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Intramuscular Injections IM’s

Intramuscular Injections IM’s. Chapter 21 Perry & Potter. Review – IV Fluids. Order: ½ NS @ 125cc/hr Drop factor: 15 gtt/ml Drop rate: 31.25 gtt/min (31-32) 125 cc/hr x 15 gtt/ml = 31.23 (31-32) 60 min Order: D5 ½ NS @ 100 ml/hr Drop factor: 10 gtt/ml Drop rate:

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Intramuscular Injections IM’s

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  1. Intramuscular Injections IM’s Chapter 21 Perry & Potter

  2. Review – IV Fluids Order: ½ NS @ 125cc/hr • Drop factor: 15 gtt/ml • Drop rate: • 31.25 gtt/min (31-32) 125 cc/hr x 15 gtt/ml = 31.23 (31-32) 60 min Order: D5 ½ NS @ 100 ml/hr • Drop factor: 10 gtt/ml • Drop rate: • 16.6 gtt/min (16-17)

  3. Review – IV Medications Order: Maxeran 10 mg IVPB ½ hour ac meals • Available: 10 mg/ml • Further dilute: 50 ml NS, infuse over 15 min • What is the rate: • 200 ml/hr • 50 ml X ? = 200 ml/hr 15 min 60 min • What is the drip rate (drop factor 15 gtt/ml): • 50 gtt/min

  4. Order: Pantoprazole 40 mg IV now • Available: 40 mg vial • Reconstitute with 10 ml NS (final concentration 4 mg/mL). Reconstituted solution may be given intravenously (over 2 minutes) or may be added to 100 mL D5W, NS, or LR (for 15-minute infusion). • Stable in D5W, LR, NS. • Y-site administration: Incompatible:Midazolam, zinc. • How much do you add to the minibag: • 10 ml • What is the rate: • 440 ml/hr • What is the drip rate with drop factor of 15 gtt/ml: • 110 gtt/min (this will be difficult to count)

  5. What would you do? Primary line: NS with 40 meq KCL @ 75 ml/hr Order:Pantoprazole 40 mg IV now What do you need to know before you begin? • Reason for primary infusion & reason for IV med • Drug information (expected & unexpected) • Client’s history & allergies • Client’s knowledge of medication • IV compatibility!!!

  6. Video Review • IV therapy • Monitoring an IV Site, checking Infusion Rate, and Changing an IV Solution Container • Replacing IV Solution Container and Administration Tubing • IV Medications • Administrating IV Medications by Piggyback Infusion

  7. Review – Subcutaneous Medication/Insulin Order: Lovenox 40 mg SC OD • Available: 300mg/3ml (100mg/ml) • Info: Lovenox is a sterile aqueous solution containing enoxaparin sodium, a low molecular weight heparin. Lovenox® is indicated for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) • How much do you withdrawl? • 0.4 ml • Identify the appropriate syringe: • 1 ml • Where are you going to administer this medication? • Outer aspect of abdomen (never arms)

  8. Video Review • Mixing Two Insulin's in One Syringe • Important information you need to know? • If insulin’s are compatible • Is it safe to give (know clients blood sugar) • Insulin(s) information (onset, peak, duration) • Draw up rapid acting insulin first (unmodified) • Check dose with RN/instructor • Know S&S of hyper/hypoglycemia • Injections sites

  9. Intramuscular Injections (IM’s) • Faster absorption • Less danger of causing tissue damage • Risk of injecting into blood vessels exists • Muscle is less sensitive to irritating and viscous drugs • Large well developed muscles (adults) can tolerate as much as 5 ml of medication (infants 0.5-1ml, toddler 1-2ml, preschool 2-3ml, adolescents 3-5ml)

  10. Vastus lateralis and ventraogluteal sites used in infants • Deltoid used in well developed children and adolescents • In estimating needle length in children, grasp muscle between thumb and index, needle length showed be half the distance between fingers. • Insert needle as close to 90 degrees as possible • Rotate sites to decrease risk of hypertrophy

  11. Needle Gauge • Gauge often determined by length • Most water soluble medications use: • 22-27 gauge needle • More viscous medications use: • 18-25 gauge needle • Older or cachectic clients may need shorter smaller gauge needle

  12. Needle length • Average length: • Children: 5/8 – 1 inch • Adults: 1- 1 ½ inches

  13. Assessment • Assess integrity of a muscle prior to injection • Help client assume a position that reduces strain on the muscle. • Area must be free of infection or necrosis, bruising or abrasions, underlying bones, nerves & major blood vessels.

