1. IM administration of medications Mgr.Renata Vytejčková Ústav ošetřovatelství 3.LF UK

2. Intramuskular injections Administering of a medication into a muscle Volume 1 – 10 ml Purpose: therapeutic or prophylactic Effect within 10-15 min

3. The advantages of IM administration Faster absorption then s.c. Larger volume Appropriate for medications that irritate subcutaneous tissue

4. Places of administration Musculus gluteus medius Musculus gluteus maximus Musculus quadriceps femoris Musculus deltoideus

5. Administration into gluteus medius Middle finger palpates crista iliaca Thumb palpates spina iliaca anterior superior Thumb into position between trochanter major and crista iliaca Insert needle into the space between thumb and index finger, 60° appr. 5 cm deep Not appropriate in children below 3 years of age and very thin patients The patient is lying on either side, the upper leg bent in hip and knee, lower leg straight

6. Administration into musculus gluteus medius

7. Gluteus muscles

8. Administration into musculus deltoideus

9. Administration into the musculus deltoideus

10. Administration into the gluteus maximus Palpate crista iliaca, spina iliaca anterior superior a spina iliaca posterior superior Make a vertical line between the two spinas The lateral (outer) space is the proper injection site Use 90° angle The four quadrants methods is possible alternative Patient is in prone position, toes turned inward

11. Administration into the musculus gluteus maximus

13. Administration into the thigh muscle The lateral (outer) middle third of the thigh Place one hand just below the trochanter and the other just above the patella, the space between the thumbs can be used for administration Supine position, lower extremity slightly flexed and relaxed

14. Administration into the musculus vastus lateralis

15. Administration into the thigh muscle

16. The equipment The order sheet Medication Sterile syringe Sterile needles (to withdraw and administer) Swabs Band aid File Disinfection Emesis basin

17. Needle selection In thin patients use shorter needle (4-5cm) In well developed muscles or obese patients use longer needle (5-6cm) In case of oily substances or antibiotics use needle with large diameter

18. The procedure Inform the patient, ask him to position himself properly Palpate the injection site Disinfect the skin Hold the syringe perpendicularly, support the needle Use the thumb and the index finger to taut the skin Gently but quickly insert the needle between the two fingers 3-5 cm deep, use 90° angle Use 60-70° angle in thin patients Aspirate Slowly inject the medication If there is blood in the syringe do not proceed and change the medication Sometimes appropriate to aspirate again during the injection Remove the needle quickly Cover the injection site with band aid Document the procedure

19. Z-track method For medications that may irritate subcutaneous tissues Leave a small bubble in the syringe Spread the skin laterally approximately 3cm away from the injection site Hold the skin taut until you remove the needle

20. Z-track method

21. Medications injected i.m. Analgesics Antibiotics Premedication in surgery Vaccines Other

22. Complications Infiltrate formation Vein puncture Hitting a bone Hitting a nerve Abscess formation

23. Infiltrate formation In absence of site rotation Formation of granulation tissue Medication easily absorbed into vascular bed Mikroembolization Prevention – site rotation

24. Vein puncture Blood in the syringe Interrupt the procedure Take a new needle and select another injection site Risk of embolism

25. Hitting a nerve Most often the nervus ischiadicus The cause – improper selection of injection site (too low, too close to the middle) Burning, tingling, pain radiating into the leg Risk of paralysis

26. Abscess formation In case of oil substances Administration into fat tissue or not deep enough into the muscle Short needle, inappropriate injection site selection Redness, pain, mass Sometimes elevated temperature

27. Hitting the bone Often in very thin patients The needle can bend, little hook at the tip of the needle will tear the tissues The needle can break, remain in the tissue X-ray control, surgical removal

28. Děkuji za pozornost