1 mL - Never more How many mL can be injected into the vastus lateralis? Some experts allow intramuscular injection with a -inch needle but ONLY if the skin is stretched flat (21). National Patient Safety Goals for the hospital program. This step prevents the spread of microorganisms. This prevents needle from touching side of the cap and prevents contamination. 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. Webavailable in a 1 mL, 2 mL, and 4 mL sizes containing the equivalent of 600,000, 1,200,000 and following injections into the buttock, thigh, and deltoid areas. The anterolateral thigh also can be used. 1 inch] if possible) so that any local reactions can be differentiated (13,29). Allow the skin to dry completely. Multi-dose vials to be used for more than one patient should not be kept or accessed in the immediate patient treatment area. Retrieved February 11, 2023, from, Institute for Safe Medication Practices (ISMP). 15. PPSV23and IPV are recommended by the manufacturer to be administered by the subcutaneous or intramuscular route. Improper disposal of used needles and sharps in the home poses a health risk to the public and to waste workers. Always wear gloves to administer injections. Changing needles between drawing vaccine from a vial and injecting it into a recipient is not necessary unless the needle has been damaged or contaminated (11). in (25 mm) Men and women,Men and women, less than 60 kg* (130 Extend your index finger to the anterior superior iliac spine and spread your middle finger pointing towards the iliac crest. Verify the correct patient using two identifiers. Use a 22- to 25-gauge needle. ), Centers for Disease Control and Prevention (CDC). Where to inject delatestryl? IM injection sites should be rotated to decrease the risk of hypertrophy. WebHow many mL can be injected into the deltoid and thigh muscles? Use a needle long enough to reach the deep muscle. 6. Review medication information, such as purpose, action, side effects, normal dose, rate of administration, time of onset, peak and duration, and nursing implications. The nurse measures 2 to 3 finger widths4 down from the acromion process and visualizes a triangle, with the base at the acromion process and the apex pointing toward the elbow. The maximum amount of medication for a single injection is generally 1 ml. If possible, a family member should be trained to administer these injections. Health-care practices should consider using a vaccination site map so that all persons administering vaccines routinely use a particular anatomic site for each particular vaccine. Other persons at increased risk for influenza complications can administer LAIV. However, because of a theoretical risk for infection, vaccination with ACAM2000 can be offered to health care personnel administering this vaccine, provided individual persons have no specified contraindications to vaccination (10). WebRecommended available dose formulations include 50 mg/ml strength, in 3 ml multiple dose vials or 100 mg/ml strength, in 5 ml multiple dose vials. To help relax the patient, ask the patient to lie flat with knees slightly bent, or have the patient in a sitting position. Source: Adapted from Minnesota Department of Health. 23. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Studies of children with previous febrile seizures have not demonstrated antipyretics to be effective in the prevention of febrile seizures (48). Prepare medication from an ampule or a vial as per hospital policy. The deltoid muscle is the site most typically used for vaccines. Vaccinations and immunizations given by IM injections are never aspirated (Centers for Disease Control, 2015). Use the correct needle length based on the patients gender and weight. The thumb is pointed toward the patients groin, with the index finger pointing to the anterior superior iliac spine, and the middle finger is extended back along the iliac crest toward the buttock. Document procedure as per agency policy. Children and infants will require shorter needles. 22. Aspiration in injections: Should we continue or abandon the practice? Medication is administered in subcutaneous tissue. Don non-sterile gloves, select the correct site, and prepare the patient in the correct position. Retrieved February 11, 2023, from, Lilley, L.L., Rainforth Collins, S., Snyder, J.S. General Best Practice Guidelines for Immunization. Deltoid muscle: This is the top, upper part of the arm. 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 For injection into the anterolateral thigh muscle, a 1.5-inch needle should be used, although a 1-inch needle may be used if the skin is stretched tightly and subcutaneous tissues are not bunched. 10. The capsules should not be opened or mixed with any other substance. It would be uncommon for persons with these conditions to be in a role administering vaccines. Non-Parenteral Medication Administration. In general, for an adult male weighing 60 to 118 kg (130 to 260 lbs), a 25 mm (1 inch) needle is sufficient. Checklist 59 outlines the steps to perform a Z-track IM injection. 