Intramuscular and Z-Track Injections

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Sierra

Cards (31)

  • Parenteral

    Refers to the path by which medication comes in contact with the body
  • Parenteral medications

    • Enter the body by injection through the tissue and circulatory system
    • Are absorbed more quickly
    • Are used with patients who are nauseated, vomiting, restricted from taking oral fluids, or unable to swallow
  • Parenteral medications

    • Can be effective and safe when prepared and administered correctly
    • Have numerous risks associated with administering them as they are invasive and absorbed readily and quickly into the body
  • Routes for parenteral medications
    • Subcutaneous (SC)
    • Intradermal (ID)
    • Intramuscular (IM)
    • Intravenous (IV)
  • Subcutaneous (SC) injection

    • Places medication/solution the loose connective tissue just under the dermis
  • Intradermal (ID) injection

    • Places the medication into the dermis just under the epidermis
  • Intramuscular (IM) injection

    • Places the medication into the body of a muscle
  • Intravenous (IV) injection

    • Places the medication/solution into a vein through an existing IV line or a short venous access device (saline lock)
    • Medications can be given as an IV bolus, as an intermittent (piggyback) medication, or in a large volume continuous infusion
  • To administer parenteral medications safely, it is imperative to understand how to prevent an infection, prevent medication errors, prevent a needle-stick injury, and prevent discomfort to the patient
  • Unsafe injection practices have resulted in patient exposure to infections leading to outbreaks of infectious diseases
  • Injectable medications must be given in a safe manner to maintain sterility of equipment and prevent the transmission of infectious diseases between patients and health care workers
  • The research and development of intramuscular drug delivery has gained significant momentum in pharmaceutical industry during past several decades
  • Intramuscular (IM) drug delivery
    • Is associated with high safety and efficacy profiles
    • Is well-suited for extended-release drugs, especially those that require large injection volumes
  • Intramuscular (IM) injections

    • Deposit medications into the muscle fascia, which has a rich blood supply, allowing medications to be absorbed faster through muscle fibres than they are through the subcutaneous route
  • Intramuscular (IM) injection site

    • Is used for medications that require a quick absorption rate but also a reasonably prolonged action
    • Can absorb larger volumes of solution, which means a range of medications, such as sedatives, anti-emetics, hormonal therapies, analgesics, and immunizations, can be administered intramuscularly in the community and acute care setting
  • Muscle tissue

    • Is less sensitive than subcutaneous tissue to irritating solutions and concentrated and viscous medications
  • Technique of IM injections
    1. An IM site is chosen based on the age and condition of the patient and the volume and type of medication injected
    2. Needle size is chosen based on the weight of the patient, age, amount of adipose tissue, medication viscosity, and injection site
  • Aspiration
    • Refers to the action of pulling back on the plunger for 5 seconds prior to injecting medication
    • Current practice in the acute care setting is to aspirate IM injections to check for blood return in the syringe
    • Lack of blood in the syringe confirms that the needle is in the muscle and not in a blood vessel
    • Recent research has found that there is no evidence to support the practice of aspiration, but despite policy changes, the procedure of aspiration continues to be taught and practised
    • Vaccinations and immunizations given by IM injections are never aspirated
  • Complications with IM injections
    • Muscle atrophy
    • Injury to bone
    • Cellulitis
    • Sterile abscesses
    • Pain
    • Nerve injury
  • Ventrogluteal site

    • Involves the gluteus medius and minimus muscle and is the safest injection site for adults and children
    • Provides the greatest thickness of gluteal muscles, is free from penetrating nerves and blood vessels, and has a thin layer of fat
    • To locate the ventrogluteal site, place the patient in a supine or lateral position (on their side), use the right hand for the left hip and the left hand for the right hip, place the heel or palm of your hand on the greater trochanter, with the thumb pointed toward the belly button, extend your index finger to the anterior superior iliac spine and spread your middle finger pointing towards the iliac crest, insert the needle into the V formed between your index and middle fingers
  • Needle gauge and length for ventrogluteal site
    • Aqueous solution can be given with a 20 to 25 gauge needle, viscous or oil-based solutions can be given with 18 to 21 gauge needles
    • Needle length is based on patient weight and body mass index, a thin adult may require a 16 mm to 25 mm (5/8 to 1 inch) needle, an average adult may require a 25 mm (1 inch) needle, and a larger adult (over 70 kg) may require a 25 mm to 38 mm (1 to 1 1/2 inch) needle, children and infants will require shorter needles
  • Vastus lateralis site

