Intramuscular injections

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Before you start

Make sure you know the following about the medication:

What is the medication?

Why is the patient having it?

What is the normal dose?

Do you know the general side effects

Are there any precautions/contra-indications?

How do you give it? Over what time/rate?

Check prescription is correct on patient's drug chart

Check allergy status is recorded on drug chart

Be able to tell patient what you intend to do and why

Be able to discuss risks and benefits of the procedure

Understand how to gain informed consent

The 7 rights (discussed later on)

Introduction

1. Wash hands

2. Introduce yourself to patient

"Hi, I'm Aleda and I'm a 3rd year medical student"

3. Confirm 3 point of identification

Name, DOB, NHS Number

4. Ask about allergies

"Do you have any allergies?"

5. Check past medical history, symptoms and previous exposure

"Do you have any medical conditions or past procedures I should know about?"

"Are you on any current medications?"

Be aware of clotting disorders/use of anti-coagulants

"Have you had an IM injection before?"

"Are you currently feeling well?"

6. Explain the procedure

"I will be giving you a dose of medication via an injection into one of your muscles, this will be with a small needle. It may be slightly uncomfortable but you shouldn't feel a severe level of pain - if you do, please let me know and I will stop. I am giving you this medication because...."

7. Explain risks and how these will be avoided

Infection

ANTT

PPE

Adverse reaction/allergy

Check patient's allergy status

Monitor patient

Side effects of medication

Pain

Aspiration pre-injection to check placement

Inject slowly

Stop if increased levels of pain are experienced

Won't massage post-injection

Bleeding/bruising

Selection of appropriate site & size of needle

8. Assess patient's understanding

"Do you understand what I have said to you?"

"Would you feel comfortable repeating it back to me in your own words?"

9. Gain consent

"Are you OK to go ahead with this procedure?"

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Equipment

PPE (Gloves & apron)

Equipment tray & trolley

Patient's prescription

Medication (Checked)

Blunt filter/drawing up needle

Injecting needle

Green = Longer

Blue = Shorter

Length depends on patient & site of injection

Syringe - Smallest syringe that will accomodate medication volume

Gauze/cotton swab

Alcohol wipe

Sharps bin

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The 7 Rights

Right person

Check the patient/patient's wristband against the name on the prescription

If possible use 2 identifiers (patient & the wristband)

Right drug

Check labelled drug against prescription

Check expiry date

Right dose

Check against prescription

Right time

Confirm when last dose was given

Right route

Right to refuse

Ensure patient has consented

Right documentation of prescription & allergies

Does patient have any allergies?

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Administering an IM injection

1. Wash hands

2. Don gloves

3. Draw up required amount of appropriate medication into syringe using drawing up needle

4. Remove drawing up needle & dispose of it into sharps bin

5. Open injection needle and attach it to syringe using ANTT

6. Choose an appropriate injection site

Deltoid (Upper arm)

Locate acromion process and measure 3 fingerwidths down

Good for smaller volumes (max 2ml)

Ventrogluteal (Upper outer buttock)

Ideal for larger volumes of medication (max 3ml)

Most comfortable & safest (not close to any major vessels/nerves)

With patient on their side, place palm of your hand on the greater trochanter, index finger on ACIS and middle finger towards the iliac crest - place injection between index & middle finger

Vastus lateralis (max 5ml)

Divife thigh into thirds and inject into middle third

Dorsogluteal

LAST RESORT IN ADULTS

DO NOT USE IN PAEDS

Consider:

Age of the patient

Children < 7 months - anterolateral thigh (vastus lateralis)

> 7 months - deltoid/ventrogluteal

Muscle bulk

The position & mobility of the patient

Volume of the injection

Previous intramuscular injections

Ask the patient if they have frequent subcutaneous injections - if so, rotate sites

If multiple injections are given, use diff sites for each subsequent injection

DO NOT use site that is inflamed, irritated, bruised or scarred

7. Expose the skin at the selected site & position the patient to provide optimal access to the site

8. Clean the area if necessary using a alcohol wipe or soap & water if visibly soiled

9. Pull back blue safety cap & expose needle

10. Pull skin taut in an upwards motion (Z-tracking) while verbally preparing patient

11.Insert needle at 90 degree angle, keeping skin taut

Approx. one third of the needle should be visible externally to ensure the correct depth

12. Aspirate plunger for 5-10 secs noting any blood

13. If clear, inject 1ml every 10 secs

14. Wait 10 secs before removing needle

15. Keep skin taut until needle is fully removed

16. Release Z-track & apply cotton wool

Check for bleeding

DO NOT massage site

17. Make needle safe on hard surface and dispose of in sharps bin

18. Ensure patient is decent before leaving bed

19. Dispose of waste appropriately

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Completing the procedure

Wash hands

Thank patient

Provide aftercare advice

"Alert a staff member if there is any swelling, redness or pain as these are signs of infection"

Inform relevant staff that procedure has been completed

Documentation

Sign the patient's drug chart