5 mL. To locate the landmark for the deltoid muscle, expose the upper arm and find the acromion process by palpating the bony prominence. Once medication is completely injected, remove the needle using a smooth, steady motion. 27. ). The muscle is thick and well developed. Because of the sciatic nerve location, the dorsogluteal muscle is not recommended as an injection site. Jet injectors prevent needlestick injuries to health-care providers (2) and can overcome improper, unsterile reuse and other drawbacks of needles and syringes in developing countries (9, 38-39). If no blood appears, inject the medication slowly and steadily. Verify the patients actual admission weight in kilograms. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html, https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2023/npsg_chapter_hap_jan2023.pdf, https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=FEDERAL_REGISTER&p_id=16265, https://www.cdc.gov/vaccines/pubs/pinkbook/safety.html, https://www.cdc.gov/vaccines/hcp/admin/admin-protocols.html, https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html. For toddlers, the anterolateral thigh muscle is preferred, and when this site is used, the needle should be at least 1 inch long. The injection site is the center of the triangle (Figure 3). 7. Due to the solubility of the active drug, the maximum concentration formulated to date is 250 mg per 5 mL (50 mg/mL). A quick injection is less painful. (e) Some experts recommend a 1-inch needle if the skin is stretched tightly and subcutaneous tissues are not bunched. 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. Discard supplies, remove PPE, and perform hand hygiene. In addition, muscle tissue is less sensitive than subcutaneous tissue to irritating solutions and concentrated and viscous medications (Greenway, 2014; Perry et al., 2014; Rodgers & King, 2000). The injection site is in the middle of the deltoid muscle, about 2.5 to 5 cm (1 to 2 inches) below the acromion process. The width of the muscle used extends from the mid-line of the thigh to the mid-line of the outer thigh. Place safety shield on needle and discard syringe in appropriate sharps container. They help us to know which pages are the most and least popular and see how visitors move around the site. For women who weigh >200 lbs (>90 kg) or men who weigh >260 lbs (>118 kg), a 1.5-inch needle is recommended (table 6-2) (20). (b) If skin is stretched tightly and subcutaneous tissues are not bunched. Assess for any factors that may contraindicate an IM injection. For adults, the deltoid muscle is recommended for routine intramuscular vaccinations (23) (Figure 3). Discoloured or outdated medication may be harmful. Discard the uncapped needle (or needle enclosed in a safety shield) and the attached syringe into a puncture-proof and leakproof receptacle. Always compare MAR to the practitioners original orders to ensure accuracy and completeness. WebEquipment: required for IM injection includes: IM medication ampoule large-bore needle for withdrawing medication from ampoule 1 mL or 2 mL syringe 23 gauge 25 mm needle or 25 gauge 16 mm needle for preterm babies two months or younger (see table below) antiseptic swab if used must be allowed to dry before injection given cotton wool swab The middle third of the muscle is used for injection. St. Louis: Elsevier. 21. With your nondominant hand, pull the skin taut. Avoid moving the syringe. Then release the skin. A thin adult may require a 16 mm to 25 mm (5/8 to 1 inch) needle, while an average adult may require a 25 mm (1 inch) needle, and a larger adult (over 70 kg) may require a 25 mm to 38 mm (1 to 1 1/2 inch) needle. Follow the organizations practice for emergency response. 14. Prepare medication from an ampule or a vial as per hospital policy. Needle gauge is determined by the solution. Webinjection-site reactions occurred in 1% of treatment courses or 7% of patients treated with one 5-mL injection and in 4.6% of treatment courses or 27% of patients treated with two The IM injection route deposits medication into deep muscle tissue, which has a rich blood supply, allowing medication to be absorbed faster than it would be by the subcutaneous route. Movement of the needle can cause additional discomfort for the patient. The anterolateral thigh can also be used. Monitor the patient for adverse and allergic reactions to the medication. Reweigh the patient if appropriate. Occupational Safety and Health Administration (OSHA) regulations do not require gloves to be worn when administering vaccinations, unless persons administering vaccinations have open lesions on their hands or are likely to come into contact with a patients body fluids (2). 