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Intramuscular injection
What is an intramuscular injection?
The insertion of an intramuscular injection is a reserved act. It may only be inserted by a doctor or by a nurse trained in this field on behalf of a doctor.
When is an intramuscular injection given?
An intramuscular injection, for example, is a vaccination. But vitamins and pain relief are also often injected intramuscularly. An intramuscular injection is also often chosen in the following cases:
– If the medicine needs to be absorbed into the blood quickly.
– When the injection fluid contains substances that cause tissue death (necrosis) under the skin
such as iron.
– When the injection fluid is absorbed relatively slowly by the body,
For example, with oily substances.
– If a ‘generous’ amount of liquid has to be injected (max. about 20 ml).
Injection sites
In an intramuscular injection, the fluid is injected directly into the muscle. It is preferable to use large muscles. Because injecting into a tense muscle is painful and increases the risk of bleeding, it is important that the client relaxes beforehand.
For small amounts of fluid, the m. deltoidus, the proximal upper arm muscle, is usually used. You then insert the injection two finger widths below the acromion. Another suitable muscle to inject into is the vastus lateralis muscle. This is located on the outside of the thigh. You then inject into the middle part on the outside of the thigh.
The gluteus maximus muscle is also a muscle that is often used for intramuscular injections. You may only inject into the upper and outer quadrant. The injection is absorbed into the body by these three muscles at about the same rate. The choice of injection area depends, among other things, on the client’s preference.
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Injection techniques
Intramuscular injection - perpendicular technique
The most commonly used technique for intramuscular injection is the perpendicular technique. The needle is inserted perpendicular to the muscle tissue through the tightened skin.
You can practice the perpendicular technique technique with the CareUp app. This can be done on your mobile phone, or via the computer. You don’t need any practice materials and the action is completely based on the Vilans protocol. Test your skills right away! If you pass the test, you will receive a certificate and also 1 accreditation point.
Intramuscular injection - depot exchange technique
With the depot swapping technique, you divide the total amount of liquid over two different areas with one injection. You can use this technique, for example, when the amount of liquid you need to inject is more than 5 ml. Or when you have to inject two liquids that should not be combined in one syringe.
You insert the needle perpendicularly and inject the first 5 ml or the first syringe. If you need to change a syringe, do it first. Then you pull the needle back halfway and insert it again, but now at an angle of about 60 degrees and inject the rest of the liquid.
Intramuscular injection - zigzag technique
The zigzag technique is also called the Z-technique or shunting technique. If you want to prevent backflow of fluid or irritation from the injected fluid, you can use this technique.
Some etching and viscous fluids can damage the subcutaneous tissue or cause pain if they flow back. This pain occurs because the pressure in the solution of the injection does not match the pressure in the body tissue. When a product is not dissolved in physiological salt (NaCl 0.9%), this is usually the case.
This is also common with syringes that contain glycerol, polypropylene or alcohol as an excipient in addition to water. If you are not sure whether you are dealing with such a liquid, it is best to ask the pharmacist.
Examples of this type of injection fluids are:
– some antibiotics
– cytostatics
– iron (CosmoFer)
-Theophylline
– phenytoin
– gold injections for rheumatism (tauredone)
When you first shift the skin sideways, then inject the fluid and then release the skin, the fluid in the muscle remains blocked.
Complications of intramuscular injection
Preventing complications is important when injecting intramuscularly to spare clients pain and unpleasant situations.
Puncture of a blood vessel
One of the possible complications is the accidental puncture of a blood vessel. If the medication is injected anyway, it can end up directly in the blood vessel. In severe cases, this may lead to shock or coma.
Nerve Touching
Another possible complication is that when you inject the gluteus maximus muscle, you accidentally hit the nerve that runs nearby, the sciatic nerve.
Blood sticks to the needle
And when you pull the needle out of the body and want to place a new injection with the same needle, a little blood gets stuck in the needle. You then inject this back into the body, causing the blood from the needle to clump together in the wrong place in the body. This can cause pain to the client.
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The latest evidence on intramuscular injection
New technique to prevent sciatica
A review has also been written about the prevention of sciatica after an injection into the dorsogluteal region. Because this is an annoying complication, the researchers propose to use a new technique to determine the area in which to prick.
They propose to divide each quadrant into four quadrants in the previously described location determination. In this way, the area to be injected is smaller and the chance that the injection will be placed in the wrong place is also smaller. In addition, they suggest using the ventrogluteal region more often for injections.
The researchers recommend that nurses and doctors are well trained in this.
Remain proficient in injecting
Do you want to remain proficient in injecting? Download the CareUp app now! With the CareUp app you can practice and test the most common reserved actions. Do you complete a test with a pass? Then you will receive a certificate and accreditation points!
And all this can be done wherever and whenever you want, via your mobile phone, a tablet or on the computer. You don’t have to go to a skills lab for it and you don’t need any practice materials. Through the 3D simulation game you practice the complete action from A to Z, both theory and practice.
Start now, because a skilled healthcare professional is a better healthcare professional!
