Intramuscular Injection

1. Intramuscular Injection • June Levine RN MSN • National Consultant AmbulatoryNursing • Ben Hudnall Memorial Trust

2. Which Site Should I Use? Consider: • age of the client • medication to be injected • client’s general condition

3. Sites • Vastas Lateralis • Deltoid • Ventrogluteal

4. SITES OF THE THIGH Vastus lateralis muscle preferred Rectus femoris muscle rarely used except for infants & self-administered injections

5. 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

6. 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

7. Vastas Lateralis

8. Vastas Lateralis

9. 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

10. Vastis Lateralis

11. 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

12. 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 armThis 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

13. Deltoid

14. Deltoid Site

15. Deltoid and Ventrogluteal Sites

16. Ventrogluteal (ven-trow-GLUE-tee-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.

17. 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.

18. 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 V-shaped triangle.

19. 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.

20. Ventrogluteal Site

21. Ventrogluteal Site

22. Ventrogluteal Site

23. Ventrogluteal Site

24. Ventrogluteal Site • 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

25. Dorsogluteal Dorsogluteal (door-so-GLUE-tee-ull) Muscle (rear-end): 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-give-an-intramuscular-injection.html#ixzz0xr4fKzGc

26. IM Injections • 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

27. 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-an-intramuscular-injection.htmal