Site Selection for Intramuscular Medical Injection

Question: Discuss about the Site Selection for Intramuscular Medical Injection. Answer: Intramuscular injection locations Australasian Medical Journal, 315-321. In this journal, the author looks at the safety that nursing students must consider in the administration of intramuscular injections and particularly, gluteal IM injection sites. The author emphasizes that IM injection technique has changed through the years as a result of evidenced-based nursing practice research, including changes in the equipment used. According to the journal, IM injection site should be selected based on the age of the patient as this determines the needle size, adipose tissue amounts, and the viscosity of the medication. Site selection is important so that people of different ages are administered with the right amount of medication and treated with appropriate equipment. The authors emphasis that the deltoid muscle among infants is not well developed and thus not appropriate for IM injections is well founded. This is because the underdeveloped muscle in infants will not absorb the medication adequately. In regard to the volume of medication, the author also indicates that it is important to do the right IM injection site selection in order to have the right volume of medication administered intra-muscularly. It is important to note that the volume of medication for IM administration varies in line with the intended site. The accepted range of medication volume for IM injection is between 1 and 4 mL. Even so, the deltoid muscle injection site should not be above1 mL. For children, who definitely have less-developed muscles just like the elderly, IM injection at the deltoid muscles remain limited between 1 and 2mL. The leaking and tracking back of medication injected intramuscularly into the subcutaneous tissue, affects the volume of medication, and hence its efficacy in the required time. The Z-track technique is thus used in the administration to IM injections in order to prevent the tracking back effect of injected medicine by sealing this medicine in the muscles of a patient. It a lso reduces the irritation from the medicine as indicated in the journal. Intended intramuscular gluteal injections Are they truly intramuscularJournal of Postgraduate Medicine, 60(2), 175. Dayananda et al(2014) highlighted the evidence-based research on IM injections focussed on investigating whether gluteal injections are practically intramuscular. The authors then discuss gluteal IM injection in regard to sustained pain and injury, the tracking back effect and the suitability of the site for injection. In regard to injury and pain, the journal indicates that it is paramount to select IM injection site carefully in order to prevent unnecessary injuries and pain on patients among other general complications. According to the journal, the major complications associated with IM injections among others; muscle atrophy, bone injuries, cellulitis, and pain, abscesses that are sterile and nerve injury. The use of IM injection option has a higher risk where a nurse may inject the medication into the bloodstream directly. Further, other factors which hinder the flow of blood in a patient to the injected local tissue impacts on the drug absorption rate. It is thus agreeable tha t the author emphasizes on the use of IM injections only as a last resort, because of the different documented effects of pain and injury. Choosing IM at the deltoid muscle for instance brings about damage to both the radial nerves and arteries at the site. Even so, IM may be preferred as the muscle tissue is relatively less sensitive when compared to the subcutaneous tissue in regard to irritating solutions and/or medications that are concentrated and viscous in nature. Sites of choice for administering intramuscular injections to adult patients in the acute care setting. This journal focuses on the choices of Staff nurses in regard to injection sites when administering IM injections in acute hospital care setting rather than in the community. According to Walsh and Brophy (2010), selection of IM injection sites particularly for deep muscular injections may depend on ones familiarity and/or confidence but not on best practice. The journal provides the appropriate IM injection sites and these include; the ventrogluteal, the Vastus lateralis, and also the deltoid muscles. Even so, the authors agree with the available evidence that the ventrogluteal site for IM injection is the most appropriate site. This particular site is the most acceptable IM injection site especially for medications that are oily and irritating. This is because it is the ventrogluteal site has minimal number of both blood vessels and the nerves. It also comprises of the greatest muscle thickness when compared with the remaining IM injection sites. It is also thus important to know t he most appropriate IM injection site in order to determine the size of the needle. This is because a longer needle that has a larger gauge may be needed to adequately penetrate some deep muscle tissues. Walsh and Brophy (2010) also indicate the different needle sizes needed for IM injection to show the importance of correct site selection. Needle length at the Vastus lateralis should be 5/8" to 1." Needles intended for the deltoid need to be between 5/8" and 1 1/4" for children and between 5/8 and 1 1/2" for adults. The ventrogluteal site requires needles of length 1 1/2" for adults. The journal also indicates that it is important to correctly select an IM injection site especially when one has to choose between it and subcutaneous injection, based on the speed of medication absorption. According to the journal IM injections are intended to deposit medications directly into muscle fascia that comprises of a rich supply of blood and therefore allows for faster absorption of medications through the muscle fibers as compared to when the subcutaneous route is used. IM injection sites are used for those medications which require quick rates of absorption, including also a reasonable prolonged action. Because of the rich blood supply, IM injection sites are able to therefore absorb even larger volumes of medication solutions. As a result, a range of medical preparations including sedatives, hormones, anti-emetics, vaccines, analgesics, among others can be comfortably administered through IM sites both in the communities and in acute care settings. References Cornwall, J. (2011). Are nursing student safe when choosing gluteal intramuscular injection locations?. Australasian Medical Journal, 315-321. Dayananda, L., Belaval, V., Raina, A., Chandana, R. (2014). Intended intramuscular gluteal injections: Are they truly intramuscular?. Journal of Postgraduate Medicine, 60(2), 175. Walsh, L. Brophy, K. (2010). Staff nurses sites of choice for administering intramuscular injections to adult patients in the acute care setting. Journal of Advanced Nursing, 67(5), 1034-1040.