Assess the injection site for complications and apply an adhesive bandage. (a) For the majority of infants, a 1-inch needle is sufficient to penetrate the thigh muscle. Explain that the patient may feel pain and anxiety during the procedure. Consider consulting a child life specialist if available. We also use third-party cookies that help us analyze and understand how you use this website. Intramuscular. (2022). Providers are sometimes concerned when they have the same contraindications or precautions as their patients from whom they withhold or defer vaccine. This is the preferred site for anaphylaxis However, these tools . Apply a gauze with light pressure for several seconds over the site; do not massage. For injection into the anterolateral thigh, most adolescents will require a 1-1.5-inch needle to ensure intramuscular administration (27). Volumes of up to 4 ml can be administered to this site if the patient's available muscle tissue is limited and dorsogluteal muscle is required. You also have the option to opt-out of these cookies. a For nonaqueous injectates, consideration must be given to the time of absorption before redosing. Small muscles absorb small volumes. Providers should address circumstances in which dose(s) of these vaccines have been administered subcutaneously on a case-by-case basis. *The anterolateral thigh may be used. Move the dominant hand to the end of the plunger. What are some examples of how providers can receive incentives? This is to prevent inadvertent contamination of the vial through direct or indirect contact with potentially contaminated surfaces or equipment that could then lead to infections in subsequent patients (3). In Meyler's Side Effects of Drugs (Sixteenth Edition), 2016. Palpate the muscle below the greater trochanter and above the lateral femoral condyle (knee joint). Overall, 5 mL has been cited for adults as the maximum volume for a single IM injection, with lower maximums proposed for adult patients with less-developed or small muscle mass. Subcutaneous injection: injection of a biological product into the layer of fatty tissue between the skin and muscle. Vaccines should be drawn up in a designated clean medication area that is not adjacent to areas where potentially contaminated items are placed. Begin by having the patient relax the arm. The evidence table for this guideline can be accessed here. Check the accuracy and completeness of the medication administration record (MAR) with the practitioners original order. Intramuscular injections commonly result in pain, redness, and swelling or inflammation around the injection site. Assess the patients muscle mass and skin condition. To prevent contamination of the vial, make sure the patient area is clean and free of potentially contaminated equipment. These injection locations allow for a high degree of safety, reliability and accessibility when a patient is lying supine, prone or in side lying position. This cookie is set by GDPR Cookie Consent plugin. Pediatric Intramuscular Injections Guidelines for Best Practice Author Information . An IM site is chosen based on the age and condition of the patient, and the volume and type of medication injected. Adults and children 12 years of age and older1 milligram (mg) or 0.2 milliliter (mL) injected under your skin. 4 What is the largest amount of medication that can be injected into the deltoid muscle? what med did you give? Severely immunosuppressed persons (i.e., those who require care in a protected environment, e.g., bone marrow transplant recipients, individuals with severe combined immunodeficiency diseases) should not administer LAIV. Pneumococcal conjugate. Avoid moving the syringe. For example, varicella vaccine should be discarded if not used within 30 minutes after reconstitution, whereas MMR vaccine, once reconstituted, must be kept in a dark place at 36F to 46F (2C to 8C) and should be discarded within 8 hours if not used. The choice of a site depends on the volume to be injected. Studies of children with previous febrile seizures have not demonstrated antipyretics to be effective in the prevention of febrile seizures (48). Explain how the patient can assist by holding still. Dorsogluteal site: Guidelines for Intramuscular and Subcutaneous In Intramuscular In 'ections .ection Administration SITE Vastus lateralis Ventrogluteal Deltoid Dorsogluteal Infant Needle length: 5/8 inch Volume: 0.5 ml, * *recommended for infants < 7 . Hepatitis B administered by any route other than intramuscular, or in adults at any site other than the deltoid or anterolateral thigh, should not be counted as valid and should be repeated (9). Trauma Erythema or swelling at the injection site. Rodgers, D. Wilson (Eds. Explain the procedure to the patient and family and ensure that they agree to treatment. Digital Edition: SKILLS - INTRAMUSCULAR INJECTIONS 01 July, 2003 An intramuscular (IM) injection is the administration of medication through the cutaneous and subcutaneous layers, into the muscle. Steps on How to Give an IM Injection. Collaborate with the patient and family to develop a plan for pain management. The anterolateral thigh can also be used (25). Cleanse the area with an antiseptic solution and allow the skin to dry. Despite various experimental studies and known solutions to reduce demolding forces, there is still not a complete understanding of the effects that occur. The injection should be given 3-5cms below the acromion, in the middle of the triangle. Don appropriate PPE based on the patients need for isolation precautions or the risk of exposure to bodily fluids. What is the maximum volume that can be injected intramuscularly? 