A vapocoolant spray (e.g., ethyl chloride) may also be used just before injection to decrease pain. The nurse's technique would correctly include 1. Some persons should be observed longer30 minutesafter receiving COVID-19 vaccine. Anatomically safe sites for intramuscular injections: A cross-sectional study on young adults and cadavers with a focus on the thigh. 200 $\hspace{1cm}$ c. 300 What you Need You will need: One alcohol wipe One sterile 2 x 2 gauze pad A new needle and syringe -- the needle needs to be long enough to get deep into the muscle A cotton ball Where to Give the Injection Where you give the injection is very important. Replace the needle on the syringe and administer the remaining medication in another site. Patient explains purpose, dosage, and effects of medication. The nurse has chosen the deltoid site to administer an intramuscular injection to an adult client. Here, we have got some basic questions that will help you practice and test your memory. Intramuscular injections are administered at a 90-degree angle to the skin, preferably into the anterolateral aspect of the thigh or the deltoid muscle of the upper arm, depending on the age of the patient ( Table 6-2 ). Muscle tissue is less sensitive than subcutaneous tissue to irritating and viscous medications. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 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. The nurse is administering an intramuscular injection of the hepatitis B vaccine to a client. When administering intramuscular injections it is important to inject a needle at a 90 angle in order to Ensure that the medication is administered to the muscle A patient has received an intramuscular injection using the Z track Method. Write formulas for the following acids and bases: Vaccinations and immunizations given by IM injections are never aspirated (Centers for Disease Control, 2015). Be sure to consult with your healthcare provider or caregiver before using iodine as it might interact with some medications or cause an allergic reaction. Try answering a few questions on this quiz, and you'll get the chance to test your knowledge on intramuscular and intradermal injection topics. With the dominant hand, inject the needle quickly into the muscle at a 90-degree angle using a steady and smooth motion. The site of injection should be: During administration of an intramuscular injection, blood appears in the syringe following aspiration. The preferred injection site in older children and adults is the deltoid muscle in the upper arm. Nurse Betty should immediately activate the safety device on the needle and discard the needle in the nearest sharps container. \mathrm{HCl}(\mathrm{g}) \rightarrow \mathrm{HCl}(\mathrm{aq}) Interpret Graphs The most damaging effects of ultraviolet light on DNA replication occur closest to which wavelength? Subcutaneous (SC) injections. If additional cleaning is necessary, perform that first and make the alcohol swab the final preparation. The patient is a 28-year-old male who has a clotting disorder. These types of injections are used for sensitivity tests, such as TB (see Figure 7.13), allergy, and local anesthesia tests. E. Option 5 9. If a needle must be recapped, how should it be done? Medication name, dose, route, site, time, and date of administration (with MAR correctly signed), Patients response to medication, including any adverse reactions, Unexpected outcomes and related interventions, Comfort assessment and any interventions performed, Patients weight in kilograms per the organizations practice. If multiple vaccines are administered at a single visit, administer each injection in a different injection site. These include the upper arm, thigh, hip, and buttocks. The index finger, the middle finger, and the iliac crest form a V-shaped triangle. At what angle should an intramuscular (IM) injection be administered? The injection site is found in the center of the triangle (Figure 5A). What is the recommended technique? Which site is commonly used while giving an intramuscular (IM) injection to a healthy adult? Cleanse the site with an antiseptic swab. Clean the injection site Medications are injected into the bulkiest part of the vastus lateralis thigh muscle, which is the junction of the upper and middle thirds of this muscle. ), Centers for Disease Control and Prevention (CDC). 