IM/SC Injection Flashcards
In which patients are IM injections not indicated?
- Hypovolaemic patients/ in shock - as they have poor peripheral circulation
- Impaired coagulation
- Oedematous
What is a complete contraindication for IM?
Thrombocytopenia
Why does some needle need to be present outside of the skin?
So the needle can be removed in the rare event of needle snapping.
What is the primary site of choice for most IM injections? What are the benefits of this site?
Ventrogluteal site:
- Easily accessible
- Greatest muscle thickness
- Free of major blood vessels and nerves
How is the ventrogluteal site found?
- Place opposing hand on greater trochanter of hip (i.e. right hand on left hip)
- Reach index finger over to the ASIS
- Stretch middle finger over iliac crest to form triangle
- Ventrogluteal region is within the triangle
What are the benefits of deltoid site?
- Easily accessible
- Rapid onset of drug due to greatest blood flow of any muscle used in IM
What are the benefits of vastus lateralis?
- Easily accessible
- Usually thick muscle bulk – so repeated injections can be tolerated
Why should IM injections into gluteal muscles never be given with patient standing?
- May prevent patient from relaxing the required muscle groups
- Harder to maintain patient dignity
- May make the patient more likely to move upon insertion of needle – leading to misplacement of needle/ injury.
- Harder to ensure 90 deg angle of insertion
What are the requirements for disinfecting an injection site?
- Use swab soaked in 70% isopropyl alcohol
- Clean for 30 seconds
- Air dry for 30 seconds
Why is Z-tracking widely used now?
- Reduces pain for patient
- Reduces leakage and irritation from injection – traps drug under the layers
Basic steps of Z-tracking…
- Identify required muscle site
- Place finger over site and laterally pull skin away from injection site about 1-2cm
- Visualise the intended muscle where the finger was initially placed
- Insert needle at 90deg at this point
- Remove finger from skin allowing layers to return to normal place
Why should you aspirate the needle before injecting?
To check for blood in aspiration – if blood is present the needle should be removed, disposed of properly and a new needle is then used to attempt the IM injection again.
What medications can be given as subcutaneous injections and why?
- Insulin injections are commonly SC, this is because there is relatively poor blood supply which means the drug will be released slowly and steadily.
- Relatively pain-free site therefore frequent injections can be given.
What is the maximum volume of injection that can be given in SC?
2ml
Basic steps of SC injection…
- Raise subcutaneous fat tissue away from muscle by pinching into a fold
- Insert needle at 45 deg, then release the fold of skin
- Inject drug slowly
- Withdraw needle rapidly
- Dispose of sharps safely