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. If possible, a topical analgesic should be applied to the injection site with sufficient time allowed for peak action before the IM injection. However, needle sizes from 22 mm to 25 mm can be used for older children. Ensure the six rights of medication safety: right medication, right dose, right time, right route, right patient, and right documentation. Adapted from Perry, A.G. and others (Eds.). Refer to agency policy regarding specifications for infants, children, adolescents, and immunizations. up to 2 weeks after birth When do you give the 1st dose of Hep B 3 How many times do you check a medication before administering it Topical lidocaine-prilocaine emulsion should not be used on infants aged <12 months who are receiving treatment with methemoglobin-inducing agents (e.g., acetaminophen, amyl nitrate, nitroprusside, dapsone) because of the possible development of methemoglobinemia (50). When injecting into the deltoid muscle, for adults a measurement of body mass/weight is allowable prior to vaccination, understanding that resources to measure body mass/weight are not available in all clinical settings. Comfort measures, such as distraction (e.g., playing music or pretending to blow away the pain), cooling of the injection site(s), topical analgesia, ingestion of sweet liquids, breastfeeding, swaddling, and slow, lateral swaying can help infants or children cope with the discomfort associated with vaccination (40-42). 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. Providers should consult package inserts for details. Cleanse the site with alcohol or an antiseptic swab, per the organizations practice. If multiple vaccines are administered at a single visit, administer each preparation at a different anatomic site (28). Variation from the recommended route and site can result in inadequate protection. Palpate for tenderness or hardness and avoid hardened areas. Inject medication at 10 seconds/ml. Additional information about implementation and enforcement of these regulations is available from OSHA. Aspiration before injection of vaccines or toxoids (i.e., pulling back on the syringe plunger after needle insertion but before injection) is not necessary because no large blood vessels are present at the recommended injection sites, and a process that includes aspiration might be more painful for infants (22). For immunizations, a smaller 22to 25 gauge needle should be used. 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. If injecting into the vastus lateralis, ventrogluteal, gluteus medius, or The muscle is thick and well developed and is located on the anterior lateral aspect of the thigh. Has 25 years experience. Instruct the patient and a family member to observe injection sites for complications and to report complications to the practitioner immediately. Data source: Centers for Disease Control, 2013, 2015; Perry et al., 2014. This is the preferred site for all oily and irritating solutions for patients of any age. Verify patient using two unique identifiers and compare to MAR. The revised standards became effective in 2001 (2). These include persons with underlying medical conditions placing them at higher risk or who are likely to be at risk, including pregnant women, persons with asthma, and persons aged 50 years (2). 26. Question 10a Anderson, C.E., Herring, R.A. (2022). Needles should be stored in Food and Drug Administrationapproved containers or in containers that are in compliance with community guidelines. Thank you for taking the time to confirm your preferences. (2021). Immune responses generated by jet injectors against both attenuated and non-live viral and bacterial antigens are usually equivalent to, and occasionally greater than, immune responses induced by needle injection. 21. Compare Mar to the patients wristband and use two patient identifiers to confirm patient. Subcutaneous injections may be administered into the upper-outer triceps area of an infant if necessary. Assess injection site for pain, bruising, burning, or tingling. Compare the patients name and one other identifier (e.g., organization identification number) with the MAR. In. Recent research has found that there is no evidence to support the practice of aspiration, but despite policy changes, the procedure of aspiration continues to be taught and practised (Canadian Agency for Drugs and Technologies in Health, 2014; Greenway, 2014; Sepah, Samad, & Altaf, 2014; Sisson, 2015). Patient complains of localized pain, bleeding, or continued burning at injection site, indicating potential injury to nerve or vessels. Reactions may include anaphylaxis, anaphylactic shock, and neurologic deficits.10 Vaccine adverse event reporting is monitored by the Centers for Disease Control and Prevention. You may repeat the injection every 5 to 10 minutes as needed. Medications left unattended may lead to medication errors. The maximum amount of medication for a single injection is 3 ml. The syringe has markings from 10 to 100. Use a bar code system or compare the MAR to the patients identification band. particles up to a hundred times smaller than those in suspensions that are however likewise suspended in a solution. Source: Adapted from Immunization Action Coalition. Provide developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, and overall neurologic and psychosocial state. Ensuring the sharps container is close by allows for safe disposal of the needle. Place safety shield or needle guard on needle and discard syringe in appropriate sharps container. 2022-2023 Targeted medication safety best practices for hospitals. Follow policy for safe medication administration. With IMs, there is an increased risk of injecting the medication directly into the patients bloodstream.