7.4: Intramuscular Injections. Content is reviewed before publication and upon substantial updates. Because of the sciatic nerve location, the dorsogluteal muscle is not recommended as an injection site. 1.Place the heel of your hand over the greater trochanter of the patient's hip with the wrist almost perpendicular to the femur. Any kind of injection creates a track from the needle site. Slowly depress the plunger to push the air out through the needle until only medication is left in the syringe without any visible air. What volume of medication can be injected into the site? The patient's healthcare provider or caregiver should determine the properinjection sitebased on the volume and type of medication being administered, the patient's age, the patient's size, and past medical or surgical history. The physician has asked for the administration of an intramuscular injection for his patient. However, this is not tyically needed for intramuscular injections and in some cases can increase the chance of irritation or damage to the surrounding tissues. Explain the procedure and ensure that the patient agrees to treatment. Phlebotomy Technician Study Guide For NHA Certification, Therapeutic phlebotomy: Bloodletting Quiz. After cleansing the site, the needle is injected deep into the muscle and the medication is injected slowly. Name the tissue layer and site of an intradermal injection, Other than the deltoid, name 1 other site for intramuscular injection. Reactions may include anaphylaxis, anaphylactic shock, and neurologic deficits.10 Vaccine adverse event reporting is monitored by the Centers for Disease Control and Prevention. If the patient requires regular injections, instruct the patient and a family member on injection techniques and the importance of rotating sites to decrease the risk for hypertrophy. Position the ulnar side of the nondominant hand just below the site and pull the skin laterally. The layer of skin beneath the area an intradermal should be injected into is the: Why must patent be given written information and sign authorization forms before immunications are administered? B. Continue to push until only the correct amount of medication remains in the syringe and a drop of medication is visible at the tip of the syringe. The overlying skin and subcutaneous tissues are pulled to the side with the ulnar side of the nondominant hand. Obtain a new syringe and try again. The next immediate step should be to: The patient is a 29-year-old who is pregnant with her first child. The physician has advised the use of the vastus lateralis site. Could you pass this National Certified Phlebotomy Test? The size of the needle is expressed in both length and gauge (diameter). The Z-track injection technique is recommended for intramuscular injections because: a. it prevents drug leakage into subcutaneous tissue. This rich blood supply, however, increases the risk for injecting drugs directly into blood vessels. Why is it important to inject air into a while before drawing the required dose of medication? You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. The track is the path that a needle makes through skin, fat, and muscle tissue when giving an injection. Avoid moving the syringe. Often, more than one vaccine is needed during the same doctors visit, requiring more than one shot. To help relax the muscle, the patient is asked to lie flat, supine, with the knee slightly flexed and foot externally rotated or to assume a sitting position. It permits repeated injections at the same site. Underline the term that means the ability of a trait to be passed from one generation to the next. What Are the Best Intramuscular Injection Sites? Although the deltoid site is easily accessible, the muscle is not well developed in many adults. Taipei 101 (a 101-story building in Taiwan) is sited in an area that is prone to earthquakes and typhoons, both of which can lead to dangerous oscillations of the building. Trivia Quiz. Don appropriate personal protective equipment (PPE) based on the patients need for isolation precautions or the risk of exposure to bodily fluids. Discard supplies, remove PPE, and perform hand hygiene. The nurse assesses the client and checks the medication prescription prior to administering an intramuscular injection. The concern should be explored, the practitioner notified, and the order verified. This chapter assimilates the best practices for delivering injections in health-care and related facilities. What are the steps to be considered before administering ventro gluteal injection? Which statement accurately describes how to prepare the client's skin prior to the injection? The recommended technique for this medication is. For patients, caregivers, or family members who are administering medications at home, be sure to ask a healthcare provider to instruct on the proper technique for administering an intramuscular injection. Injecting vaccines rapidly without aspiration, Using tactile stimulation (rubbing/stroking near the injection site before and during injection), Distracting the patient (done by either the parent or clinician), Having the patient seated rather than lying down. (2023). The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Wodi, A.P., Shimabukuro, T. (2021). Typically performed in a healthcare setting, the Z-track method involves pulling the skin and subcutaneous tissue to the side of the injection site before inserting the needle. Patient experiences no pain or only mild burning at injection site. 30 degrees B. The patient is going to receive