clinical skills: intramuscular injection

Question 1

what is intramuscular injection?

Answer 1

Intramuscular injection (IM) is a means of installing medications into the depth of
specifically selected muscles.

Question 2

when should drugs be intramuscularly?

Answer 2

• prophylactic
• curative purposes

Question 3

what are the common medications given IM?

Answer 3

Antibiotics- penicillin G Benzathine penicillin, streptomycin
* Biologicals- immunoglobins, vaccines, and toxoids
* Hormonal agents- testosterone, medroxyprogesterone
Any non-irritant and soluble drugs may be given IM during an emergency scenario

Question 4

what are the therapeutic indications in pts?

Answer 4

• Unable to receive drugs through other common routes
• Do not tolerate oral medications
• Noncompliant
• Uncooperative
• Reluctant

Question 5

what are the contraindications for IM?

Answer 5

-Active infection, cellulitis, or dermatitis at the site of administration.
-Known allergy or hypersensitivity to the drug.
-Acute myocardial infarction- the release of muscle enzymes complicate the diagnostics
and management strategy of AMI.
- Thrombocytopenia.
-Coagulation defects.
-Hypovolemic shock - the drug’s absorption may be hampered due to compromised
vascularity of the muscle.
- Myopathies
-assoc. muscular atrophy

Question 6

equipment used?

Answer 6

1. an appropriately sized syringe with correct length
   2.Second needle 20 - 22G for drawing medications.
2. Alcohol-based antiseptic solution.
3. The correct drug in an appropriate dose.
4. Dry cotton swab.
5. Self-adhesive bandage.
6. The safe needle and waste disposal containers

Question 7

what are the 7 rights of medication administration in IM?

Answer 7

• right person
• right drug
• right dose
• right time
• right route
• right to refuse
• right to documentation of the prescription and allergies

Question 8

what are sites of administration?

Answer 8

-Infants: vastus lateralis
- Children: vastus lateralis and deltoid
- Adults: ventrogluteal, dorsogluteal and
deltoid

Question 9

outline the sequential method for IM injection

Answer 9

1.preparation for the IMI:
- put on apron
- wash hands and wear gloves
- clean the injection site, wair for 30 sec for skin to dry
- draw medication
-insert needle in the bevel up fashion
2. the Ztrack technique is recomm.
3. insert the needle at an angle of 75-90 degrees
4. quick darting movement while inserting the needle
5. Insure intramuscular positioning of the needle via confirming restricted side-to-side movement of the needle as
opposed to when the needle is in the subcutaneous plane.
6. Aspirate for at least 5 to 10 seconds when performing dorsogluteal injections prior to injecting the medication
7. Slow injection (10 seconds per millilitre) allows stretching of the muscle fibres for retention of the drug, which
minimizes the risk of leakage along the needle track.
8. Wait for 10 seconds to allow the drug to diffuse within the muscle bulk.
9. Withdraw the needle with a smooth and steady movement.
10. Safe disposal of the needles and other wastes. Where necessary to recap a needle use the ‘Scoop method’ of
replacing the needle cap to prevent inadvertent prick injuries.
11. Assess the injection site for probable early and late complications.

Question 10

what are the likely complications?

Answer 10

1Persistent pain at the site of injection (common)
2. Muscle fibrosis and contracture
3. Infections:
* Abscess at the injection site
* Skin necrosis / slough
* Gangrene
4. Nerve injury
* the sciatic nerve in gluteal injection,
* the femoral nerve in vastus lateralis injection,
* the superior gluteal nerve in dorsogluteal injection,
* the femoral nerve in vastus lateralis injection,
* radial nerve in deltoid injection
5. Vascular injury
6. Periostitis, osteomyelitis
7. Transmission of HIV, hepatitis virus
8. Inadvertent injection of glass particles while using glass vials and ampoules.

Question 11

what are the main factors contributing to the risk of injury

Answer 11

-Anatomical site of injection
- The length of the needle
- The angle of injection
- Positioning of the patient during injection and
- The expertise of the health personnel

Question 12

what are the severity of injury of never scale?

Answer 12

1. First degree showing reversible conduction block with conservative management,
2. Second-degree showing Wallerian degeneration with reactive fibrosis. They often show
   slow and incomplete recovery, and
3. Third-degree comprises necrosis and fibrosis, and the chances of recovery are minimal.

Question 13

clinical significance and advantages of IM?

Answer 13

-Rapid and uniform absorption of the drug, especially the aqueous solutions
- Rapid onset of the action compared to that of the oral and the subcutaneous routes
- IM injection bypasses the first-pass metabolism of the drug
- It also avoids the gastric factors affecting drug absorption
-Has efficacy and potency comparable to that of the intravenous drug delivery system
- Highly effective for emergency scenarios such as acute psychosis and status epilepticus
-Depot injections allow slow, sustained, and prolonged drug action
-A large volume of the drug can be administered compared to the subcutaneous route

Question 14

DIsadvantage

Answer 14

An expert and a trained person are necessary for administrating the drug by IM route
 The absorption of the drug is determined by the bulk of the muscle and its vascularity. “Bigger the better.”
 Painful procedure. This can lead to anxiety in the patient, especially among children. Need for temporary
restraint of the patients, especially in crying children
 IM injection at the appropriate landmarks may be difficult in a child as well as in patients requiring physical
restrains.
 Self-administration of the drug can be difficult
 Suspensions, as well as oily drugs, cannot be administered
 In case of inadvertent scenarios such as anaphylaxis or neurovascular injuries, additional intravenous (IV)
routes for emergency drug administration need to be secured.