Intramuscular injections Flashcards
Q: Why is the vastus lateralis site commonly used for intramuscular injections?
A:
Easily accessible, especially for self-administration.
Few major blood vessels and nerves, reducing the risk of injury.
Suitable for patients of all ages, including infants and adults.
Q: What are the advantages and disadvantages of using the vastus lateralis site?
A:
Advantages:
Safe and accessible site for large medication volumes.
Suitable for patients who cannot receive injections in other areas.
Disadvantages:
Can be painful and may cause discomfort.
Subcutaneous tissue depth varies, affecting medication absorption.
Q: What are the contraindications for administering intramuscular injections?
A:
Infection or inflammation at the injection site.
Nerve damage, poor blood supply, or oedema in the area.
Increased risk of bleeding in patients on anticoagulants or with clotting disorders.
Q: What equipment is required for administering an intramuscular injection?
A:
Appropriately sized syringe and needle.
Blunt fill needle (with filter for glass ampoules).
Alcohol swabs for skin cleaning.
Non-sterile gloves and apron.
Sharps bin for safe disposal.
Gauze swab for aftercare.
Q: How should the needle size be selected for an intramuscular injection?
A:
Based on the patient’s age, weight, and muscle mass.
38 mm (1.5 inch) needle for adults over 90 kg.
Oil-based or viscous medications may need a larger gauge.
Q: What steps should be taken to prepare for an intramuscular injection?
A:
Explain the procedure and gain verbal consent.
Perform hand hygiene and wear PPE.
Verify the medication, dose, and route using the MAR.
Inspect the injection site for swelling, infection, or lesions.
Q: How is the vastus lateralis injection site located?
A:
Find the area between a hand’s breadth above the knee and a hand’s breadth below the greater trochanter.
Use the anterior lateral aspect of the thigh.
Identify the middle third of the muscle as the injection site.
Q: What is the correct injection technique for the vastus lateralis site?
A:
Stretch the skin using the Z-track method to prevent medication leakage.
Insert the needle at a 90º angle using a darting motion.
Inject the medication slowly (~1 mL per 10 seconds).
Wait 10 seconds before removing the needle.
Q: Why is the Z-track method used for intramuscular injections?
A:
Prevents medication leakage into subcutaneous tissue.
Reduces pain and irritation.
Promotes better absorption of the medication.
Q: Is it necessary to aspirate when administering an intramuscular injection at the vastus lateralis site?
A: No, aspiration is not required as there are no major blood vessels in this area.
Q: What is the proper way to handle and dispose of sharps after injection?
A:
Activate the safety device on the needle.
Dispose of the needle immediately into a sharps bin.
Never recap the needle to avoid needlestick injuries.
Q: What aftercare should be provided following an intramuscular injection?
A:
Apply gentle pressure with a gauze swab if needed.
Monitor for adverse effects like swelling, redness, or pain.
Advise the patient that the injection site may be sore for 1–2 days.
Q: What should be documented after administering an intramuscular injection?
A:
Record the drug name, dose, route, and time in the MAR.
Note the injection site and any observations (e.g., side effects).
Sign and date the documentation as per local policy.
Q: What are the risks of using incorrect needle size for intramuscular injections?
A:
Subcutaneous injection instead of intramuscular, leading to poor absorption.
Increased risk of pain, abscess formation, and tissue damage.
Q: What complications should patients be informed about after receiving an intramuscular injection?
A:
Possible pain, bruising, or swelling at the site.
Rare complications include infection, nerve damage, or anaphylaxis.
Instruct patients to report any unusual symptoms to their healthcare provider.
Q: Why is it important to check for medication compatibility before administration?
A:
Prevents chemical reactions between drugs when multiple injections are required.
Ensures safe mixing of medications in the same syringe (if allowed).
Always consult the pharmacist or refer to trusted resources before combining drugs.
Q: What are effective pain management techniques for intramuscular injections?
A:
Use the Z-track method to reduce medication leakage and irritation.
Allow the alcohol swab to dry completely to prevent stinging.
Inject the medication slowly (1 mL per 10 seconds) to minimize discomfort.
Distract the patient or encourage deep breathing to reduce anxiety.
Q: What are the special considerations for administering intramuscular injections to pediatric patients?
A:
Use a shorter needle (16 mm–25 mm) for infants and small children.
The vastus lateralis is the preferred site for infants under 12 months.
Limit the injection volume to 0.5 mL for infants and 1 mL for small children.
Ensure proper restraint and comfort during the procedure.
Q: What is the maximum volume that can be safely injected into the vastus lateralis muscle?
A:
Up to 5 mL in adults with well-developed muscle mass.
For smaller adults or children, limit to 1–2 mL to prevent tissue damage.
If a larger dose is needed, split it into multiple injections in different sites.
Q: Why is it important to rotate injection sites for patients receiving frequent IM injections?
A:
Prevents muscle fibrosis, tissue damage, and abscess formation.
Reduces the risk of pain and skin irritation.
Maintain a record of previous injection sites to avoid repeated use.
Q: Why is the deltoid site used for intramuscular injections?
A:
Easily accessible with minimal exposure required.
Suitable for small-volume injections (≤ 2 mL).
Commonly used for vaccines and medications like hydroxocobalamin.
Q: What are the advantages and disadvantages of using the deltoid site?
A:
Advantages:
Convenient and requires less patient repositioning.
Preferred for vaccinations.
Disadvantages:
Limited to small volumes.
Risk of injury to the axillary nerve and radial nerve.
Q: What are the contraindications for intramuscular injections?
