Intramuscular Injection

1. INTRAMUSCULARINJECTION Dr. Kamlesh R. Lala MBBS, D PED, FCGP AHMEDABAD

2. HISTORY The first injection was given in 1920, but became popular only after second world war. Now injections are probably the most common percutaneous procedure practiced worldwide

3. MAGNITUDE • An estimated 12 billion injections are administered each year. • The average no of injections range from 0.9 to 8.5 per person per year.

4. DEFINITION Intramuscular injections are a common yet complex technique used to deliver medication deep into the large muscles of the body It may be for curative, diagnostic or recreational purpose

5. SURVEY • An Indian survey found that 96% of all injections given by private doctors were of antibiotics, vitamins, analgesics and chloroquine. • Surprisingly 70 to 95 % of such injections were unnecessary.

6. WHY INJECTIONS ??? • Injections are stronger medication • Injections work faster and drug is more effective • Patient’s non compliance • Financial incentives • If I won’t give my colleague will give

7. COMPLICATIONS Giving IM injection is not a benign procedure. It is with risk of disease, disability and even death The most common one is transmission of blood borne infections mainly Hepatitis B, Hepatitis C and HIV These infections may be passed to HCW and even in society Do you know how ???

8. Others are • Abscess • Muscle or fat necrosis • Muscle fibrosis and contracture • Gangrene • Nerve Injury

9. WHAT IS SAFE INJECTION • Does no harm to recipient • Does not expose the HCW to any risk • Does not result in waste that is dangerous for the community • Do you know two third of injections given in our country are UNSAFE !! By reuse of syringe and needle

10. Indications of injection

11. Severe and life threatening illness • Inability to swallow • Profuse vomiting • Non availability of effective oral agent

12. So before giving any injection just ask yourself • Is it necessary • Is it justified • And if “YES” then see that it is “SAFE”

13. GIVING IM INJECTION

14. It can be discussed under following heads • Site Selection • Preparation of Injection • Procedure • Post Injection Care

15. Site Selection • The most common injection site is anterolateral thigh into Vastus Lateralis muscle • Never use gluteal muscle in children • The other site in adult and in older children is deltoid muscle

16. Anterolateral Thigh

17. Deltoid

18. Selecting Gluteus Muscle

19. REMEMBER For giving vaccines including anti rabies vaccine never select gluteal muscle. They are ineffective if injected so.

20. RISKS OF GLUTEUS INJECTION • Injury to sciatic nerve • If medication is in fatty tissue then it may result into necrosis and abscess • Chloroquine, Diclofenac and oily, viscous or depot injections are always to be injected into gluteus muscle

21. PREPARATION OF INJECTION

22. Injection medication may be • Available in prefilled syringe • Available in liquid form • Has to be reconstituted • Either in single dose or multidose vial

23. MULTIDOSE VIAL • Where possible use single dose vial rather than a multidose one • Never make multiple withdrawals from a single dose vial Why ??? Single dose vials do not contain prophylactic antibiotics, and so there are all chances of contamination

24. Chances of infection are more common with MD vial Because of • Reuse of same syringe for filling medication • Permanent insertion of needle into the vial • Storage of reconstituted vial • Opened vial kept submerged in water or ice • Rubber stopper wiped with antiseptic • Lack of proper hand hygiene

25. EQUIPMENT SELECTION • Use only new disposable syringe and needle every time • Changing only the needle on the same syringe is also not safe • Use wide bore needle rather than a narrow one • For oily or viscous injection use 20 or 21 no. needle • Use longer possible needle • For gluteus injections always use 1½ ” needle

26. Skin preparation • Avoid site with oozing dermatitis or infection • If the skin is clean than no use of disinfection • Clean the site with single use spirit or alcohol swab in a circular motion in an area 5-8 cms • Pre wetted cotton swabs are better to be avoided • If spirit is not available normal saline can be used • Never use Savlon or Dettol • Let the site be dry before injection

27. Preparing Syringe • The area for preparing injection should be clean • Clean your hands with alcohol based hand wash • If you have cut or injury on fingers, cover it with water proof adhesive • No need to use gloves routinely

28. Preparing syringe • Remember to use new equipment • Observe aseptic precautions • No need to change the needle after withdrawing medication • Do not ever wipe the needle with swab • Do not keep the air bubble inside the syringe

29. Giving injection • We have found giving injection necessary • We have selected the site • We have prepared the syringe So now comes giving injection

30. Giving injection • Make the patient comfortable and give him a proper position so as to identify the proper site for injection • Properly hold the child • Hold the syringe in your hand as if holding a pen • Remove needle cap immediately before giving injection…not earlier

31. Giving injection • Ensure smooth and steady insertion of the needle at 90 degree with a dart technique • No need to aspirate • Slowly push the medication allowing muscle fiber to stretch and accommodate the injected volume • Wait for a while and remove the needle in the same direction as it was pushed • Apply gentle pressure with a dry gauze

32. Z technique

33. Preventing Needle Stick Injury • Anticipate abrupt movement of the patient and take care • More the used needle is handled or carried, the greater is the risk of sharp injury • Never try to recap, bend or manually remove needle from syringe • Do not move around with used equipment in hand • Keep needle destroyer near by only • Properly dispose it

34. Multiple injections • Some times multiple injections are to be given in a single visit especially for vaccines • Any no of injections can be given in a single visit • Use different anatomical site • If same limb is to be used than separate two injections by 1-2”

35. Post Injection Syncope • This is known side effect especially in adolescents. So it is better to observe the patient for 10-15 minutes

36. According to WHO Use injections only when necessary – oral medicines are effective in most cases.