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Intramuscular injection techniques
Hunter J (2008) Intramuscular injection techniques. Nursing Standard. 22, 24,35-40. Date of acceptance: October 29 2007 Summary The administration of intrairiLiscLitar (IM) injections is an important part of medication management and a common nursing intervention in clinical practice, A skilled injection technique can make the patient's experience less painful and avoid unnecessary complications.
AnIM injection is chosen when a reasonably rapid systemic uptake of the drug (usually within 15-20 minutes} is needed by the body and when a relatively prolonged action is required. The amounts of solution that can he given will depend on the muscle bed and range from 1 -5ml for adults. Much smaller volumes are acceptable in children (Rodger and King 2000, Corben 2005). The medication is injected into the denser part ofthe muscle fascia below the subcutaneous tissues. This is ideal because skeletal muscles have fewer pain-sensing nerves than subcutaneous tissue and can absorb larger volumes of solution because ofthe rapid uptake ofthe drug into the bloodstream via the muscle fibres. This means that IM injections are less painful when administered correctly and can be used to inject concentrated and irritant drugs that could damage subcutaneous tissue (Rodger and King 2000, Greenway 2004). Examples of drugs administered via this route are analgesics, anti-emetics, sedatives, immunisations and hormonal treatments. It is important to recognise and understand potential complications associated with IM injections and that rapid absorption of the drugs may increase these risks (Foster and Hilton 2004). The administration of any medication can present a risk and, therefore, the nurse must be able to recognise the signs of an anaphylactic (allergic) reaction, with signs of, for example, urticaria, pruritus, respiratory distress, shock or even cardiac arrest. Inappropriate selection of site and poor technique can increase the risk of patient injury and lead to pain, nerve injury, bleeding, accidental intravenous administration and sterile abscesses caused through repeated injections at one site with poor blood flow (Rodger and King2000).
Janet Hunter is lecturer in adult nursing, City Community and Health Sciences, incorporating St Bartholomew School of Nursing and Midwifery, City University, London. Email: firstname.lastname@example.org
Clinical procedures; Drug administration; Injection technique Tliese keywords are based on the subject headings from the British Nursing Index. Tliis article has been subject to double-blind review. For author and research article guidelines visit the Nursing Standard home page at www.nursing-standard.cD.uk. For related articles visit our online archive and search using the keywords.
THE NURSING and Midwifery Council's (NMC's) (2007) Standards for Medicines Management state that administration of medicines 'is not solely a mechanistic task to be performed in strict compliance with the written prescription of a medical practitioner (now independent/supplementary prescriber). It requires thought and the exercise of professional judgement.' Therefore, the administration of intramuscular (IM) injections requires the healthcare practitioner to possess the knowledge and rationale of the guiding principles that underpin these clinical skills. It is essential that all aspects of these techniques -anatomy, physiology, patient assessment, preparation and nursing interventions - are evidence based so that the nurse can perform safe and accountable practice (Shepherd 2002, NMC...
References: Corben V (2005) Administratior of medicines. In Baillie L (Ed) Developing Practical Nursing Sh 'Ik. Second edition. Hoflder Arnold, London, 114-154, Donaldson C, Green J (2005) Using the ventrogluleal site for intramuscular injections. Nursing Times. 101,16, 36-38. Foster J, Hilton P (2004) Maintaining a safe environment In HiltDH P (Ed) Fundamental Nursing Skills. Whure, London, 75-127 Greenway K (2004) Using the ventrogiuteal site for intramuscular injection. Nursing Standard. 18, 25, 39-42. tration: general principles. !n Dougherty U Lister S (Eds) The Royal Marsden Hospital Manual of Clinical Procedures. Sixth edition, Blackwell Publishing, Oxford. 184-227 Little K (2000) Skin preparation for intramuscular injections. Nursing Times. 96, 46, 6-8. Nkol M, Bavin C, Bedford-Turner S, Croniii P, Rawlmgs-Anderson K (?004) Essential Nursing Skills. Second edition, Mosby, Edinburgh. Nisbet AC (2006) Intramuscular gluteal injections in the increasing obese population: retrospective study, British Medical Journal. 332, 7542, 637-638, hospitals in England. Journal of Hospital Infection 65, Sitppl 1, S1-S64, Rodger MA, King L (2000) Drawing up and administering intramuscular injections: a review of the literature. Journal of Advanced Nursing. 31, 3, 574-582. Shepherd M (2002) Medicines 2, Administration of medicines. Nursing Times. 98,16, 45-48, Small S (2004) Preventing sciatic nerve injury from intramuscular injections: literature review. Journal of Advanced Nursing. A7.3. 287-296. Workman B (1999) Safe injection techNursing Standard. 13, 39, 47-53. Wynaden D, Landsborougli I, Chapman R, McGowan S, Lapsley Jl Finn M (2005) Establishing best practice guidelines for administering of intramuscular injections in the adult a systematic review of the literature, Cantemporary Nurse. 20, 2, 267-277
Jamieson E, McCail J, Whyte L (2002) Clinical Nursing Practices: Guidelines for Nursing and Midwifery Council (200/) Evidence-Based Practice. Fourth edition, Standards fur Medicines Management Churchill Livingstone, Edinburgh, NMC, London, King L (2003) Subcutaneous insulin injecPratt RJ, Pellowe CM, Wilson JA et al tion technique. Nursing Standard. 17 34, (2007) epic2: national 45-52 evidence-based guidelines for preventing healthcare-associated infections in NHS Lister 5, Sarpal N (2004) Drug admitiis-
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