A:
Infection, inflammation, or oedema at the site.
Risk of nerve damage or poor blood supply.
Patients on anticoagulants or with bleeding disorders.
Q: How is the deltoid injection site located?
A:
Identify the acromion process.
Measure 2–3 finger-widths below the acromion.
Imagine a rectangle between this point and the axilla.
Inject into the center of this area.
Q: What are the steps for preparing the medication?
A:
Perform hand hygiene and wear PPE.
Draw up medication using a blunt fill needle.
Replace with an appropriate safety needle.
Expel air bubbles and label the syringe if necessary.
Q: What aftercare should be provided post-injection?
A:
Apply gentle pressure with a gauze swab if needed.
Advise the patient that mild soreness may occur for 1–2 days.
Monitor for side effects and advise on when to seek medical help.
Q: What are the maximum volume limits for the deltoid muscle?
A:
Adults: Up to 2 mL.
Children: 0.5–1 mL, depending on age and muscle development.
Q: What are common complications of deltoid IM injections?
A:
Pain, bruising, and swelling.
Nerve injury (axillary or radial nerve).
Rarely, infection or abscess formation.
Q: What are key considerations when injecting viscous medications?
A:
Use a larger gauge needle (19–21 gauge).
Inject slowly to reduce pain and ensure proper absorption.
Q: How is patient consent obtained for an injection?
A:
Explain the procedure, risks, and benefits.
Obtain verbal consent and document it.
Respect the patient’s right to refuse.
Q: What is the maximum volume for frail or elderly patients receiving a deltoid IM injection?
A:
Limit the injection volume to 1 mL to prevent muscle damage and pain.
Consider using an alternative site (e.g., vastus lateralis) for larger volumes.
Q: Why is the ventrogluteal site recommended for intramuscular injections?
A:
Located away from major nerves and blood vessels, reducing the risk of injury.
Suitable for administering 1–3 mL of medication.
Safe for most patients due to consistent muscle thickness and minimal fat tissue.
Q: What are the advantages and disadvantages of the ventrogluteal site?
A:
Advantages:
Deep muscle with minimal subcutaneous fat, ensuring proper medication absorption.
Lower risk of injuring the sciatic nerve or blood vessels.
Accessible in multiple patient positions.
Disadvantage:
Underutilized due to lack of familiarity among healthcare professionals.
Q: How do you locate the ventrogluteal injection site?
A:
Place the heel of your hand on the patient’s greater trochanter.
Point the thumb towards the patient’s groin.
Place the index finger on the anterior superior iliac spine.
Spread the middle finger toward the iliac crest to form a “V”.
Inject into the center of the “V”.
Q: Is aspiration required when administering a ventrogluteal injection?
A:
No, aspiration is not necessary because the site is free of major blood vessels.
Q: What is the maximum volume for a ventrogluteal intramuscular injection?
A:
1–3 mL for effective absorption.
Split larger doses into multiple sites if necessary.
Q: How should the patient be positioned for ventrogluteal injection?
A:
Patient can lie supine, side-lying, or stand with the knee slightly bent.
Ensure the patient is comfortable and the site is easily accessible.
Q: Why is the ventrogluteal site preferred over the dorsogluteal site?
A:
Lower risk of injuring the sciatic nerve.
Fewer blood vessels, reducing the risk of vascular injury.
Easier to landmark and safer for medication absorption.
Q: Why is the dorsogluteal site used for intramuscular injections?
A:
It is a traditional and commonly used site, especially in mental health settings.
Familiarity among practitioners and patient preference contribute to its use.
Suitable for injecting oil-based, depot, or slow-release medications.
Q: What are the risks of using the dorsogluteal site for IM injections?
A:
Risk of sciatic nerve damage, potentially causing pain or paralysis.
Risk of injecting into the superior gluteal artery.
Possibility of injecting into subcutaneous tissue, leading to irritation and poor absorption.
Potential for tissue necrosis, gangrene, and fibrosis.
Q: What are the contraindications for dorsogluteal intramuscular injections?
A:
Infection, inflammation, or oedema at the injection site.
Patients on anticoagulants or with clotting disorders.
Sites with nerve damage or poor blood supply.
Q: How is the dorsogluteal site located for an intramuscular injection?
A:
Position the patient on their side with the knee bent.
Locate the greater trochanter and posterior superior iliac spine.
Draw an imaginary line between these points.
Inject into the upper outer quadrant of the buttock.
Q: Why is aspiration recommended for dorsogluteal injections?
A:
To check for blood return, preventing accidental injection into a blood vessel.
If blood appears, withdraw the needle and restart with a new needle.
Q: What is the maximum volume for a dorsogluteal intramuscular injection?
A:
1–3 mL for effective absorption.
Use multiple sites for larger volumes.
Q: Why is the dorsogluteal site used cautiously in some patients?
A:
Contains major nerves and blood vessels.
Higher risk of complications compared to the ventrogluteal site.
Requires careful site selection and patient assessment.
Q: When should an alternative injection site be used instead of the dorsogluteal site?
A:
If the patient has nerve damage, infection, or scarring at the dorsogluteal site.
For patients at higher risk of sciatic nerve injury or those with bleeding disorders.
The ventrogluteal site is often preferred for its lower risk of complications.
Q: What should be done if a patient experiences signs of sciatic nerve injury during or after injection?
A:
Stop the injection immediately if the patient reports sharp pain or numbness.
Monitor the patient for worsening symptoms.
Report the incident to a supervisor and complete an incident report.
Refer the patient for further medical evaluation if symptoms persist.