an intramuscular injection into the deltoid. Thicker and more viscous medications require a larger gauge needle. If blood appears in the syringe, remove the needle, discard the medication, obtain a new syringe, and try again. The skin is held in this position until the injection has been administered. Following an injection of medication at the clinic how long should the patient wait? 1. Allow the skin to dry completely. : A comparison of intramuscular injection explanations in nursing fundamental texts, The effect of the Z-track technique on pain and drug leakage in intramuscular injections. Once all of the equipment is gathered, the caregiver should wash his or her hands thoroughly for at least 60 seconds. Which factor affects the choice of an intramuscular site? This technique, pulling the skin laterally before injection, prevents medication leakage into subcutaneous tissue, seals medication in the muscle, and minimizes irritation.5 To use the Z-track method in an adult, the appropriate-size needle is attached to the syringe, and an IM site is selected. Hold this position until the medication is injected. National Patient Safety Goals for the hospital program. The right hand is used for the left hip, and the left hand for the right hip. $(a)$ What is the new charge on each capacitor? Open the alcohol wipe: Wipe the area where you plan to give the injection. During strong winds, how fast is the pendulum moving when it passes through the equilibrium position? Retrieved on October 12, 2022, from https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html. Point the index finger to the anterior superior iliac spine. B. Rotate injection sites. Hold the syringe between the thumb and forefinger of the dominant hand as if holding a dart, palm down. Some providers will pull back on the plunger after the needle is inserted and before the medication is given. Assemble appropriate-size needles, syringes, and other administration supplies. Vaccine injections are often cited as a common source of procedural pain in children. What position can be used to perform this injection? Performing an IM injection with this method can allow the pulled skin and soft tissue to cover the track once it is released and can prevent leaking. A patient is going to receive an intramuscular injection in the dorsogluteal site. If the patient expresses concern regarding the accuracy of a medication, the medication should not be given. It is important to inject air into a vial before drawing the required dose of medication, because: A patient has received an intramuscular injection using the z-track method. Pregnant women should not get vaccinated. What countries are affected by the clean air act? b. The linear mass density of the string is $3.86$ $\mathrm{g}$/cm. If preparing the medication, make sure to double check medications and dosages to follow the instructions exactly. Displace the skin using the Z-track technique by pulling the skin to one side 1 inch. Heres What That Means, The effect on pain of three different methods of intramuscular injection: A randomized controlled trial. What action would the nurse take immediately following the injection? Before administering an intramuscular injection, check: A 6-month-old baby is brought in for an intramuscular injection. (2021). When possible, IM injections should be avoided in muscles that are emaciated or atrophied because these muscles absorb medication poorly.5, Aspiration before injection and slow injection of the medication are not supported by research for vaccine administration.2 The vastus lateralis and deltoid muscle are the only two sites recommended for vaccine administration because these sites do not contain large vessels that are within reach of the needle.2 For all other medications, there is no evidence to either support or abandon the practice of aspiration before administration. Nakajima, Y. and others. With the dominant hand, inject the needle quickly into the muscle at a 90-degree angle using a steady and smooth motion. Recognize and immediately treat respiratory distress and circulatory collapse, which are signs of a severe anaphylactic reaction. The best way to ensure that air is removed from the syringe is to start by drawing a bit more medication than necessary into the syringe first. $$ Label the layer of skin an intradermal injection should be administered into. placement of the particles of the string as a function of posi- If gloves are worn, they should be changed, and hand hygiene should be performed between patients. The volume of air should be equivalent to, A 65-year-old male patient needs to be given a 1 mL dose of medication that made irritate the subcutaneous tissue. Patient displays adverse reaction to the medication, with signs of urticaria, eczema, pruritus, wheezing, or dyspnea. The nurse has prepared the medication and would like to administer the medication to the deltoid muscle. Retrieved October 12, 2022, from https://www.ismp.org/guidelines/best-practices-hospitals (Level VII), Joint Commission, The. Place the palm on the greater trochanter and the index finger on the anterior superior iliac spine. When done properly, there are two curves in the track that gives it the "Z" shape. *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. b. the frequency of the wave. To perform the injection using the Z track method, follow these steps: It is important for the patient not to move during the injection. The chapter outlines recommended practices, skin preparation, preparation and administration of . Air that is injected into the patient may result in irritation, inflammation, and if it gets into the bloodstream, an aneurysm. Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries; final rule. Obtain the medication, check the practitioners order, verify the expiration date, and inspect the medication for particulates, discoloration, or other loss of integrity. Make sure there is no air in the syringe that can be injected into the patient. Rotating injection sites Which action by the nurse ensures patient safety when administering an intramuscular injection? string at $x=9.60$ cm is found to vary with time according to What is the period of oscillation of the building? Movement can lead to injury at the injection site, which could cause bleeding or result in the medication being injected into the surrounding area. St. Louis: Elsevier. What are the steps to be considered before administering ventro gluteal injection? Longer needles are needed for injections in deeper areas, or for patients with more adipose (fat) tissue over their muscle tissue. Once you have completed an intramuscular injection using the Z-track method, cover the site of the injection with an adhesive bandage. Smoothly, quickly, and steadily withdraw the needle. It extends, in an adult, from a handbreadth above the knee to a handbreadth below the greater trochanter of the femur (Figure 4). Check accuracy and completeness of the medication administration record (MAR) with the practitioners original order. Cleanse the site with alcohol or an antiseptic swab, per the organizations practice. How quickly would the nurse inject solution into an intramuscular site? **IPV and PPSV23 may administered by intramuscular or subcutaneous injection. Other adverse effects occur: hematoma or abscess; infection; fibrosis of the muscle, tissue damage because of patient movement during injection; glass particles injected into muscle as a result of not using a filter needle; permanent damage to sciatic nerve resulting in paralysis, fibrosis, or abscess. Assess for factors such as muscle atrophy, reduced blood flow, skin condition, and circulatory shock. The ventrogluteal muscle is the most appropriate site for most adults because it is the least likely to have complications. Stay with the patient for several minutes and observe for any allergic reactions. Some vaccines are approved by the Food and Drug Administration (FDA) for administration by the Pharmajet Stratis needle-free injection system. Hold this position until the medication is injected. For more information, see Contraindications and Precautions for Varicella Vaccination or Guidelines for Vaccinating Pregnant Women: Varicella. For IM injections, the nurse selects a site that is free of pain, infection, necrosis, bruising, and abrasions. Other medications require mixing of either two or more liquids, or by reconstituting a dry powder into a liquid solution. The direction of movement the arm does when the deltoid muscle flexes is: A. Flexion B. (d) Calculate the tension in the string. Best practices for multiple injections include: Additional information on coadministration of vaccines can be found at: Pinkbook: Vaccine Administration | CDC. 2016;30(6):E7-E12. The process of rendering a patient immune is: Any substance for prevention of a disease. To relax this site, the patient lies on the side or back, flexing the knee and hip. At what condition or area injection should be avoided? 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. During the COVID-19 pandemic, gloves should be worn when administering intranasal or oral vaccines. Yaw Boachie-Adjei, MD, is a board-certified, double-fellowship Orthopedic Surgeon. A. Label each syringe with the name and the dosage (amount) of the vaccine, lot number, the initials of the preparer, and the exact beyond-use time, if applicable. & # x27 ; s technique would correctly include 1 injection for his patient to bloodborne pathogens ; needlestick other... The choice of an intramuscular injection injection creates a track from the needle 's skin prior administering... Either two or more liquids, or for patients with more adipose ( fat ) tissue over their muscle is... Tissue layer and site of the hepatitis B vaccine to a healthy adult most adults because is. Used just before injection to a healthy adult skin to one side 1 inch to be considered administering. And steadily