The document discusses the history, prevalence, and proper procedures for intramuscular injections. It notes that while injections became popular after World War II, as many as 70-95% of injections given in India are unnecessary. The document provides guidance on selecting injection sites, preparing syringes safely, administering injections correctly, and disposing of used equipment to avoid infections and other complications. It emphasizes giving injections only when truly needed and ensuring any injection administered is done so safely.

1. Dr. Kamlesh R. Lala
MBBS, D PED, FCGP
NARANPURA
AHMEDABAD
1

2. HISTORY
The first injection was given in 1920,
but became popular only after second world war.
Now injections are probably the most common
percutaneous procedure practiced worldwide
2

3. MAGNITUDE
 An estimated 12 billion injections are administered
each year.
 The average no of injections range from 0.9 to 8.5 per
person per year.
3

4. DEFINITION
Intramuscular injections are a common yet complex
technique used to deliver medication deep into the large
muscles of the body
It may be for curative, diagnostic or recreational purpose
4

5. SURVEY
 An Indian survey found that 96% of all injections
given by private doctors were of
antibiotics, vitamins, analgesics and chloroquine.
 Surprisingly 70 to 95 % of such injections were
unnecessary.
5

6. WHY INJECTIONS ???
 Injections are stronger medication
 Injections work faster and drug is more effective
 Patient’s non compliance
 Financial incentives
 If I won’t give my colleague will give
6

7. COMPLICATIONS
Giving IM injection is not a benign procedure. It is with
risk of disease, disability and even death
The most common one is transmission of blood borne
infections mainly Hepatitis B, Hepatitis C and HIV
These infections may be passed to HCW and even in
society
Do you know how ???
7

8. Others are
 Abscess
 Muscle or fat necrosis
 Muscle fibrosis and contracture
 Gangrene
 Nerve Injury
8

9. WHAT IS SAFE INJECTION
 Does no harm to recipient
 Does not expose the HCW to any risk
 Does not result in waste that is dangerous for the
community
 Do you know two third of injections given in our
country are UNSAFE !! By reuse of syringe and needle
9

10. Indications of injection
10

11.  Severe and life threatening illness
 Inability to swallow
 Profuse vomiting
 Non availability of effective oral agent
11

12. So before giving any injection just ask yourself
 Is it necessary
 Is it justified
 And if “YES” then see that it is “SAFE”
12

13. GIVING IM INJECTION
13

14. It can be discussed under following heads
 Site Selection
 Preparation of Injection
 Procedure
 Post Injection Care
14

15. Site Selection
 The most common injection site is anterolateral thigh
into Vastus Lateralis muscle
 Never use gluteal muscle in children
 The other site in adult and in older children is deltoid
muscle
15

16. Anterolateral Thigh
16

17. Deltoid
17

18. Selecting Gluteus Muscle
18

19. REMEMBER
For giving vaccines including anti rabies vaccine
never select
gluteal muscle.
They are ineffective if injected so.
19

20. RISKS OF GLUTEUS INJECTION
 Injury to sciatic nerve
 If medication is in fatty tissue then it may result into
necrosis and abscess
 Chloroquine, Diclofenac and oily, viscous or depot
injections are always to be injected into gluteus muscle
20

21. PREPARATION OF INJECTION
21

22. Injection medication may be
 Available in prefilled syringe
 Available in liquid form
 Has to be reconstituted
 Either in single dose or multidose vial
22

23. MULTIDOSE VIAL
 Where possible use single dose vial rather than a
multidose one
 Never make multiple withdrawals from a single dose vial
Why ???
23

24. Chances of infection are more common with MD vial
Because of
 Reuse of same syringe for filling medication
 Permanent insertion of needle into the vial
 Storage of reconstituted vial
 Opened vial kept submerged in water or ice
 Rubber stopper wiped with antiseptic
 Lack of proper hand hygiene
24

25. EQUIPMENT SELECTION
 Use only new disposable syringe and needle every time
 Changing only the needle on the same syringe is also
not safe
 Use wide bore needle rather than a narrow one
 For oily or viscous injection use 20 or 21 no. needle
 Use longer possible needle
 For gluteus injections always use 1½ ” needle
25

26. Skin preparation
 Avoid site with oozing dermatitis or infection
 If the skin is clean than no use of disinfection
 Clean the site with single use spirit or alcohol swab in a
circular motion in an area 5-8 cms
 Pre wetted cotton swabs are better to be avoided
 If spirit is not available normal saline can be used
 Never use Savlon or Dettol
 Let the site be dry before injection
26

27. Preparing Syringe
 The area for preparing injection should be clean
 Clean your hands with alcohol based hand wash
 If you have cut or injury on fingers, cover it with water
proof adhesive
 No need to use gloves routinely
27

28. Preparing syringe
 Remember to use new equipment
 Observe aseptic precautions
 No need to change the needle after withdrawing
medication
 Do not ever wipe the needle with swab
 Do not keep the air bubble inside the syringe
28

29. Giving injection
 We have found giving injection necessary
 We have selected the site
 We have prepared the syringe
So now comes giving injection
29

30. Giving injection
 Make the patient comfortable and give him a proper
position so as to identify the proper site for injection
 Properly hold the child
 Hold the syringe in your hand as if holding a pen
 Remove needle cap immediately before giving
injection…not earlier
30

31. Giving injection
 Ensure smooth and steady insertion of the needle at
90 degree with a dart technique
 No need to aspirate
 Slowly push the medication allowing muscle fiber to
stretch and accommodate the injected volume
 Wait for a while and remove the needle in the same
direction as it was pushed
 Apply gentle pressure with a dry gauze
31

32. Z technique
32

33. Preventing Needle Stick Injury
 Anticipate abrupt movement of the patient and take
care
 More the used needle is handled or carried, the greater
is the risk of sharp injury
 Never try to recap, bend or manually remove needle
from syringe
 Do not move around with used equipment in hand
 Keep needle destroyer near by only
 Properly dispose it
33

34. Multiple injections
 Some times multiple injections are to be given in a
single visit especially for vaccines
 Any no of injections can be given in a single visit
 Use different anatomical site
 If same limb is to be used than separate two injections
by 1-2”
34

35. Post Injection Syncope
 This is known side effect especially in
adolescents. So it is better to observe the patient
for 10-15 minutes
35

36.  According to WHO
Use injections only when necessary – oral
medicines are effective in most cases.
36