1. Intramuscular Injections

2. Goal:
-After giving this review session student/co-worker will be able to confidently administer an intramuscular injection, know sites used for injections, and demonstrate different techniques of giving an intramuscular injection.
-Perform giving IM injections.
-Demonstrate correct technique for giving IM injections.
-Identify equipment used for giving IM injections.
-Demonstrate and explain: Z track method and Air lock technique.
-Demonstrate correct disposal of used needle.
-Explain and be able to identify how the patient tolerated the IM injection.

3. -In this session learner will be educated in IM injections-
-Where to give an IM injection.
-Technique for giving IM injection
-Demonstrate different method for giving an IM injection.
-Equipment needed to perform an IM injection.

4. -Equipment needed to perform an IM injection-
-Syringe 1-2 inches in length.
-Medication to be administered.
-Gloves
-Band-Aid
-Alcohol swab
-Patient
-Muscle where medication will be administered

5. -Choosing the site to administer medication-
-There are several different sites an IM injection can be given.-
Site determination-
-Stage of patients development.
-Body build
-Physical condition
-Amount of the medication to be given

6. -Sites- Mid Deltoid- common site, upper arm, 3 fingers width.
Dorsalgluteal- look out for sciatic nerve, given in the butt.
Rectus femoris- right on top of the thigh.
Ventrolgluteal- side of the butt, or on the hip.
Vastis lateralis- outer thigh, in the middle.

7. How to find sites-

8. Mid Deltoid-
-Is on the upper arm.
- Take 3 fingers and place them at the top of the shoulder.
-At the end of the third finger in the middle of the muscle is where the injection can be made.

9. Dorsalgluteal- - -Injection is in the butt.
-Watch out for the sciatic nerve.
-Have patient stand or lay face down with toes pointing inward. (relaxes muscle)
-Divide the buttocks into 4 quadrants; give the injection in the outer, upper quadrant toward the hip.
-DO NOT give to children who are not walking yet. (Muscles are not developed enough)

10. Ventrogluteal- -Good for adults and small children.
- Find the upper part of the hip.
-Place palm on hip (greater trochater), with fingers point to the ground, and make a very large “V” with your pointer finger and middle finger.
-In the middle of the “V” is where the injection can be done.

11. Rectus Femoris
-On the anterior thigh, above the knee.
-Used mostly by people who have to get themselves injections.
-This is painful, because the muscles in the anterior thigh are tense when given.

12.  Vastus Lateralis-
-Most preferred site.
-Given to children under 5 years of age.
- Patient should be sitting when this injection is to be given.
-On the outer thigh about half way between the knee and the hip.

13. -Technique of Giving an Intramuscular Injection-
-Check the 5 rights of medication administration.
-Choose the site the IM injection.
-Check the patient for any allergies.
-Gather you supplies needed to perform IM injection.
-Wash your hands.
-Put on gloves.
-Open alcohol swab and in a circular motion, clean area in a 2 inch diameter at the site of the intended IM injection.
-Let fully dry.

14. Continued… -Pull skin around the clean site taut.
- take needle in dominate hand between the thumb and the index finger.
- At a 90 degree angle, plunge the needle into the skin in a dart like motion.
-Depending on the site and the condition of the patient, determine how far the needle is going to have to go into the skin to be in the muscle.
-Stabilize the needle with the non dominate hand.
-Use dominate hand to pull back on the plunger and aspirate or blood. (If there is blood aspirated back into the needle, remove and dispose in a sharps container. start from the beginning.)
-Push the medication at a slow and steady pace. Remember to hold the needle as steady as possible.

15. Continued..
To take the needle out, quickly pull up at a 90 degree angle.
-Make sure to cover the needle immediately after withdrawing it from the skin.
-Apply some pressure at the site with the alcohol swab that was used to clean the site.
-Message the site to help disperse the medication that was just given.
-Cover site with Band-Aid.
-Dispose of needle into a sharps container.
-Throw away gloves and wash hands.
-Observe the patient for signs of any allergic reaction, N&V, or any other adverse reactions that may go along with the medication.
- Always remember to document.

16. -Different Methods of Giving IM injections-
-Just giving IM injection and massaging site-
- Z track
- Air lock

17. Just giving IM injections and messaging site-
-Just dose of medication given.
-Message site after to help disperse medication in to the muscle.

18. Z track method-
-Used for medications that can cause irritation, can be used for all IM medications.
-Pull skin at the site to the side.
- Still give the injection at 90 degree angle.
-When shin is let go and needle removed the needle track is cut off and the medication can not leak out.
-This will decrease irritation and bruising of the skin.

19. Air lock Technique- -Medication is drawn up.
-0.2mL of air can be added to the medication.
-This will ensure that all the medication has been pushed though the needle.
- Still given at a 90 degree angle.
-Make sure medication is given first and the air lock second.
-Seals needle track so medication will not go into the subquncaneaus tissue, which can cause pain, soreness and bruising.

20. Review- -Always remember 5 rights of medication administration.
-Right dose
-Right patient
-Right time
-Right route
-Right medication
-Choosing an IM Injection site that works best for your patient.
(Ex: Infants can not have injections in the dorsal gluteal (butt), In determining a site take into account the patients body build, try to avoid flabby tissue.)
-Different techniques of giving an IM injection: Z track, Air lock.

21. Evaluation:

22. 1.) Name the site that should not be used for children who are not walking yet?

23. Dorsal gluteal.

24. -Describe Z track method:

25. pulling skin to the side, then giving the shot, cutting off the needle track.

26. 2.) How do you clean a site for injection?

27. Alcohol swab, 2inches around the site in diameter, let dry completely.

28. 3.)How do you determine where to give a mid deltoid IM injection?

29. Upper arm, 3 fingers down from the top of the shoulder
Upper arm, 3 fingers down from the top of the shoulder. In the middle of the arm. Use patients non dominate arm.