IM Injections Flashcards
What is an IM injection
injection into the muscle
T or F: land marking is important for IM injections are there are nerves in the muscle layers
T - nerves can be affected if land marking off
T or F: SC has better blood supply than IM
F - IM has better blood supply so faster absorption (10-30mins)
Examples of IM Vaccines
Covid
Hib
Hep A + B
Herpes zoster
HPV
Flu
meningococcal
pneumococcal conjugate
rabies
RSV
tetanus
typhoid
Japanese encephalitis
Examples of IM meds
analgesics, antemetics, Abxs, Depo, Epipen, Test and Vit B12
Site of IM injection if under 1
Vastus lateralis muscle in leg
Site of IM injection if over 1
deltoid of arm
- if not enough muscle mass here: can use VL too
T or F: you need to definitively avoid injection into tattoos and birthmarks
F - no evidence that you need to avoid
- if can, go for it but don’t need to
What does the injection skin need to be free of
infection, necrosis, bruising + abrasions
What happens if you landmark too high on deltoid injection
may damage nerves that feed from the arm to the SC or you can cause SIRVA (shoulder injury related to Vaccine Admin)
Land marking of deltoid IM injection
ID: acromion process (bony thing on shoulder blade)
top limit: 2-3 fingers below acromion
- large hands or land marking kid: use 2 fingers
- if slender fingers: use 3 fingers
lower limit: in line with axilla/armpit
overall target is the size of a golf ball or toonie
What is the max V of admin IM
1 mL
What size of needle do you use for children or adults < 60kg
5/8 needle
What size needle do you use for adults >/= 60kg?
1”
What size needle do you used for overweight patients
1.5”
— if not sure if should use: use longer needle as if too short === will inject into SC
T or F: If you need to give 2 IM injections, you need to give them in 2 separate visits
F - can do 2+ in same visit
- if 2: give one in each arm
- if 3 + or if the patient can only be injected in one arm (has no lymph nodes on one side of body) ==== give them 1 inch from each other
How to landmark IM injection in Vastus lateralis
divide the leg bw the greater trochanter of femur + knee into 3rds
- locate the middle 3rd of the leg; can inject anywhere in this arm from the midline of the leg/front to the midline of outer side of thigh
** aka aim in the outer part of thigh
What impacts the choice of needle gauge
solution thickness—- want to pick the highest gauge that is possible based on solution to allow for patient comfort
What factors impact needle length decision
age + weight of pt
What needle length should you use for leg IM injections over 1 year old?
1- 1 1/4”
At what angle do you admin IM injections
90
T or F: you should inject IM injections like you are throwing a dart
T - same idea
** doesn’t really matter if needles bevel is up or down
What happens if you do your IM injection too slow
skin dimples before piercing skin
What is a inject safe barrier bandage?
type of bandage you put on before injection + insert the needle into the middle of bandage during injection
—- may be good for those on blood thinning meds or who has a history of bleeding a lot after injections
What is the purpose to the Z track technique
minimize irritation to non-muscle tissue
Prevent staying in of skin if dark coloured med
Help reduce leakage of injection fluid out of injection site
Why is the technique called the Z track technique
Named base don the trail the needle leaves in the skin (Z) which helps trap the fluid in the muscle layer
How to do the Z technique
place fleshy side of non dominant hand about 1 inch away from where you want to inject
- press your hand gently down and slide the skin away from injection site about 1 inch upwards
** keep skin pulled like this throughout injection, depression, removal of needle
What is SIRVA caused by
injection of the fluid into the bursa of shoulder capsule which causes inflammation
SS of SIRVA
shoulder pain + limited range of motion that can persist for months without treatment or be permanent
- suspect if their pain doesn’t improve with OTC analgesics + recent injection (REFER)
How is SIRVA normally managed
corticosteroids +/or physio
What to do if you think you inserted your needle too high
pull needle out without injecting fluid + try again
T or F: you should always inject when sitting or kneeling so that the patients arm is at eye level
T
T or F: you can inject across a table
F
