Inyeccion

Clinical Practice

IM injections:

How’s your technique?
Good injection technique can mean the difference between less pain and injury. Angela Cocoman and John Murray explain
Giving an IM injection into the Vastus lateralis site
T To find the thigh injection site, make an imaginary box on the upper leg. Find the groin. One hand’s width below the groin becomes the upper border of the box TFind the top of knee. One hand’s width above the top of the knee becomes the lower border of the box T Stretch the skin to make it tight T Insert the needle at a right angle to the skin (90°) straight in T Up to 2ml of fluid may be given into this site
Vastus Lateralis Rectus Femoris

IM injection into the Gluteus medius site (buttock)
T Find the trochanter. It is the knobbly top portion ofthe long bone in the upper leg (femur). It is the size of a golf ball T Find the posterior iliac crest. Many people have ‘dimples’ over this bone
Greater Trochanter

Gluteus Maximus

T Draw an imaginary line between the two bones T After locating the centre of the imaginary line, find a point one inch toward the head. This is where (X) to insert the needle T Stretch the skin tight T Hold thesyringe like a pencil or dart. Insert the needle at a right angle to the skin T Up to 3ml of fluid can be given in this site

Sciatic Nerve

THE ADMINISTRATION of intramuscular injections is a common nursing intervention in clinical practice.1 This article aims to, raise awareness in relation to the injection sites used for intramuscular injection and, to highlight best practice in relation toIM injection administration. The importance of good injection technique cannot be understated. It should not be forgotten that among potential complications of IM injection are abscess, cellulites, tissue necrosis, granuloma, muscle fibrosis, contractures, haematoma and injury to blood vessels, bones and peripheral nerves.2 Although IM injection is a commonplace nursing practice, there is a dearthof guidelines for nursing staff in this area.3,4 It has been outlined that there are no working policies or procedures on administering injections to which nursing staff can refer.3 Furthermore, the technique and preparation by certain staff may not be substantiated by evidence.4 Sites of the thigh (Rectus femoris and Vastus lateralis) The uptake of drugs from the thigh region is slower than fromthe arm but faster than from the buttock, thus facilitating better drug serum concentrations than is possible with the gluteal muscles.5 The thigh may be utilised when other sites are contraindicated or by clients who administer their own medication, as it is readily available in the sitting or lying back position. However, the main disadvantage is that injections in the Rectus femoris site maycause considerable discomfort.6 This site can be used for infants, children and adults. Needle length used is usually 2.5cm or less. The dorsogluteal site This site is commonly referred to as the outer upper quadrant and is contraindicated in children. The presence of major nerves and blood vessels, the relatively slow uptake of medication from this site compared with others and the thick layer ofadipose tissue commonly associated with it, makes this site problematic.7 The sciatic nerve and superior gluteal artery lie only a few centimetres distal to the injection site, thus great care needs to be taken to identify landmarks accurately. Palpating the ileum and the trochanter is important; using visual calculations alone can result in injection being placed too low and

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WIN April2006

Clinical Practice

Giving an IM injection into the deltoid site
T Find the knobbly top of the arm (acromion process) T The top border of an inverted triangle is two finger widths down from the acromion process T Stretch the skin and then bunch up the muscle T Insert the needle at a right angle to the skin in the centre of the inverted triangle Caution: This is a small site – give only...