Session 6 Administration of Drugs by Intramuscular Route

Session 6 Administration of Drugs by Intramuscular Route

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Learning Objectives

Learning Objectives

By the end of this session, students are expected to be able to:

Describe parental route of drug administration

Mention advantages and disadvantages of parental route

Explain requirements used for administration of drug by parental route

Describe essential steps for safely administering of parental medications by intramuscular, intravenous, intradermal and subcutaneous routes

Demonstrate skills in the administration of drugs parenteraly

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Descriptions of Parenteral Routes of Drug Administration

Descriptions of Parenteral Routes of Drug Administration

The term parenteral is used to describe the injection of a liquid substance into body via a route other than alimental canal.

The most common used parental routes are

Intramuscular: Injection into the muscle; the needle is held at 90o angle, passing through the skin in the subcutaneous tissue and penetrating deep into the tissue.

Intravenous: Injection into the vein. The needle is inserted (at less than a 15 o angle) into the patient’s vein

Intradermal: Injection into the epidermal layer of the skin, it is given at an angle between 5 o and 10 o

Subcutaneous: Injection is given just below the surface of the skin.

It is usually given at a 45o angle with an amount not exceeding between 0.5 to 1.0 ml.

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Advantages and Disadvantages of Parenteral Route

Advantages and Disadvantages of Parenteral Route

Advantages of Parental Route

The drug acts quicker than by the oral route

It is a route of choice when a patient is unconscious

It is also useful in emergence

The route is useful for uncooperative patient who refuses to take drug orally e.g. (psychiatric patient)

Desired dosage can be determined more accurately

Some patients get psychological satisfaction with injection

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Disadvantage of Parental Route

Disadvantage of Parental Route

Syringes and needles are expensive

Injections are painful and some patients especially children may be very tense prior to an injection

If sterility is poor, abscesses may occur

If wrong drug is injected, it is difficult to neutralize or take it out

If injection site is not carefully selected nerves may be injured resulting in paralysis

If air is not completely expelled before giving injection, it may cause air embolism

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Syringes, Needles and Containers for Injectable Drugs

Syringes, Needles and Containers for Injectable Drugs

Administration of drug by parental route involves the use of sterile syringes and needles.

Syringes

The usual sizes of syringe are 2ml, 5ml, 10ml, 20ml, 30ml and 50 ml.

The most commonly used sizes are 2 & 5 mls.

Also there are some syringes which are designed for special use. E.g. Insulin and Tuberculin syringe.

Needles

Come in various length and gauges and are disposable.

Needle should be selected accordingly to

Site to be injected.

The type and the amount of the drug to be injected.

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Containers for Injectable Drugs

Containers for Injectable Drugs

Ampoule: A sealed glass or plastic containing dose of drug in form of a sterile solution or powder for injection.

The amount is usually for a single dose.

Vial: A small cylindrical shaped bottle containing injectable drug in solution form or powder form (which will need to be diluted) and is covered by a rubber stopper and soft metal.

They come in different sizes from single dose to multiple doses.

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Vial vs ampoules

Vial vs ampoules

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Administration of Drugs by Intramuscular Route

Administration of Drugs by Intramuscular Route

Intramuscular injection: The drug is injected into the muscle.

This route is used for the following reasons

Drug which is so irritating into the subcutaneous tissue are less irritating when given into the muscles because deep muscles have fewer nerve endings.

The muscles can tolerate bigger volumes of drug than the subcutaneous route.

Up to 5 ml of solution can be injected on one site.

The vascularity of the muscle enables absorption to take place faster than the subcutaneous route.

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Sites for Intramuscular Injections

Sites for Intramuscular Injections

Selection of a suitable site is very important in order to avoid giving the injection into a blood vessel, nerve or periosteum.

Different sites for intramuscular injection

The buttock site

The upper outer quadrant of the buttock

The drug is injected on to the gluteal muscle, in order to avoid injury to the sciatic nerve and superior gluteal artery

The buttock is divided into quadrants

First draw an imaginary line across the buttock halfway between the iliac crest and head of the femur, and then draw a vertical line to divide the buttock into four equal parts (quadrants)

Select the upper outer quadrant of the buttock

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Technique (procedure) for Administering an Intramuscular Injection

Technique (procedure) for Administering an Intramuscular Injection

Assess allergies to medication(s)

Specific drug action

Side effects and adverse reaction

Clients knowledge of and learning needs about the medication

Tissue integrate of the selected site

Client’s age and weight to determine site and needle size

Client’s ability or willingness to cooperate

Determine whether the size of muscle is appropriate to the amount of the medication to be injected

Note: An adult’s deltoid muscle can usually absolve 0.5ml of medication, although some authorities believe 1ml can be absolved by a well –developed deltoid muscle

The gluteus medius muscle can absolve 1 to 5 ml

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Planning: Equipment

Planning: Equipment

Preparation of necessary equipment including

Trolley for carrying drugs in case is for many patients

Tray for carrying drugs in case of one patient

Sterile disposable syringes and needles for the appropriate size and amount of solution to be administered

Vials or ampoules

Galipot for sterile swabs

Dissecting forceps for picking sterile swabs

Files for filling the ampoules

Clean gloves

Safety box for used syringes and needles

Spirit for wiping the injecting site

Kidney dish for used swabs

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Performance

Performance

Wash hands and observe appropriate infection control procedures.

Prepare medication from ampoule or vial for drug withdrawal.

