On occasion, learning how to administer an intramuscular injection may become necessary, especially when you or a member of your family have a medical condition that requires this type of treatment. Your doctor will make this decision at the time of providing treatment. The patient's nurse will explain to the carer how to perform the intramuscular injection, exactly as described in this article.
Steps
Part 1 of 3: Performing an Intramuscular Injection
Step 1. Wash your hands before starting
It is essential to comply with the correct hygiene rules to minimize the risk of infections.
Step 2. Reassure the patient by explaining how the procedure will take place
Tell him where the injection site is and describe how the drug feels when it is injected, if he does not already know them.
Some medicines may initially cause pain or burning; most of them do not cause any sensation, but it is important that the patient is informed, to limit the anguish resulting from not knowing
Step 3. Disinfect the injection site with an alcohol wipe
Before proceeding, it is vital that the skin surface covering the muscle where the drug will be injected is clean and sterilized. All this to minimize the possibility of post-injection infections.
- Disinfect the skin with a circular motion from the inside outwards or with a comma motion without passing the swab over the disinfected area again.
- Wait for the alcohol to dry. Do not touch your skin until you are ready to inject, otherwise you will need to clean the area again.
Step 4. Encourage the patient to relax
If the affected muscle is contracted, the injection will be more painful; then ask the person to relax the muscles as much as possible, to ensure that the pain is minimized.
- In some cases it is useful to distract the patient before the injection by asking him questions about his life. When an individual is distracted, the musculature is generally relaxed.
- Some people prefer to take a position that prevents them from seeing the procedure. The vision of the needle approaching the skin generates stress and concern in some patients; all of this not only causes anxiety, but also leads to muscles contracting. To help the patient calm down, let him direct his attention elsewhere, where he prefers.
Step 5. Insert the needle into the specific place on the body
First, remove the protective cap, then insert the needle into the skin with a quick, smooth motion. Let the needle penetrate in the direction perpendicular to the skin. The faster you are, the less pain the patient feels. However, be very careful if this is your first injection; if you are too rushed, you may miss the exact spot or cause more skin damage than necessary.
- If this is your first injection, proceed with caution, but be aware that quick action tends to be less stressful for the patient.
- It may be helpful to keep the skin taut with the non-dominant hand (as the dominant hand holds the syringe) before injection. In this way you first identify the exact site of the injection and, secondly, reduce the pain felt by the patient as the needle penetrates the muscle.
Step 6. Before injecting the medication, pull the plunger towards you
Once the needle has entered the muscle and before administering the medicine, pull the plunger lightly. While it may seem counterintuitive, it is actually an important detail because if you were to aspirate blood, you might understand that the needle is inside a blood vessel rather than a muscle.
- This type of medicine is formulated to be injected into the muscle and not into the bloodstream; if you notice blood in the syringe when you pull the plunger, you will need to insert the needle elsewhere before continuing. There is nothing to worry about as long as you notice blood before injecting the drug, so you can reposition the needle.
- In most cases the needle penetrates the muscle; it rarely enters a blood vessel. However, it is better to be safe than sorry and make sure there are no problems.
Step 7. Slowly inject the medicine
Although it is best to insert the needle quickly to reduce pain, it is wise to administer the drug slowly for the same reason. This is because the liquid takes up space within the muscle tissue, which in turn must dilate. If you inject the medicine slowly, you allow the fibers to stretch and adapt without too much pain for the patient.
Step 8. Pull out the needle respecting the same insertion angle
Do this when you are sure that all of the medicine has been administered.
Apply gentle pressure to the injection site with 5x5cm gauze. The patient may feel some discomfort, but this is completely normal
Step 9. Dispose of the needle properly
Don't just throw it in the trash. With the purchase of the syringes you may have received a specific hard plastic container for the disposal of these medical instruments. Alternatively, you can use a soft drink bottle or other similar container with a screw cap. Make sure that both the needle and the syringe can enter the container without difficulty and that they cannot pop out on the sides.
- Never cap the needle once it has been used. You avoid the risk of biting yourself and passing on infections.
- Ask your doctor or pharmacist about the rules to be respected for the disposal of this hazardous waste.
Part 2 of 3: Knowing the Process
Step 1. Know the parts of the syringe
It will be much easier to inject if you understand the mechanism behind what you are doing.
- Syringes consist of three elements: the needle, the plunger and the hollow body. The needle penetrates the muscle; the hollow body is the part that contains the medicine and is equipped with notches accompanied by numbers that indicate the volume both in cubic centimeters (cm3) and in milliliters (ml). Finally, the plunger is used to aspirate and inject the drug.
- The doses of drugs that are administered intramuscularly are measured in both milliliters and cubic centimeters; however, the quantity does not vary according to the unit of measurement.
