I have had the opportunity to re-learn this in clinical school (semester 6) in a little more detail, so I shall post this up here.
introduction - (for semester 2 students)
- an Intramuscular Injection is a substance injected directly into a muscle.
- drugs injected intramuscularly are absorbed into the muscle fairly quickly.
- Immunization is usually done on the deltoid (the shoulder muscle) because they are small in dose, and is highly soluble.
- Other medications such as analgesics, anti-emetics, immunoglobulin and pre-op medicine are injected into larger muscles (like the Gluteus Major, your buttocks) because they are caustic to tissue, can be thick in consistency and needs extensive blood supply for absorption.
- 6 precautions of injection
- right dose
- right patient
- right medication
- right site
- right time
- right documentation
so while carrying out the injection, always keep those 6 things in mind.
... that'll be enough for intro, so here we go.
Injection of Intramuscular Injections
Summary of events
1. GIEP - special consideration on the explanation and identification
of patient
2. Washing hands
3. Equipment check
4. Preparation of medication from vial / ampoule
5. Select injection site
6. Don gloves.
7. Locating and cleaning site
8. Preparation of syringe for injection
9. Injection of medication (not required to DO during pre-clinical
OSCEs - only KNOW)
10. Thank patient
11. Wash hands
12. Documentation of injection
13. Finished. Leave.
GIEP - special consideration on the explanation and identification of patient
About 30% of marks comes from here.
·
Greet and introduce yourself.
·
Explain the procedure -
include…
o The procedure requires exposing the area needed for injection
o The procedure involves a needle, and patient will experience
discomfort.
o That the patient has the right to stop any time if s/he feels TOO
uncomfortable, but please do bear with me so I can help you.
·
Get permission.
·
Now, Identify the patient, and
correlate his/her information with the document given. Verbalize this so that
examiner will know what you are doing. - you may double check, by checking the
patient’s tag on the wrist. (if s/he has any tag - it is there for a reason!) RIGHT PATIENT
Washing hands
Wash hands. Quick quick quick!
Equipment check
Another 30% of marks here.
Preparation of medication from vial / ampoule
Quite confusing - so please practice.
·
Check all the equipments -
vocalize this.
o Sterile medication vial / ampoule - RIGHT
MEDICATION
o Syringe - choose the correct size according to the dosage
given.
§
- BUT sometimes, it is a good
idea to choose a syringe one size bigger than the required dose - for e.g. if
you need to give 1 ml of medication, you may use 10ml syringe -
§
WHY? It reassures the patient when the
medication dosage LOOKS small. A 1ml medication in a 1ml syringe, and 1ml
medication in 10ml syringe has a different impression on the patient.
o 2 needles of the correct size - 21G to 23G needle for adult IM
injection. 23G to 26G (with 1inch length) for children IM.
§
WHY 2 Needles?
·
One needle for extracting the
medication from the vial / ampoule.
·
One needle for injection.
·
Needles must be separate due to
the fact that the needle is considered BLUNT when it is used once, no matter it
is used for injection or extraction.
o Dry gauze / cotton ball
o 2 Antiseptic swab (alcohol swab)
§
One for injection site, one for
medication vial / ampoule
o Disposable Gloves
o Sharps bin
·
Extraction of the medication
into syringe
o Don gloves
o Open the needle wrapper halfway - so that you don’t touch the needle
direcly, but hub is accessible.
o Open wrapper of syringe.
o Attach the hub of needle onto the syringe.
o Put down the syringe for now, and pick up the vial/ampoule
§
Re-confirm the medication. Vocalize.
o Remove sheath from the syringe and needle, and expose the needle.
o Vial
§
Pop off vial top
§
Clean mouth of vial using
antiseptic swab
§
Pull syringe to insert air into
the barrel - the air is needed to break the vacuum in the vial.
§
Insert air into vial
§
Pull out medication from vial
§
Leave the needle into the vial,
and push out excess air from barrel.
o Ampoule
§
Clean the ampoule neck
§
Tap the ampoule to make sure
all the medication is below the neck
§
Wrap the ampoule neck with
cotton swab
§
Break off the ampoule head,
careful not to cut yourself.
§
Insert needle into ampoule and
extract medication
§
Expel air from barrel.
o Make sure you have the appropriate dosage, by holding the syringe
vertically.
o Done. Make sure you dispose the needle into sharps bin / leave in
the vial
Select and clean injection site
RIGHT SITE
·
Select injection site, and ask
/ check for any…
o
Tenderness (palpate the area
and ask for pain)
o
hardness
o
swelling
o
scarring
o
itching
o
burning
o
localized inflammation
·
Deltoid
o
3 cm below acromial process, on
the lateral surface of deltoid muscle
·
Dorsogluteal
o
To find suitable postion -
§ Divide one buttock into 4 segments
§ From the center of 4 segments, (on the middle of buttock), draw
another diagonal imaginary line towards the Posterior Superior Iliac Spine.
§ Inject on the mid-way between the diagonal line.
·
Clean the area of injection
site.
o
Swab center first - rotate
outwards
o
About 5 cm in diameter
o
Allow to dry
Injection of medication (not required to DO during pre-clinical OSCEs - only KNOW)
·
IM injections should be 90
degrees to the skin.
·
Hold syringe as you would hold
a pen
·
Warn patient
·
Inject
·
Pull on syringe - see if blood
is aspirated (to ensure you did not hit any vessels)
·
If blood is aspirated, pull out
needle and re-locate injection site. Repeat with a different needle.
·
You may employ a Z-track
technique if medication is caustic to subcutaneous or dermis
o
Used for haloperidol or
vistaril
o
Also for coloured solutions,
such as Iron solutions
Thank patient and documentation
·
Mention that you will document
the injection. RIGHT DOCUMENTATION
Wash hands and leave
possible viva
·
When do you NOT use antiseptic
swab?
o
BCG injection - because this
involves injection of live-attenuated vaccine. If the antiseptic is used, it
may kill off the bacterias.
·
How do you select injection site
for IM injection?
o
Depending on…
§ Amount of medication
·
Small amount - can be injected
on smaller muscles (deltoid)
·
Large amount - should be
injected on larger muscle (dorsogluteal)
§ Consistency of medication
·
More soluble - can be injected
on smaller muscles
§ Causticity of medication
·
More caustic - should be
injected on larger, more vascularized muscles
§ Age of patient
·
Young patients should receive IM
through dorsogluteal site
§ Skinny patients
·
May not be able to inject the
deltoid muscle - too small.
No comments:
Post a Comment
hi. any kinds of comments are welcome! thank you...