Intramuscular Injection Intradermal Injection Subcutaneous Injection By: Haidee E. Terry, RN Clinical Nurse Educ

1. MA/LVN Medication Administration Class: Injection Techniques Intramuscular Injection Intradermal Injection Subcutaneous Injection By: Haidee E. Terry, RN Clinical Nurse Educator 12/30/08

2. MA/LVN Medication Administration Intramuscular Injection Definition: To deliver medication into the muscle tissue Angle of insertion is 90 degrees Purpose: For gradual and optimal absorption into the bloodstream Absorption is usually faster than subcutaneous injections Risks: Infection, local pain and irritation May damage nerves

3. MA/LVN Medication Administration Intramuscular Injection (IM) Sites (common) Deltoid Vastus Lateralis Rectus Femoris Dorsogluteal Please mention that in an inpatient/hospital setting, the most common injection site is the dorsogluteal site. But in the clinic/outpatient setting, the deltoid site is the most common, due to its easy accessibility. This is included in the test. Please point out that the rectus femoris has the same landmarks and volume limitations as the vastus lateralis muscle. The rectus femoris is usually spared since it is responsible for the �lifting movement� of the leg; and if used for injection, may cause more noticeable discomfort than the vastus lateralis. No more aspirating for blood return when giving ONLY immunizations/vaccines. Aspirating for blood is still recommended for other medications given intramuscularly. This new guideline was released from KP-Region in November, 2008, under the direction of Joyce Johnson, PhD, RN-BC Regional Director, Education and ResearchPlease mention that in an inpatient/hospital setting, the most common injection site is the dorsogluteal site. But in the clinic/outpatient setting, the deltoid site is the most common, due to its easy accessibility. This is included in the test. Please point out that the rectus femoris has the same landmarks and volume limitations as the vastus lateralis muscle. The rectus femoris is usually spared since it is responsible for the �lifting movement� of the leg; and if used for injection, may cause more noticeable discomfort than the vastus lateralis. No more aspirating for blood return when giving ONLY immunizations/vaccines. Aspirating for blood is still recommended for other medications given intramuscularly. This new guideline was released from KP-Region in November, 2008, under the direction of Joyce Johnson, PhD, RN-BC Regional Director, Education and Research

4. MA/LVN Medication Administration Intramuscular Injection - Deltoid Deltoid Muscle To Locate: One - two fingerbreadths below the Acromion process Adult: Up to 1ml volume ~May give multiple injections � 1 inch apart (limit to 2 injections/site) Child 3-15: Up to 0.5 ml Birth to 3: Not recommended Please emphasize that for the adult patient:, to use 2 fingers to establish landmark for the deltoid site. Please emphasize for the child (3 � 15yrs old), to use 1 finger to establish landmark for the deltoid site.Please emphasize that for the adult patient:, to use 2 fingers to establish landmark for the deltoid site. Please emphasize for the child (3 � 15yrs old), to use 1 finger to establish landmark for the deltoid site.

5. MA/LVN Medication Administration Intramuscular Injection � Vastus Lateralis Vastus Lateralis: Adult To Locate: One-hand width below the proximal end of the greater trochanter and one-hand width above the top of the patella (knee cap) Volume: Up to 2.5ml per injection ~May give multiple injections � 1 inch apart (limit to 2 injections/site)

6. MA/LVN Medication Administration Intramuscular Injection � Vastus Lateralis Vastus Lateralis: Infant/Toddler Locate: Gently pinch the side of thigh, between hips and knee Volume: 1ml to 2 ml per injection ~May give multiple injections � 1 inch apart (limit to 2 injections/site)

7. MA/LVN Medication Administration Intramuscular Injection � Dorsogluteal Dorsogluteal: Adult To locate: Draw 4-sided window. Use upper, outer �window� area Volume: 2.5 ml