    • Is commonly used for immunizations in children from infants through to toddlers
    • The muscle is thick and well developed, located on the anterior lateral aspect of the thigh and extends from one hand's breadth above the knee to one hand's breadth below the greater trochanter, the middle third of the muscle is used for injections, the width of the muscle used extends from the mid-line of the thigh to the mid-line of the outer thigh
    • To help relax the patient, ask the patient to lie flat with knees slightly bent, or have the patient in a sitting position
  • Needle length and gauge for vastus lateralis site
    • The length of the needle is based on the patient's age, weight and body mass index, in general, the recommended needle length for an adult is 25 mm to 38 mm (1 to 1 1/2 inch), aqueous solutions can be given with a 20 to 25 gauge needle, oily or viscous medication should be administered with 18 to 21 gauge needles, a smaller gauge needle (22 to 25 gauge) should be used with children, the length will be shorter for infants and children
  • The deltoid muscle has a
  • VASTUS LATERALIS
    • The length of the needle is based on the patient's age, weight and body mass index
    • In general, the recommended needle length for an adult is 25 mm to 38 mm (1 to 1 1/2 inch)
    • The gauge of the needle is determined by the type of medication administered
    • Aqueous solutions can be given with a 20 to 25 gauge needle
    • Oily or viscous medication should be administered with 18 to 21 gauge needles
    • A smaller gauge needle (22 to 25 gauge) should be used with children
    • The length will be shorter for infants and children; see agency guidelines
  • DELTOID MUSCLE

    • The deltoid muscle has a triangular shape and is easy to locate and access, but is commonly underdeveloped in adults
    • The injection site is in the middle of the deltoid muscle, about 2.5 to 5 cm (1 to 2 inches) below the acromion process
    • For an adult male weighing 60 to 118 kg (130 to 260 lbs), a 25 mm (1 inch) needle is sufficient
    • For women under 60 kg (130 lbs), a 16 mm (5/8 inch) needle is sufficient
    • For women between 60 and 90 kg (130 to 200 lbs), a 25 mm (1 inch) needle is required
    • A 38mm (1 1/2 inch) length needle may be required for women over 90 kg (200 lbs) for a deltoid IM injection
  • ASSESSMENT

    1. Check accuracy and completeness of each medication administration record (MAR) with prescriber's medication order
    2. Review pertinent information related to medication: action, purpose, normal dose, route, side effects, adverse reactions, time of onset, peak of action and nursing implications
    3. Assess patient's medical and medication history and history of allergies. Know his or her normal response to an allergy
    4. Check date of expiration for medication
    5. Assess patient symptoms or condition for which medication has been prescribed
  • PLANNING

    1. Prepare the materials needed
    2. Obtain the appropriate medication. Read the MAR and prepare medications for one client at a time. Select the proper medication from the unit stock/ patient's medication drawer
    3. Compare the label of the medication against the order on the patient's MAR/ CMAR. Check the expiration date and perform calculations. Return expired medications to the pharmacy
    4. Bring medications to patient's bedside and keep in sight at all times
  • IMPLEMENTATION
    1. Wash hands
    2. Identify the patient using two identifiers (i.e name and birth date or name and account number.) Compare identifiers with information on the patient's medical record
    3. Explain the procedure and purpose to the patient and family
    4. Provide privacy
    5. Re-check again the medication against the MAR at the patient's bedside
    1. TRACK

    1. Select the injection site for IM injections: ventrogluteal, vastus lateralis, dorsogluteal, rectus femoris and deltoid site
    2. Help patient to comfortable position depending on the muscle selected. Drape, as needed, to expose only the site area being used
    3. Identify the appropriate landmarks for the site chosen
    4. Cleanse the skin using a firm circular motion starting at the center and widening the circle outward. Allow the area to dry thoroughly
    5. Hold cotton between third and fourth fingers of non-dominant hand
    6. Uncap the needle with by pulling it straight off
    7. Grasp the muscle.If patient's muscle mass is small, grasp body of muscle between thumb and fingers
    8. Injection of the medication: Hold the syringe in the dominant hand like a dart, inform the patient and quickly plunge the needle at an angle of 90 degree into the skin until about 1 cm of the needle is left showing. Z-Track technique: Position ulnar aspect of your non- dominant hand just below site and pull skin approximately 2.5 to 3.5 cm (1.5 inches) down or laterally to administer in a Z-track. Hold this position until medication is injected
    9. Holding the syringe between thumb and forefinger (as if holding a pen), pierce the skin quickly and smoothly at a 90 degree angle. Insert the needle into the muscle
    10. Hold the syringe steady with non-dominant hand and aspirate by pulling back on the plunger with your dominant hand. Aspirate for 5 to 10 seconds. If no blood appears, inject medicine slowly, at a rate of 1 mL/10 seconds
    11. Once the medication has been instilled, wait for 10 secs before withdrawing the needle
    12. Withdraw the needle quickly. Using the dry cotton, apply gentle pressure to the site after the needle is withdrawn. Do not massage
    13. Assist patient to comfortable position
    14. Discard uncapped needle or needle enclosed in safety shield and attached syringe into puncture-proof and leak-proof receptacle
    15. Remove gloves and perform hand hygiene. Care for equipment
  • EVALUATION

    1. Document the administration of medication. (medication, time injected, route, site and nursing assessments)
    2. Return to room and ask if patient feels any acute pain, burning, numbness, or tingling at injection site
    3. Conduct appropriate follow up such as desired effect (e.g., relief of pain, sedation, lowered blood sugar, a prothrombin time within pre-established limits), any adverse effects (e.g., nausea, vomiting, skin rash) and clinical signs of side effects
    4. Observe patient's response to medication at times that correlate with onset, peak, and duration of medication
    5. Ask patient to explain purpose and effects of medication to evaluate patient's understanding of information given