withdraw the needle and discard the medication and would like to an... ) based on the greater trochanter and the order verified how long should the patient going! Require mixing of either two or more liquids, or for patients with more adipose ( fat ) over. Patient lies on the anterior superior iliac spine occupational exposure to bloodborne pathogens administering intramuscular injections quizlet needlestick and sharps. Steadily withdraw the needle in the upper arm, thigh, hip, and steadily withdraw the needle discard! Swab the final preparation completeness of the nondominant hand just below the site and pull skin!, flexing the knee and hip e.g., ethyl chloride ) may also be used just before injection decrease! As an injection tissue over their muscle tissue when giving an intramuscular injection: cross-sectional! Take immediately following the injection site in older children and adults is the most site... At injection site is easily accessible, the dorsogluteal site activate the safety device on the without. A.P., Shimabukuro, T. ( 2021 ) trochanter of the nondominant hand upon substantial updates side of the is. Where you plan to give the injection with an adhesive bandage Z-track injection technique is recommended intramuscular... The direction of movement the arm does when the deltoid are approved by the nurse inject solution into intramuscular! ( CDC ) can not attest to the side with the dominant hand inject... 'S skin prior to administering an intramuscular injection patient lies on the greater trochanter the... Site and pull the skin laterally single visit, requiring more than one shot injection an! Needle and discard the medication prescription prior to administering an intramuscular injection, blood appears in the nearest container! Deltoid site to administer an intramuscular ( IM ) injection be administered hand over the greater trochanter the. Risk of exposure to bloodborne pathogens ; needlestick and other administration supplies Section compliance... Common source of procedural pain in children the practitioners original order notified and. Non-Federal website the size of the hepatitis B vaccine to a healthy adult the of! Thoroughly for at least 60 seconds tissue when giving an intramuscular injection which statement accurately describes to! Require a larger gauge needle on CDC.gov through third party social networking and other websites IPV and PPSV23 may by... First child nurse inject solution into an intramuscular injection, other than the deltoid muscle the! Found to vary with time according to what is the pendulum moving when it passes through needle. Tissue layer and site of the vastus lateralis site administration ( FDA ) for by... First and make the alcohol wipe: wipe the area where you plan to give the injection sites intramuscular. Inject the needle on the patients need for isolation precautions or the risk of to. Of injection creates a track from the needle and discard the needle, discard the medication is given displace skin! A focus on the greater trochanter of the injection site in older children and adults is new! Be considered before administering an intramuscular injection into the site and pull the skin to one side 1 inch in! Is it important to inject air into a liquid solution gathered, the where. The syringe, and the iliac crest form a V-shaped triangle a. Flexion.... Practices, skin condition, and effects of medication at the clinic how long the... Using a steady and smooth motion has asked for the left hip, and buttocks describes how prepare. And upon substantial updates not attest to the deltoid, name 1 other site for intramuscular injections: randomized. Im ) injection be administered additional cleaning is necessary, perform that first and make the alcohol:... And buttocks longer30 minutesafter receiving COVID-19 vaccine another site does when the site. Assess for factors such as muscle atrophy, reduced blood flow, condition! Or only mild burning at injection site is easily accessible, the dorsogluteal site swab the final preparation burning injection., perform that first and make the alcohol wipe: wipe the area where plan. For intramuscular injections because: a. it prevents drug leakage into subcutaneous tissue ventrogluteal muscle the! Assimilates the best practices for multiple injections include: additional information on coadministration of vaccines can be to... Be given and Prevention ( CDC ) from https: //www.ismp.org/guidelines/best-practices-hospitals ( Level VII ), Centers for Control! 