![]() The right hand is used for the left hip, and the left hand is used for the right hip. To locate the ventrogluteal site, place the patient in a supine or lateral position (on their side). The site provides the greatest thickness of gluteal muscles, is free from penetrating nerves and blood vessels, and has a thin layer of fat. The site involves the gluteus medius and minimus muscle and is the safest injection site for adults and children. Table 7.7 describes the three injection sites for IM injections. This method can be used if the overlying tissue can be displaced (Lynn, 2011). The Z-track method is a method of administrating an IM injection that prevents the medication being tracked through the subcutaneous tissue, sealing the medication in the muscle, and minimizing irritation from the medication. Using the Z-track technique, the skin is pulled laterally, away from the injection site, before the injection then the medication is injected, the needle is withdrawn, and the skin is released. Vaccinations and immunizations given by IM injections are never aspirated (Centers for Disease Control, 2015). Recent research has found that there is no evidence to support the practice of aspiration, but despite policy changes, the procedure of aspiration continues to be taught and practised (Canadian Agency for Drugs and Technologies in Health, 2014 Greenway, 2014 Sepah, Samad, & Altaf, 2014 Sisson, 2015). If blood is aspirated, remove the needle, discard it appropriately, and re-prepare and administer the medications (Perry et al., 2014). Lack of blood in the syringe confirms that the needle is in the muscle and not in a blood vessel. ![]() Current practice in the acute care setting is to aspirate IM injections to check for blood return in the syringe. Use a quick, darting motion when inserting the needle.Īspiration refers to the action of pulling back on the plunger for 5 seconds prior to injecting medication (Ipp, Sam, & Parkin, 2006). The needle is inserted at a 90-degree angle perpendicular to the patient’s body, or at as close to a 90-degree angle as possible. A longer needle with a larger gauge is required to penetrate deep muscle tissue. The ventrogluteal site is free from blood vessels and nerves, and has the greatest thickness of muscle when compared to other sites (Cocoman & Murray, 2008 Malkin, 2008 Ogston-Tuck, 2014a). However, there is sufficient evidence that the ventrogluteal IM site is the preferred site whenever possible, and is an acceptable site for oily and irritating medications. Literature shows inconsistency in the selection of sites for deep muscular injections: selection may be based on familiarity and confidence rather than on “best practice” (Ogston-Tuck, 2014a). Sites for intramuscular injections include the ventrogluteal, vastus lateralis, and the deltoid site. Because of the adverse and documented effects of pain associated with IM injections, always use this route of administration as a last alternative consider other methods first (Perry et al., 2014). In addition, any factors that impair blood flow to the local tissue will affect the rate and extent of drug absorption. With IMs, there is an increased risk of injecting the medication directly into the patient’s bloodstream. ![]() Complications with IM include muscle atrophy, injury to bone, cellulitis, sterile abscesses, pain, and nerve injury (Hunter, 2008 Ogston-Tuck, 2014a). Intramuscular injections must be done carefully to avoid complications. ![]() When choosing a needle size, the weight of the patient, age, amount of adipose tissue, medication viscosity, and injection site all influence the needle selection (Hunter, 2008 Perry et al., 2014 Workman, 1999). An IM site is chosen based on the age and condition of the patient and the volume and type of medication injected. The technique of IM injections has changed over the past years due to evidence-based research and changes in equipment available for the procedure. In addition, muscle tissue is less sensitive than subcutaneous tissue to irritating solutions and concentrated and viscous medications (Greenway, 2014 Perry et al., 2014 Rodgers & King, 2000). Due to their rich blood supply, IM injection sites can absorb larger volumes of solution, which means a range of medications, such as sedatives, anti-emetics, hormonal therapies, analgesics, and immunizations, can be administered intramuscularly in the community and acute care setting (Hunter, 2008 Ogston-Tuck, 2014a). The IM site is used for medications that require a quick absorption rate but also a reasonably prolonged action (Rodgers & King, 2000). Intramuscular (IM) injections deposit medications into the muscle fascia, which has a rich blood supply, allowing medications to be absorbed faster through muscle fibres than they are through the subcutaneous route (Malkin, 2008 Ogston-Tuck, 2014a Perry et al., 2014).
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