IM Injections: Indications, Contraindications, and Administration PDF

Indications for Intramuscular (IM) Injections IM injections may be indicated for the following: Noncompliant clients Uncooperative clients Clients that are unable to receive medications through other routes Drug only available for this route Counterindications for IM Injections Active infect...

Indications for Intramuscular (IM) Injections IM injections may be indicated for the following: Noncompliant clients Uncooperative clients Clients that are unable to receive medications through other routes Drug only available for this route Counterindications for IM Injections Active infection, cellulitis, or dermatitis at the site of administration. Known allergy or hypersensitivity to the drug. Acute myocardial infarction- the release of muscle enzymes complicate the management strategy. Thrombocytopenia. Coagulation defects. Hypovolemic shock - the drug's absorption may be hampered due to compromised vascularity of the muscle. Myopathies. Associated muscular atrophy - leads to delayed drug absorption and increases the risk of neurovascular complications. Advantages to IM Injection Rapid and uniform absorption of the drug, especially the aqueous solutions Rapid onset of the action compared to that of the oral and the subcutaneous routes IM injection bypasses the first-pass metabolism of the drug It also avoids the gastric factors governing drug absorption Has efficacy and potency comparable to that of the intravenous drug delivery system Highly effective for emergency scenarios such as acute psychosis and status epilepticus Depot injections allow slow, sustained, and prolonged drug action A large volume of the drug can be administered compared to the subcutaneous route Polania Gutierrez JJ, Munakomi S. Intramuscular Injection. [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556121/  Disadvantages to IM Injections The absorption of the drug is determined by the bulk of the muscle and its vascularity The onset and duration of the action of the drug are not adjustable IM injection at the appropriate landmarks may be difficult in a child as well as in patients requiring physical restrains Inadvertent injection within the subcutaneous plane can lead to delayed action of the drug Painful procedure Suspensions, as well as oily drugs, cannot be administered Self-administration of the drug can be difficult The precipitation of the drug following faster absorption of the solvent may lead to delayed or prolonged action of the drug IM Administration : Delegation and Collaboration The task of administering intramuscular injections cannot be delegated to UCP. The nurse directs UCP about: Potential medication side effects and the need to report their occurrence to the nurse Reporting to the nurse any change in the patient’s condition  Ten Rights of Medication Administration The right medication The right dose The right patient The right route The right time and frequency The right documentation The right reason The right to refuse The right patient education The right evaluation Edition. Mosby Perry, Anne Griffin. Clinical Nursing Skills and Techniques, 7th Comparison of the angles of insertion of intramuscular (90 degrees), subcutaneous (45 to 90 degrees), and intradermal (15 degrees) injections Intramuscular Medication Administration Follow medication administration principles Assemble equipment Adhere to medication precautions for multi-dose vials, single dose vials and ampules Check compatibility of medications Controlled substance procedure Placement confirmation Z track Z Track for Intramuscular Perry, Anne Griffin. Clinical Nursing Skills and Techniques, 7th Edition. Mosby  Intramuscular Sites Ventrogluteal Vastus Lateralis Deltoid  Ventrogluteal Deep and situated away from major nerves and blood vessels Easily identified by prominent bony landmarks Preferred site for medications that are larger in volume, more viscous, and irritating Less painful than vastus lateralis Usual volume is 1-3mL but can accommodate up to 5 mL for exceptions Ventrogluteal Injection Site  Vastus Lateralis Absence of major nerves and blood vessels Drug absorption rapid Site used for immunizations in children Recommended as preferred site for IM injection of vaccines for infants and children Can accommodate 0.5 to 1 mL in infants and pediatrics and up to 2 mL in adults Vastus Lateralis  Deltoid Easily accessible but not well developed in most patients Used for small volumes of medication Faster absorption rate May be used as a vaccination site for adults, based on development of muscle Recommend no more then 1 mL volume Landmarks for Deltoid Site Perry, Anne Griffin. Clinical Nursing Skills and Techniques, 7th Edition. Mosby  Administering Intramuscular Injections Unexpected Outcomes Client complains of localized pain or continued burning at injection site. During injection blood is aspirated. Client displays adverse reaction. Client cannot Teach Back the information provided about the reasons for the IM injection and what to expect.  Special Considerations Home Care Self-administration of an IM injection is difficult, especially in the vastus lateralis. Teach a family caregiver to identify and administer injections in this site. Instruct clients who require frequent injections to apply EMLA cream or a Vapo coolant to the injection site 1 hour before administration. Clients will need instruction about safe disposal of syringes and needles. Reconstitution Copyright © 2017 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Mixing Medications Some medications need to be mixed from two vials or from a vial and an ampule. Mixing compatible medications avoids the need to give a patient more than one injection. Consult a compatibility chart or a pharmacist for compatible medications.  Mixing for IM Check drug compatibility Do not contaminate one medication with another Check equipment Check site Check how medication is supplied Drug Calculations Use the basic Formula Desired Dose x Volume mL Dose on Hand Covert all volumes to ML 3-mL syringe: calculate to hundredths, round to nearest tenth 1-mL syringe: calculate to thousandths, round to nearest hundredth NEVER round to the whole number