Intramuscular and sucutaneous workshop
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This document provides information on an upcoming workshop about intramuscular and subcutaneous injection techniques. The workshop will cover 7 key points to consider before administration: 1) drug, 2) storage, 3) route of administration, 4) dosage, 5) preparation, 6) timing, and 7) recording. It then discusses subcutaneous and intramuscular injection sites, implementation techniques for each, and the Z-track method for intramuscular injections.
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Intramuscular and sucutaneous workshop
- 1. INTRAMUSCULAR & SUBCUTANEOUS INJECTION WORKSHOP LORELEI J. CABALUNA, RN, MN Botany Lecture and Laboratory Room August 22, 2014 12:00 nn to 4:00 pm Adventist Medical Center College Department of Pharmacy
- 2. 1) Drug 2) Storage 3) Route of Administration 4) Dosage 5) Preparation 6) Timing 7) Recording 7 POINTS TO CONSIDER BEFORE ADMINISTRATION!
- 3. Outpatient only! The patient must have a complete prescription. Check expiration date. Ask for drug allergies. 1. Drug
- 4. Drug to be used have been stored properly. Example: Vaccines (biologicals) should be stored in a cold temperature (2 – 8 C)ᵒ 2. Storage
- 5. Determine the best route of administration. Factors: Age Physical Characteristics Clinical Condition Dosage Form 3. Route of Administration
- 6. Calculate the dosage appropriately. Double check with drug literature. 4. Dosage
- 7. Observe STERILE TECHNIQUE! Remove remaining air inside the syringe prior to administration. Syringe and needle must be appropriate for the amount of solution. 5. Preparation
- 8. Consider Drug-drug interaction and appropriate time interval between administrations. 6. Timing
- 9. Observe proper documentation! 7. Recording
- 13. IMPLEMENTATION • Wash hands, provide privacy • Select an injection site (no bruises, edema, inflammation, scars), if abdomen at least 2 inches away from umbilicus, rotate injection sites • Apply gloves, hold a dry gauze in nondominant hand • Cleanse site with antiseptic swab (allow to dry) • Remove needle cap • Hold syringe between thumb and forefinger of dominant hand
- 14. IMPLEMENTATION • Pinch skin with nondominant hand • Inject firmly at appropriate angle • With needle in site, grasp lower end of syringe with nondominant hand and inject medication with dominant hand on plunger • Remove needle and place dry gauze over site with gently pressure (do not massage) • Discard needle and syringe • Remove gloves and wash hands
- 16. IM INJECTION SITES Deltoid Dorsogluteal Ventrogluteal Vastus lateralis Note: Vastus lateralis and ventraogluteal sites used in infants
- 17. DELTOID MUSCLE
- 18. GLUTEUS MAXIMUS
- 19. GLUTEUS MEDIUS
- 20. VASTUS LATERALIS
- 21. Z-Track • Minimizes tissue irritation by sealing the drug within the muscle tissues and decreasing pain. • Recommended technique for all IM’s when possible.
- 22. IMPLEMENTATION • Privacy • Wash hands • Expose only required area • Select appropriate injection site & ensure client is comfortable • Landmark site • Cleanse site with antiseptic (center and rotate outward ~ 5 cm) • With nondominant hand, pull skin 2.5-3.5 cm down or lateral (Z track), hold this position until medication is administered. • Gauze in nondominant hand.
- 23. IMPLEMENTATION • Remove cap (pull straight off) • Hold syringe like a dart • Inject quickly at 90 degrees • Hold lower part of syringe to stabilize syringe • Pull back on plunger 5-10 sec, if no blood inject medication slowly (1 ml/10 sec) • Wait 10 sec, slowly withdraw needle, place gauze over site • Assess site • Observe response to medication
Editor's Notes
- Deltoid Find the lower edge of the acromial process and the point on the lateral arm in line with the axilla. Insert the needle 1 to 2 (2.5 to 5 cm) below the acromial process, usually two or three fingerbreadths, at a 90-degree angle or angled slightly toward the process. Typical injection: 0.5 ml (range: 0.5 to 2.0 ml). Dorsogluteal Inject above and outside a line drawn from the posterior superior iliac spine to the greater trochanter of the femur. Or, divide the buttock into quadrants and inject in the upper outer quadrant, about 2 to 3 (5 to 7.6 cm) below the iliac crest. Insert the needle at a 90-degree angle.Typical injection: 1 to 4 ml (range: 1 to 5 ml). Ventrogluteal Locate the greater trochanter of the femur with the heel of your hand.Then, spread your index and middle fingers from the anterior superior iliac spine to as far along the iliac crest as you can reach. Insert the needle between the two fingers at a 90-degree angle to the muscle. (Remove your fingers before inserting the needle.) Typical injection: 1 to 4 ml (range: 1 to 5 ml). Vastus lateralis Use the lateral muscle of the quadriceps group, from a handbreadth below the greater trochanter to a handbreadth above the knee. Insert the needle into the middle third of the muscle parallel to the surface on which the patient is lying.You may have to bunch the muscle before insertion.Typical injection: 1 to 4 ml (range: 1 to 5 ml; 1 to 3 ml for infants).
- MIDDLE THIRD OF THE DELTOID MUSCLE: USE the needle 1 to 2 ml Client may be positioned sitting, standing, supine, or prone.Locate site by measuring 2–3 fingerbreadths below the acromion process on the lateral midline of the arm. Administer in nondominant arm when possible.
- UPPER, OUTER QUADRANT OF THE BUTTOCK: Use 2 – 5 ml syringe, black (green) needle.Do not use this site in children < 2 yr or emaciated clients.Position client in side-lying or supine position, with knee flexed on injection side, or prone with toes pointed inward to rotate femur.Locate site by palpating the posterior iliac spine where the spine and pelvis meet. Imagine a line from the posterior iliac spine to the greater trochanter. Administer medication above imaginary line at midpoint.
- Use if volume is 1 - 3 ml. Use a 20 - 23 gauge, 1-1/2 inch needle.This is the preferred site for adults and children < 7 mo.Position client in supine lateral position.Locate site by placing the hand with heel on the greater trochanter and thumb toward umbilicus. Point to the anterior iliac spine with the index finger (forming a "V"). Injection of medication is given within the "V" area.
- ANTERIOR, LATERAL SURFACE OF THE THIGH: Use 22–25 gauge, 5/8–1 inch needle.This is the preferred site for infants and children < 7 mo.Position client in supine or sitting position.Locate by identifying the greater trochanter and lateral femoral condyle. Injection site is the middle third and anterior lateral aspect of the thigh.