Step 2. Know where to inject
The human body has several places where a medicine can be administered intramuscularly.
- Vastus lateral muscle: located in the thigh. Look at the patient's thigh and mentally divide it into three equal parts. The central portion is the injection site. This is a great site to inject yourself, as it is easy to see and accessible. In addition, it is perfect for administering medication to children under three years of age.
- Ventrogluteal muscle: This is located in the hip. To locate it correctly, place the base of your hand on the upper and outer thigh, where it meets your butt. Point the thumb towards the groin and the fingers towards the patient's head. Form a "V" with your fingers by separating your index finger from the other three. At this point, you should feel the edge of the pelvis bone with the tip of your little finger and ring finger. The site where you need to insert the needle is in the center of the "V". This is a good position for both adults and babies who are over seven months old.
- Deltoid muscle: located in the upper arm. Fully expose the patient's arm and feel the bone that passes through this area, called the acromial process. The lower part of this bone forms the base of a triangle, the tip of which is exactly under the center of the base, at the level of the armpit. The exact place for injection is the center of the triangle, 2.5-5 cm from the acromial process. Do not use this site on very thin patients or if the muscle is very small.
- Dorsogluteal muscle: located on the butt. Expose one side of your butt; draw a line from the top of the gap between the buttocks to the hip using a wipe soaked in alcoholic cleanser. Find the midpoint of this line and move up by 7.5 cm. From this position draw another line that crosses the first and ends more or less in the middle of the buttock. This way you should have drawn a cross. In the upper outer quadrant delimited by the cross you should perceive a curved bone; the injection is done just below this bone. Do not use this region on infants or children under three years of age, as their muscles are not yet developed enough.
Step 3. Consider who you are giving the injection to
Each subject has a "best spot" for intramuscular injections. Consider some factors before proceeding:
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The age of the patient. For anyone over the age of two, the thigh muscle is the best spot. If the patient is over three years of age, you can evaluate the deltoid or thigh. You should use a 22 to 25 gauge needle.
Note: If the children are very young, you will need to use even smaller needles. Remember that the thigh muscle can handle larger needles than the upper arm
- Evaluate the areas where previous injections were given. If the patient has just received a medicine intramuscularly, try to give the next dose to a different place on the body to avoid scarring and skin changes.
Step 4. Learn how to fill the syringe with medication
Some syringes are sold pre-filled with the necessary medication. Other times, the drug is in a vial and needs to be drawn into the syringe. Before administering a drug from the vial, make sure it is the right one, that it has not expired, that it is not discolored and that there are no foreign bodies inside the vial.
- Sterilize the tip of the vial with a cotton swab dipped in alcohol
- Hold the syringe with the needle pointing up, do not remove the cap. Pull the plunger back to the appropriate dose mark, thus filling the syringe with air.
- Insert the needle through the rubber stopper of the vial and press the plunger, pushing the air into the vial.
- Holding the vial upside down and the needle in the liquid, pull the plunger back to the desired notch again (or just above if there are any air bubbles). Shake the syringe a little to make the air bubbles move up, then push them into the vial. Make sure you have the right dose inside the syringe.
- Remove the needle from the vial. If you don't use it right away, be sure to cover the needle with the cap.
Part 3 of 3: Using the Z-Track Technique
Step 1. Understand the benefits of the Z-Track method
When you administer a drug intramuscularly, the penetrating action of the needle creates a kind of channel or path within the tissue. This creates the possibility of the drug leaking out of the body. The method described below reduces possible skin irritation and allows effective absorption of the drug by the muscle.
Step 2. Repeat the steps for washing your hands, filling the syringe, and cleaning the injection site
Step 3. Pull the skin to the side, about 2 cm, with your non-dominant hand
Hold it firmly to keep the skin and subcutaneous tissue in place.
Step 4. Insert the needle into the muscle at a 90 ° angle
Pull back the plunger slightly (Lesser Maneuver) to check for blood, then slowly inject the medication.
Step 5. Hold the needle in place for about ten seconds
This allows the drug to distribute itself evenly in the tissue.
Step 6. Pull the needle off and release the skin
A sort of zigzag path will be created that closes the path left by the needle and practically keeps the drug inside the fabric. As a result, the patient may experience some discomfort at the injection site.
Avoid massaging the area - this can cause the drug to leak and also cause possible irritation
Advice
- It takes some time to get used to doing an intramuscular injection. At first you will feel insecure and awkward, but remember that practice makes perfect and over time everything will become easier.
- Your doctor or pharmacist will advise you on how to properly dispose of used syringes and needles. This procedure is extremely important for safety reasons; so don't just throw them in the trash, as they are hazardous waste.