Select correct drug for the patient, by reading the medication before taking from the cupboard, shelf draw or refrigerator.

Use only medications that have clear legible labels to ensure accuracy.

Check the expiry date of the medication, expired medication should not be administered.

Ask the patient’s name for verification and compare with the treatment card/chart or prescription.

This is the second safety check to reduce chances of error.

Calculate medication dosage accurately without contamination.

Inform the client about the procedure.

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Provide for client’s privacy.

Provide for client’s privacy.

Invert the syringe needle uppermost and expel all excessive air.

Assist the patient to the appropriate position depending on the chosen site.

This promotes relaxation of the target muscle.

Obtain assistant in holding an uncooperative client in order to prevent injury due to sudden movement after needle insertion.

Select, locate and clean the site.

Make sure the site is palpated for detection of tenderness to the site.

Put on gloves and clean the site with antiseptic swab using circular motion starting at the center and move outward about 5cm.

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Remove the needle cover without contaminating the needle.

Transfer and hold the swab between the 3 and 4th finger of your nondominant hand in readiness for needle withdrawal or position the swab on the client/s skin above the intended site.

Remove the needle cover without contaminating the needle.

With the needle at a 90 degree angle while pressing down and holding the skin taut quickly insert the needle into the tissue.

In case of an emaciated client or infant the muscle may be pinched.

This helps to make the muscle firmer and facilitates needle insertion.

Hold the barrel of the syringe steady with your non-dominant hand and aspirate by pulling back on the plunger with your dominant hand.

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Aspirate for 5 to 10 seconds.

Aspirate for 5 to 10 seconds.

If blood appears in the syringe, withdrawal the needle and prepare a new injection.

This step determines whether the needle has been inserted in the blood vessel.

If blood does not appear in the syringe, inject the medication steadily and slowly while holding the syringe steady.

After injection wait for 10 seconds to disperse into the muscle tissue thus decreasing the client’s discomfort.

Withdraw the needle smoothly at the same angle of insertion.

This minimizes tissue injury.

Apply gently pressure at the site with a dry swab.

Do not massage the site as this can increase discomfort due to tissue irritation.

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If bleeding occurs apply pressure with dry sterile swab until bleeding stops.

If bleeding occurs apply pressure with dry sterile swab until bleeding stops.

Discard the needle and syringe in the safety box.

Remove gloves and dispose according to hospital policy.

Wash hands.

Document all relevant information including the time of administration, drug name, dose route and client’s name.

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Sites for Intramuscular Injection

Sites for Intramuscular Injection

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The thigh site

The thigh site

The mid-outer aspect of the thigh.

The drug is injected into the vastus lateralis muscle in the mid-anterior thigh on the front of the leg.

The deltoid site

This site is used only when the patient has big enough muscle on the arm.

The location of the site is about 2-3 fingerbreadths down from the acromion process on the outer aspects of the upper arm.

As the muscle is small at this site the amount of drug should not exceed 2 mls.

This site should never be used in children as the muscle is not well developed.

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Lifespan Considerations

Lifespan Considerations

Infants

The ventrogluteal site cannot be used for children under seven months of age.

The vastus lateralis is recommended as the site of choice for intramuscular injection for infants 7months of age and younger.

Because there no major blood vessels or nerves in the area, it is desirable for infants whose gluteal muscles are poorly developed.

It is situated on the anterior aspect of the thigh.

Obtain assistant to immobilize an infant or young child to prevent accidental injury during the procedure.

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Children

Children

Infants and young children usually require small, shorter needles (#22 to #25 gauge, 5/8 to 1 inch long) for intramuscular injection

The gluteal muscles are developed by walking.

Therefore, the dorsogluteal site should not be used for children under 3years unless the child has been walking for at least 1 year.

Elders

Older clients may have a decreased muscle mass or muscle atrophy and therefore a shorter needle may be needed.

Assessment of the appropriate injection site is critical.

Absorption of medication may occur more quickly than expected.

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Key Points

Key Points

The vastus lateralis site is recommended as the site of choice for intramuscular injections for infants even less than 4 months because there are no major blood vessels or nerves in the area.

Infant and young children usually require smaller, shorter needles (22-25 gauges for IM injection).

The gluteus muscles are developed by walking, therefore, the dorsogluteal site should not be used for children under 3 years, unless the child has been walking for at least 1 year.

Older clients may have a decreased muscle mass or muscle atrophy.

A short needle may be needed.

Assessment of appropriate injection site is critical.

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Evaluation

Evaluation

What is a meaning of a parental route of drug administration?

Mention 4 common parenteral routes.

Mention advantages and disadvantages of parental route.

Mention sites for intramuscular injection.

What considerations would bear in mind when giving an intramuscular injection to an infant, a three year old child and to an elderly client?

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References

References

Adams, M. P. et al. (2008). Pharmacology for Nurses. A Pathophysiologic Approach. (2nd ed.). New Jersey: Pearson

Kozie, B. et al, (2004). Fundamentals of Nursing. Concepts Process and Practice. (7th ed.) New Jersey: Pearson Education, Inc.,

MOHSW (2008). Basic Nursing Procedures. A manual for Nursing Practice in Tanzania. (3rd ed). Dar es Salaam, Tanzania: Ministry of Health and Social welfare.

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Everybody wants to go to heaven, but nobody wants to die

Everybody wants to go to heaven, but nobody wants to die

Ooohoo No,why don’t I brush my teeth daily.

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