IM Injections

Question 1

What is an IM injection

Answer 1

injection into the muscle

Question 2

T or F: land marking is important for IM injections are there are nerves in the muscle layers

Answer 2

T - nerves can be affected if land marking off

Question 3

T or F: SC has better blood supply than IM

Answer 3

F - IM has better blood supply so faster absorption (10-30mins)

Question 4

Examples of IM Vaccines

Answer 4

Covid
Hib
Hep A + B
Herpes zoster
HPV
Flu
meningococcal
pneumococcal conjugate
rabies
RSV
tetanus
typhoid
Japanese encephalitis

Question 5

Examples of IM meds

Answer 5

analgesics, antemetics, Abxs, Depo, Epipen, Test and Vit B12

Question 6

Site of IM injection if under 1

Answer 6

Vastus lateralis muscle in leg

Question 7

Site of IM injection if over 1

Answer 7

deltoid of arm
- if not enough muscle mass here: can use VL too

Question 8

T or F: you need to definitively avoid injection into tattoos and birthmarks

Answer 8

F - no evidence that you need to avoid

• if can, go for it but don’t need to

Question 9

What does the injection skin need to be free of

Answer 9

infection, necrosis, bruising + abrasions

Question 10

What happens if you landmark too high on deltoid injection

Answer 10

may damage nerves that feed from the arm to the SC or you can cause SIRVA (shoulder injury related to Vaccine Admin)

Question 11

Land marking of deltoid IM injection

Answer 11

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

Question 12

What is the max V of admin IM

Answer 12

1 mL

Question 13

What size of needle do you use for children or adults < 60kg

Answer 13

5/8 needle

Question 14

What size needle do you use for adults >/= 60kg?

Answer 14

1”

Question 15

What size needle do you used for overweight patients

Answer 15

1.5”

— if not sure if should use: use longer needle as if too short === will inject into SC

Question 16

T or F: If you need to give 2 IM injections, you need to give them in 2 separate visits

Answer 16

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

Question 17

How to landmark IM injection in Vastus lateralis

Answer 17

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

Question 18

What impacts the choice of needle gauge

Answer 18

solution thickness—- want to pick the highest gauge that is possible based on solution to allow for patient comfort

Question 19

What factors impact needle length decision

Answer 19

age + weight of pt

Question 20

What needle length should you use for leg IM injections over 1 year old?

Answer 20

1- 1 1/4”

Question 21

At what angle do you admin IM injections

Answer 21

90

Question 22

T or F: you should inject IM injections like you are throwing a dart

Answer 22

T - same idea

** doesn’t really matter if needles bevel is up or down

Question 23

What happens if you do your IM injection too slow

Answer 23

skin dimples before piercing skin

Question 24

What is a inject safe barrier bandage?

Answer 24

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

Question 25

What is the purpose to the Z track technique

Answer 25

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

Question 26

Why is the technique called the Z track technique

Answer 26

Named base don the trail the needle leaves in the skin (Z) which helps trap the fluid in the muscle layer

Question 27

How to do the Z technique

Answer 27

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

Question 28

What is SIRVA caused by

Answer 28

injection of the fluid into the bursa of shoulder capsule which causes inflammation

Question 29

SS of SIRVA

Answer 29

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)

Question 30

How is SIRVA normally managed

Answer 30

corticosteroids +/or physio

Question 31

What to do if you think you inserted your needle too high

Answer 31

pull needle out without injecting fluid + try again

Question 32

T or F: you should always inject when sitting or kneeling so that the patients arm is at eye level

Answer 32

T

Question 33

T or F: you can inject across a table

Answer 33

F