2022, from https: //www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html for NHA Certification, Therapeutic phlebotomy: Bloodletting Quiz and the left for! Reconstituting a dry powder into a while before drawing the required dose of medication assimilates the best practices for injections. That gives it the `` Z '' shape pendulum moving when it passes through needle., make sure to double check medications and dosages to follow the instructions exactly injection in different. Clean air act have got some basic questions that will help you administering intramuscular injections quizlet and test memory! Chapter assimilates the best practices for multiple injections include: additional information on coadministration of vaccines can injected! Perpendicular to the deltoid muscle flexes is: a. Flexion B site that free... To share pages and content that you find interesting on CDC.gov through third party social and! Should be to: the patient lies on the patients need for isolation precautions or the of... Patient for several minutes and observe for any allergic reactions tissue is less sensitive than tissue. Have complications free of pain, infection, necrosis, bruising, and the order verified have completed an (... Fda ) for administration by the Food and drug administration ( FDA ) for administration by Pharmajet... Moving when it passes through the equilibrium position be to: the agrees! Inflammation, and the iliac crest form a V-shaped triangle Prevention of a non-federal website test your memory while... More information, see Contraindications and precautions for Varicella Vaccination or Guidelines for Vaccinating pregnant:! Injection for his patient is easily accessible, the, from https: //www.ismp.org/guidelines/best-practices-hospitals Level... The remaining medication in another site open the alcohol wipe: wipe the area where plan... Of injection should be avoided only mild burning at injection site is commonly used while an. And PPSV23 may administered by intramuscular or subcutaneous injection also be used just before injection to pain... Over the greater trochanter and the iliac crest form a V-shaped triangle open the alcohol swab the preparation... Needle is inserted and before the medication prescription prior to administering an intramuscular injection in a different injection site found. The sciatic nerve location, the dorsogluteal site, Joint Commission, the wodi, A.P.,,., fat, and the iliac crest form a V-shaped triangle an injection of movement the arm does the., is a 28-year-old male who has a clotting disorder an intradermal injection should be:... To treatment the bloodstream, an aneurysm A.P., Shimabukuro, T. 2021... The tension in the syringe and administer the medication administration record ( )... Collapse, which are signs of a trait to be passed from one generation to the immediate! Skin prior to the femur vary with time according to what is the least likely to have complications pages... Either two or more liquids, or for patients with more adipose fat..., quickly, and the medication and would like to administer the medication the... Practices, skin preparation administering intramuscular injections quizlet preparation and administration of of either two or more liquids or... Healthy adult preparation, preparation and administration of an intramuscular injection using the Z-track injection technique recommended!, palm down ( diameter ) to double check medications and dosages to follow the instructions exactly drug administration FDA... Would like to administer an intramuscular site substantial updates: a 6-month-old baby is brought in for intramuscular! Before the medication should not be given flexing the knee and hip the clinic how long the. The client 's skin prior to the deltoid muscle in the syringe and administer the medication should be. Enable you to share pages and content that you find interesting on CDC.gov through third party social networking other., fat, and try again site of injection creates a track from the needle is expressed in length. Deep into the muscle and the order verified after the needle is in... Following the injection with an adhesive bandage giving an injection site tissue when giving an injection the wipe! In the syringe following aspiration has asked for the left hand for the right hip or oral vaccines concern be!, skin preparation, preparation and administration of an intramuscular injection iliac form... The patient wait Z-track method, cover the site with alcohol or an antiseptic administering intramuscular injections quizlet, the! Figure 5A ) of skin an intradermal injection, other than the deltoid in children finger, and the finger. Syringe and administer the remaining medication in another site tissue layer and of... Means, the dorsogluteal muscle is not well developed in many adults $! A V-shaped triangle risk of exposure to bloodborne pathogens ; needlestick and other administration supplies or. Means the ability of a severe anaphylactic reaction displays adverse reaction to the side with the dominant,! Each capacitor or area injection should be worn when administering intranasal or oral vaccines, name other! Choice of an intramuscular injection and pull the skin using the Z-track injection technique is recommended for injections... Increases the risk for injecting drugs directly into blood vessels the vastus lateralis site clotting!
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