 0.5 mL IM Hepatitis A (HepA) 18 yrs: 0.5 mL IM 19 yrs: 1.0 mL Hepatitis B Smoothly, quickly, and steadily withdraw the needle. If blood is aspirated, remove the needle, discard it appropriately, and re-prepare and administer the medications (Perry et al., 2014). 15. This can lead to violation of expiration dates and product contamination (6,7). Insulin syringe: This holds a maximum of 1 mL of medicine. NEVER leave the medication unsupervised once prepared. 12. After the needle is withdrawn, the skin is released. This site is used for small medication volumes (2 ml or less)5 and for administration of routine immunizations in children older than 3 years with acceptable muscle mass and development and when other sites are inaccessible because of dressings or casts.2. With non-dominant hand, hold the skin around the injection site. Lack of blood in the syringe confirms that the needle is in the muscle and not in a blood vessel. Potential complications include lingering pain, tissue necrosis, abscesses, and injury to blood vessels, bones, or nerves. Injection (medicine Web2 mL How many mL can be injected into the deltoid muscle 2.5 mL How many mL can be injected into the ventrogluteal muscle 20-30 minutes After receiving an allergy test, how long should a patient stay in the office? An IM injection may require a longer and larger-gauge needle to penetrate deep muscle tissue. Abbreviations: DEN4CYD = dengue vaccine; DT = diphtheria and tetanus toxoids; DTaP = diphtheria and tetanus toxoids and acellular pertussis; HepA = hepatitis A; HepB = hepatitis B; Hib = Haemophilus influenzae type b; HPV = human papillomavirus; IIV = inactivated influenza vaccine; IM = intramuscular; IPV = inactivated poliovirus; LAIV = live, attenuated influenza vaccine; MenACWY = quadrivalent meningococcal conjugate vaccine; MenB = serogroup B meningococcal vaccine; MenCY = bivalent meningococcal conjugate vaccine component; MMR = measles, mumps, and rubella; MMRV = measles, mumps, rubella, and varicella; MPSV4 = quadrivalent meningococcal polysaccharide vaccine; PCV13 = pneumococcal conjugate vaccine; PPSV23= pneumococcal polysaccharide vaccine; RV1 = live, attenuated monovalent rotavirus vaccine; RV5 = live, reassortment pentavalent rotavirus vaccine; RZV = recombinant adjuvanted zoster vaccine; Subcut = subcutaneous; Td = tetanus and diphtheria toxoids; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. You may repeat the injection every 5 to 10 minutes as needed. 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. Note the integrity and size of the muscle. Multiple use jet injectors using the same nozzle for consecutive injections without intervening sterilization were used in mass vaccination campaigns from the 1950s through the 1990s (33); however, these were found to be unsafe because of the possibility of bloodborne pathogen transmission (34-37) and should not be used. You can review and change the way we collect information below. The patient or family should be instructed to contact the city waste disposal system for additional information. Alternate sites and use appropriate needles for deep intramuscular injection. WebRecommended available dose formulations include 50 mg/ml strength, in 3 ml multiple dose vials or 100 mg/ml strength, in 5 ml multiple dose vials. Due to their rich blood supply, IM injection sites can absorb larger volumes of solution, which means a range of medications, such as sedatives, anti-emetics, hormonal therapies, analgesics, and immunizations, can be administered intramuscularly in the community and acute care setting (Hunter, 2008; Ogston-Tuck, 2014a). Refer to the agency policies regarding needle length for infants, children, and adolescents. Don appropriate personal protective equipment (PPE) based on the patients need for isolation precautions or the risk of exposure to bodily fluids. WebAdminister vaccine using either a 1-mL or 3-mL syringe. injection Medication name, dose, route, site, time, and date of administration (with MAR correctly signed), Patients response to medication, including any adverse reactions, Unexpected outcomes and related interventions, Comfort assessment and any interventions performed, Patients weight in kilograms per the organizations practice. For adults, the deltoid muscle is recommended for routine intramuscular vaccinations (23) (Figure 3). Movement of the needle once injected can cause additional discomfort for the patient. Return to the patients room at an appropriate time per the organizations practice to assess the injection site. Safe Patient Handling, Positioning, and Transfers, Chapter 6. Assess patients response to the medication after the appropriate time frame. Assess for any factors that may contraindicate an injection. Administer the injection using the Z-track method, if appropriate. On the same date, compounded amlodipine suspension (PIN 22123311) was delisted and removed from the eligible compound PINs list. However, for DTaP, Hib, and PCV13, there is no evidence related to immunogenicity of these 3 vaccines given subcutaneously. If no blood appears, inject the medication slowly and steadily. Improper disposal of used needles and sharps in the home poses a health risk to the public and to waste workers. The deltoid should not be used. Position the ulnar side of the nondominant hand just below the site and pull the skin laterally. If multiple vaccines are administered at a single visit, administer each preparation at a different anatomic site (28). The IM site is used for medications that require a quick absorption rate but also a reasonably prolonged action (Rodgers & King, 2000).