3 mL in an adolescent Maximum volumes to be injected subcutaneously: Recommended maximum volumes to be injected subcutaneously may range from 0.5 mL to 2 mL depending on your patient. Use a bar code system or compare the MAR to the patients identification band. The ventrogluteal site, rectus femoris and vastus lateralis location are the preferred location for large volume deep muscle IM injections. For pediatric patients, 2 mL is the max in the VL. Greater The ventrogluteal muscle can accommodate up to 2.5 ml, with a maximum volume of 3 ml. 7. ? Because unused prefilled syringes also typically must be discarded if not used within the same day that they are filled, vaccine wastage might occur. -Rapid injection is preferred. Explain to the patient and family the step-by-step procedure for IM medication administration. Live, attenuated injectable vaccines (e.g., MMR, varicella, yellow fever) and certain non-live vaccines (e.g., meningococcal polysaccharide) are recommended by the manufacturers to be administered by subcutaneous injection. management in all ages. Evidence does not support use of antipyretics before or at the time of vaccination; however, they can be used for the treatment of fever and local discomfort that might occur following vaccination. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Intramuscular injection: injection of a biological product into muscular tissue. Don't even think about delt on little ones, unless it's a tetanus vaccine. Children receive numerous vaccines, and pediatric nurses administer the majority of these vaccines via the intramuscular route, and thus must be knowledgeable about safe and evidence-based immunization These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. The patient may require longer observation periods depending on the medication they receive, Provide education to the patient and their family on signs and symptoms to monitor for, e.g., pain, redness, abscess, bruising at the site or anaphylaxis, Warm or cold compresses can be applied to the area for comfort. Pediatric Nursing Procedures (pp. A higher gauge needle refers to a smaller outside diameter of the needle tubing. Z- tracking: A technique used to prevent medication leakage, particularly for oily injections. When in doubt about the appropriate handling of a vaccine, vaccination providers should contact that vaccines manufacturer. Use of a topical refrigerant (vapocoolant) spray immediately before vaccination can reduce the short-term pain associated with injections and can be as effective as lidocaine-prilocaine cream (51). Insert the needle at a 90-degree angle (straight up and down) into the injection site. The demolding of plastic parts remains a challenging aspect of injection molding. The patient can be positioned lying on their stomach or standing up. In a 2-year carcinogenicity study of rats given hydralazine by gavage at dose levels of 15, 30, and 60 mg/kg/day (approximately 5 to 20 times the . In this case the needle length should be 1 inch to 1.25 inches. Assess the family for ways they can assist in the procedure. Also, the vastus lateralis muscle has a larger muscle mass than the gluteal region and therefore has reduced risk of severe local reactions. If the skin is stretched flat, a 1/2 inch needle is sufficient. trochanter:A bony prominence at the top of the femur where the hip and thigh muscles are fixed. Up to 1ml can be injected into this site in neonates, up to 3mls in children and up to5mls in adults. Repeating doses of vaccine administered by the intramuscular route when recommended to be by the subcutaneous route is not necessary (10). With the dominant hand, inject the needle quickly into the muscle at a 90-degree angle using a steady and smooth motion. For administration of routinely recommended vaccines, there is no evidence of risk of exposure of vaccine components to the health care provider, so conditions in the provider labeled as contraindications and precautions to a vaccine components are not a reason to withdraw from this function of administering the vaccine to someone else. For this reason, laboratory devices and in-process measurement injection molding tools have been developed to measure demolding forces. Evidence indicates that this cream does not interfere with the immune response to MMR (45). Follow the manufacturers instructions for application and time to peak effect. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. The method of administration of injectable vaccines is determined, in part, by the inclusion of adjuvants in some vaccines. The administration device is a nasal sprayer with a dose-divider clip that allows introduction of one 0.1-mL spray into each naris. If a vaccine and an immune globulin preparation are administered simultaneously (e.g., Td/Tdap and tetanus immune globulin [TIG], hepatitis B and hepatitis B immunoglobulin [HBIG]), separate limbs should be used for each injection (29-30). aspect, lateral to the midpoint of the thigh. Subcutaneous means under the skin. 4 mL 100mg/mL . . This cookie is set by GDPR Cookie Consent plugin. The volume of medication will vary: for children under 2-years old, the maximum volume should be 1 mL; for adults, the maximum volume is 1 mL for the deltoid muscle and 3 mL . Contraindications Relative Known bleeding disorder or thrombocytopenia. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. When all the medicine has been given, remove the needle from the skin at the same angle it went in. Many medications must be injected intramuscularly because of chemical properties, pharmacokinetics, desired onset, intensity and duration of the effect, and certain patient characteristics related to treatment compliance. Prepare the needle: Hold the syringe with your writing hand and pull the cover off with your other hand. Instruct the family regarding the potential adverse effects of the medication. Necessary cookies are absolutely essential for the website to function properly. Just clear tips and lifehacks for every day. If the gluteal muscle must be used, care should be taken to define the anatomic landmarks. For women under 60 kg (130 lbs), a -inch (16 mm) needle is sufficient, while for women between 60 kg and 90 kg (130 to 200 lbs) a 1-inch (25 mm) needle is required. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Hydralazine hydrochloride injection, USP is an antihypertensive available in a 1 mL vial for intravenous and intramuscular administration. Overall, 5 mL has been cited for adults as the maximum volume for a single IM injection, with lower maximums proposed for adult patients with less-developed or small muscle mass.