For medical undergraduates

1. SKILLED TRAINING
SUPERIOR EXTREMITY AND INFERIOR EXTREMITY

2. PROCEDURES
1. Intramuscular injection
2. Intravenous injection
3. Venesection
4. Intra- arterial catheterization
5. Intra-venous catheterization

3. INTRAMUSCULAR INJECTION

4. INTRAMUSCULAR INJECTION
• It is the injection of a substance directly into muscle. In medicine, it is
one of several methods for parenteral administration of medications.
• Indications:
1. Appropriate vein could not be located
2. A particular drug would irritate the vein
3. Digestive system would render pills ineffective
4. Absorption faster than intra-dermal, subcutaneous injection.

5. INTRAMUSCULAR INJECTION
• Commonest site are:
1. Deltoid
2. Gluteal region (Outer upper quadrant)
3. Thigh (Vastus lateralis)

6. PROCEDURE
• 1. Wash the hands
• Wash the hands thoroughly with soap and warm water. Pay careful attention to the area between the fingers
and under the fingernails.
• 2. Gather supplies
• Before giving the shot, get the following items ready:
• an alcohol wipe
• a sterile gauze pad
• a cotton ball
• a bandage
• a puncture-resistant container to dispose of the needle
• the medication
• a new needle and syringe
• A doctor should provide advice on the type of needle to use. It needs to be long enough to reach deep into the muscle
tissue.
• Most adults will require a 1-inch needle, but the exact size depends on the person's weight. It is essential to ask a doctor or
pharmacist which size needle to use before giving an injection.
• 3. Prepare the injection site
• Locate the injection site according to the instructions above. Gently spread the skin between two fingers and
keep the muscles relaxed. Clean the skin with the alcohol swab and allow to air-dry.

7. PROCEDURE
• 4. Prepare the vial and syringe
• If using a multidose vial, note the date you first opened it. Clean the rubber
stopper with an alcohol swab.
• Remove the cap from the syringe. Draw air into the syringe by pulling back
the plunger. Fill the syringe with air up to the same level as the medication
dose.
• Remove the cap from the needle and push it through the top of the vial.
Inject all the air into the vial.
• Turn the vial and syringe upside down so that the needle points upward.
Draw back the plunger to fill the syringe with the correct amount of
medication.
• Remove air bubbles by gently tapping the syringe and pressing the plunger.
Avoid touching the needle to ensure it stays clean.

8. PROCEDURE
• 5. Inject the medication
• An intramuscular injection should not cause blood to appear in the syringe. Insert the needle into the
muscle at a 90-degree angle. Use the index finger and thumb to stabilize the syringe while using the
other hand to pull back on the plunger slightly to look for blood.
• If there is blood, it means the needle is in a blood vessel and not a muscle. Withdraw and start over
with a new needle, syringe, and injection site.
• If there is no blood, the needle is in the correct position. Press down on the plunger of the syringe to
inject the medication.
• 6. Remove the needle
• Quickly remove the needle from the skin and dispose of it in a puncture-resistant container.
• 7. Press on the injection site
• Using gauze, apply light pressure to the injection site. Light bleeding at the injection site is normal, but
a person can use a bandage if necessary.

9. PROCEDURE
https://youtu.be/pfAhHZQpenM

10. TIPS
• The following tips may reduce discomfort before and after the injection:
• Numb the injection site with ice or a numbing cream before cleaning the skin
with the alcohol swab.
• To avoid stinging, ensure the alcohol dries completely.
• Before putting medication into the syringe, warm the vial up by rubbing it
between the hands.
• Relax the muscles, as much as possible, when receiving the injection.
• Discuss changing injection sites with a doctor. Too many injections in the
same location can cause scarring and skin changes.
• People who find injecting themselves difficult should ask a friend, family
member, or caregiver to help them.

11. COMPLICATIONS
• Minor discomfort after an intramuscular injection is normal. Less commonly, more
serious complications can arise, including:
• an abscess, or collection of pus
• tissue necrosis, or tissue death
• granuloma, or inflammation in the tissue
• muscle fibrosis, or scarring of muscle tissue
• hematoma, where blood seeps out of blood vessels into the surrounding tissue
• injury to blood vessels and nerves
• People who notice the following symptoms should call a doctor immediately:
• severe pain at the injection site
• prolonged or excessive bleeding
• tingling or numbness around the muscle
• redness, swelling, or warmth at the injection site
• drainage at the injection site
• signs of an allergic reaction, such as swelling or breathing problems