  14. Assessment • Review order (medication rights) • Obtain medication information • Review history and assess factors contraindicating injection (muscle atrophy, shock, impaired circulation) • What would you do if contraindicated? Call prescriber for alternative route! • Medical history, allergies, medication history • Client’s knowledge/concerns

  15. Prepare Medication • 6 rights, 3 checks • Prepared correct dose from vial/ampule • Replace needle with needle for injection • Children: 5/8 – 1 inch • Adults: 1- 1 ½ inches (22-27 gauge) : 1 ½ inch (18-25 gauge) viscous medications • Check arm band/compare with MAR • Explain procedure, locate site, BE CONFIDENT

  16. Ventrogluteal Site: #1 • A deep site, situated away from major nerves and blood vessels, less chance of contamination in incontinent clients or infants because it is away from rectum. • Easily identified by prominent bony landmark. • Safe for all clients

  17. Ventrogluteal • Land marking (p. 725): • Place heel of hand over the greater trochanter of the client's hip • right hand over left hip • left hand over right hip

  18. Ventroglutealcon’t… • Point thumb towards client's groin • Index finger over anterior superior iliac spine • Extend middle finger back along the iliac crest toward the buttock • Create a triangle between index finger, middle finger and the iliac crest (towards the buttocks) • Inject in the middle of this triangle • Flexing of the knee and hip helps person to relax

  19. VastusLateralis site • Vastus Lateralis - lacks major nerves and blood vessels, rapid drug absorption, developed muscle • Site used for giving children IM medication (preferred for immunizations) • Client should lie with the knee slightly flexed or in a sitting position

  20. Vastus Lateralis Cont’d • Land marking (p.725): • Located on the anterior lateral aspect of the thigh • Handbreadth above the knee to a handbreadth below the greater trochanter of the femur. • In width, from the midline of the thigh to the midline of the thighs outer side. • Inject into the middle third of the muscle.

  21. Deltoid site • Not well developed in most adults & children (not recommended for use in infants or children) • Radial & ulnar nerves & brachial artery lie within the upper arm along the humerus • Used when other injection sites are inaccessible • Used for small amount of drugs (2 ml or less)

  22. Deltoid site con’t… • Landmarking (p. 726): • Expose upper arm • Palpate lower edge of the acromion process (base of triangle) • Inject in the middle of the triangle (3-5 cm below the acromion process)

  23. Dorsogluteal site • No longer a recommended site • Runs risk of striking underlying sciatic nerve, greater trochanter, major blood vessel. • Often used by nurses in hospitals (4 quadrant landmarking), practice is slowly changing

  24. Z track Method • Minimizes tissue irritation by sealing the drug within the muscle tissues and decreasing pain. • Recommended technique for all IM’s when possible

  25. Z track Method

  26. Implementation • Privacy • Wash hands • Expose only required area • Select appropriate injection site & ensure client is comfortable • Landmark site • With nondominant hand, pull skin 2.5-3.5 cm down or lateral (Z track), hold this position until medication is administered. • Cleanse site with antiseptic (center and rotate outward ~ 5 cm) • Gauze in nondominant hand

  27. Remove cap (pull straight off) • Hold syringe like a dart • Inject quickly at 90 degrees • Hold lower part of syringe to stabilize syringe • Pull back on plunger 5-10 sec, if no blood inject medication slowly (1 ml/10 sec) • Wait 10 sec, slowly withdrawl needle, place gauze over site • Assess site • Observe response to medication • Record on MAR, record response (i.eprn/STAT) • Document and report undesirable effects

  28. Video: Intramuscular Injection

  29. Practice Examples • Order: Demerol 50 mg IM q4h, prn Order: Gravol 25 mg IM, q4h, prn Supplied : • Demerol 50 mg / ml (ampule) • Gravol 50 mg / ml (vial) How much do you need of each? • Demerol: 1 ml • Gravol: 0.5 ml (Draw up medication from vial first, using filtered needle)

  30. Practice Examples 2. Order: Diphenhydramine 25mg IM stat Supplied: 50 mg/ml 3. Order: Dimenhydrinate 50mg IM/IV/PO q4-6 h prn Supplied 50 mg/ml

  31. Example Order: Solumedrol 100 mg IM stat Directions for Reconstitution Available 40 mg: Aseptically add 1 mL Bacteriostatic Water for Injection Available 125 mg: Aseptically add 2 mL Bacteriostatic Water for Injection How much do you draw up in the syringe? • 1.6 ml 125 mg X 100 mg = 1.6 ml 2 ml ? Or Dose X Stock 100 mg X 2ml = 1.6 ml Have 125 mg

  32. Lets Practice Next Lab: Sterile Dressings Perry & Potter: Chapter 37 & 38

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