The deltoid should not be used. The ventrogluteal muscle is the preferred and safest site for all adults, children, and infants for medications with larger volumes that may be more viscous and irritating.5 The ventrogluteal site should be used with caution in infants.1 It is recommended that only an experienced pediatric health care team member use this site. 18. Perform hand hygiene. It extends, in an adult, from a handbreadth above the knee to a handbreadth below the greater trochanter of the femur (Figure 4). The width of the muscle used extends from the mid-line of the thigh to the mid-line of the outer thigh. Apply gentle pressure to the site; do not massage. Thanks. NEVER leave the medication unsupervised once prepared. However, this site is not common for self-injection because its small muscle mass limits the volume of medication that can be injected typically no more than 1 Ensure a sharps disposal container is close by for disposal of needle after administration. If required by agency policy, aspirate for blood prior to administering an IM medication. Options for safe sharps disposal at home include allowing patients to transport their own sharps containers from home to collection sites (e.g., practitioners office, hospital, pharmacy), mailing their used syringes to a collection site (mail-back programs), participating in syringe exchange programs, or using special devices that destroy the needle on the syringe, rendering it safe for disposal. With the dominant hand, inject the needle quickly into the muscle at a 90-degree angle, using a steady and smooth motion. The concern should be explored, the practitioner notified, and the order verified. NEVER leave the medication unsupervised once prepared. This can lead to violation of expiration dates and product contamination (6,7). Variation from the recommended route and site can result in inadequate protection. Always wear gloves to administer injections. (version 3, peer review, 2 approved). particles up to a hundred times smaller than those in suspensions that are however likewise suspended in a solution. With skin held to one side, quickly insert needle at a 90-degree angle. Using reduced doses administered at multiple vaccination visits that equal a full dose or using smaller divided doses is not recommended (4). An aqueous solution can be given with a 20 to25 gauge needle. For adults, use a 1- to 1.5-inch needle. Prepare medication from an ampule or a vial as per hospital policy. For men and women who weigh <130 lbs (<60 kg), a -inch needle is sufficient to ensure intramuscular injection in the deltoid muscle if the injection is made at a 90-degree angle and the tissue is not bunched. The right hand is used for the left hip, and the left hand for the right hip. Patient displays adverse reaction to the medication, with signs of urticaria, eczema, pruritus, wheezing, or dyspnea. Sep 0. what is the maximum volume for intramuscular injection pediatric Cover injection site with sterile gauze, using gentle pressure, and apply Band-Aid as required. The location of all injection sites with the corresponding vaccine injected should be documented in each patients medical record. Review the patients previous verbal and nonverbal responses to injections. If a medication is discoloured or cloudy, always check manufacturers specification for the medication. Apply a dry cotton ball or gauze with light pressure for several seconds over the site. Place the heel or palm of your hand on the greater trochanter, with the thumb pointed toward the belly button. Cleanse the site with alcohol or an antiseptic swab, per the organizations practice. (DTaP, DT, Tdap, Td) 0.5 mL. (2020). Remove needle cap by pulling it straight off the needle. For women under 60 kg (130 lbs), a 16 mm (5/8 inch) Rotavirus, adenovirus, cholera vaccine, and oral typhoid vaccines are the only vaccines administered orally in the United States. Discoloured or outdated medication may be harmful. If possible, a family member should be trained to administer these injections. (2023). While going through one of them I found a chart that said it is ok to give up to 2ml in the deltoid, 3ml for the ventrogluteal, and 3ml in the vastus lateralis. 4. Reactions may include anaphylaxis, anaphylactic shock, and neurologic deficits.10 Vaccine adverse event reporting is monitored by the Centers for Disease Control and Prevention. However, for DTaP, Hib, and PCV13, there is no evidence related to immunogenicity of these 3 vaccines given subcutaneously. Place safety shield or needle guard on needle and discard syringe in appropriate sharps container. Remove the needle cap by pulling it straight off. This allows for easy access to dry gauze after injection. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Administering a vaccine containing an adjuvant either subcutaneously or intradermally can cause local irritation, induration, skin discoloration, inflammation, and granuloma formation. *In these skills, a classic reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice. Studies of children with previous febrile seizures have not demonstrated antipyretics to be effective in the prevention of febrile seizures (48). Place a clean swab or dry gauze between your third and fourth fingers. Jun 9, 2012. Assess patient data such as vital signs, laboratory values, and allergies before preparing and administering medications by injection. Muscle tissue is less sensitive than subcutaneous tissue to irritating and viscous medications. Assess the site and apply a bandage if needed. Movement of the needle can cause additional discomfort for the patient. WebFor a well-developed adult, no more than 3 ml of medication should be administered in a single IM injection because the muscle tissue does not absorb it well in larger volumes. These federal regulations require the use of engineering and work practice controls to eliminate or minimize employee exposure to bloodborne pathogens. You can review and change the way we collect information below. It is suitable for small volume injections. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Due to their rich blood supply, IM injection sites 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 (Hunter, 2008; Ogston-Tuck, 2014a). If no blood appears, inject the medication slowly and steadily. 21. Hand hygiene prevents the transmission of microorganisms. In certain circumstances (e.g., physical obstruction to other sites and no reasonable indication to defer doses), the gluteal muscle can be used. Next, the lower edge of the acromion process, which forms the base of a triangle in line with the midpoint of the lateral aspect of the upper arm, is palpated. After the needle pierces the skin, use the thumb and forefinger of the nondominant hand to hold the syringe barrel while still pulling on the skin. Learn more about Clinical Skills today! PPSV23and IPV are recommended by the manufacturer to be administered by the subcutaneous or intramuscular route. Multi-dose vials to be used for more than one patient should not be kept or accessed in the immediate patient treatment area. After cleansing the site, the needle is injected deep into the muscle and the medication is injected slowly. The Needlestick Safety and Prevention Act (2) was enacted in 2000 to reduce the incidence of needlestick injury and the consequent risk for bloodborne diseases acquired from patients. Recognize and immediately treat respiratory distress and circulatory collapse, which are signs of a severe anaphylactic reaction. Using larger-than-recommended dosages can be hazardous because of excessive local or systemic concentrations of antigens or other vaccine constituents. This site is used for small medication volumes (2 ml or less)5 and for administration of routine immunizations in children older than 3 years with acceptable muscle mass and development and when other sites are inaccessible because of dressings or casts.2. An adjuvant is a vaccine component distinct from the antigen that enhances the immune response to the antigen, but might also increase risk of adverse reactions. An IM site is chosen based on the age and condition of the patient and the volume and type of medication injected. 24. Children weighing less than 30 kgDose is based on body weight and must be determined by your doctor. Vaccine recommendations and guidelines of the ACIP: Vaccine administration. To locate the ventrogluteal site, the heel of the hand is placed over the greater trochanter of the patients hip with the wrist almost perpendicular to the femur. Oral typhoid capsules should be administered as directed by the manufacturer. If not using the Z-track method, follow these steps for injection. For non-live vaccines, manufacturers typically recommend use within the same day that a vaccine is withdrawn or reconstituted. If blood appears in the syringe, remove the needle, discard the medication, obtain a new syringe, and try again. Retrieved February 11, 2023, from, Lilley, L.L., Rainforth Collins, S., Snyder, J.S. This muscle is located on the anterior lateral aspect of the thigh and extends from one hands breadth above the knee to one hands breadth below the greater trochanter. Distraction, such as blowing bubbles and applying pressure at the injection site before giving the injection, may help alleviate the childs anxiety. (2022). Want to create or adapt OER like this? Inspect the skin surface over sites for bruises, inflammation, or edema. Unused syringes that are prefilled by the manufacturer and activated (i.e., syringe cap removed or needle attached) should be discarded at the end of the clinic day. Assess the patient for specific contraindications to receiving IM injections and advise the practitioner accordingly. Chapter 3. 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. Use a quick, darting motion when inserting the needle. Knowledge of the medication ensures the correct patient receives the correct dose of the correct medication at the correct time via the correct route for the correct reason using the correct documentation.
