Generally, a needle is the scariest part of any hospital visit. It would appear that intramuscular medications are the commonest routes for parental administration of medications, for out-patients. An intramuscular injection delivers medication directly into a muscle. Doctors frequently use intramuscular injections to administer vaccines and certain other drugs.
People with specific conditions, such as Diabetes Mellitus and want to live without its complications, may need to give themselves this type of injection at home. They can also ask a caregiver to help.
We understand the challenge this may pose, hence in this article, we explain where and how to administer an intramuscular injection.
Locations for Intramuscular Injection
There are different areas on the body where people can receive intramuscular injections. In some of these areas, it requires supervisory assistance to effectively give the medication.
Intramuscular injection sites include:
The upper arm
In the shoulders is located the deltoid muscle and it serves as the most common site for vaccines.
It can only receive small volumes of medication, usually 1 milliliter or less. Therefore, doctors do not use it for drugs that require larger quantities.
People self-administering medication rarely use the deltoid as an injection site, because it is a thin muscle (in non-athletic people) and could be difficult to reach.
LOCATE THE DELTOID:
To find the deltoid muscle, a person feels for the bone at the top of the upper arm. Two finger-widths below this, there is a triangular muscle. The needle should enter the triangle’s center.
Typically, people who need to self-administer injections use the vastus lateralis muscle in the thigh.
To locate the correct spot, imagine dividing the thigh vertically into three equal parts.
Give the injection into the outer top part of the middle section.
Before doctors began using the hip as an injection site, they used the dorsogluteal muscles in the buttocks. The buttock muscles are the commonest intramuscular sites for administering medications, especially in the hospital place.
Doctors and nurses are usually extra careful when using these muscles because of the potential risk of injury to the sciatic nerve.
People should avoid self-administering medications into the dorsogluteal muscles.
Healthcare professionals often give intramuscular injections into the ventrogluteal muscle of the hip.
This muscle is a very safe injection site for adults and infants more than 7 months old because it is thick and located away from major nerves and blood vessels. But it can be challenging to self-administer medication into the hip.
To locate the ventrogluteal muscle on someone else, place the heel of the hand on the hip, with the fingers pointing toward the head. The thumb should point toward the groin.
Position the index and middle fingers into a V then administer the shot in the middle of the V.
Uses of an Intramuscular Injection
In practice, intramuscular injections offer some benefits over other types of delivery methods, such as oral, intravenous injections into a vein and subcutaneous injections into fatty tissue under the skin.
A doctor may use an intramuscular shot if:
- The indication for administering the drug is via the muscles
- the particular drug would irritate the veins
- the digestive system would render pills ineffective
- uncommonly, they cannot locate an appropriate vein
Intramuscular injections have other advantages too. The muscles have a plentiful supply of blood, which helps ensure that the body absorbs the medication quickly. The tissue in the muscles can also hold more medication than fatty tissue.
Doctors administer most injectable vaccines into the muscles.
How to give an intramuscular injection
Intramuscular injection is usually given by a healthcare professional. Even though this is a procedure that requires some degree of expertise, it could be thought to non-healthcare professionals as well.
So, a healthcare professional should provide people with training and education before asking them to administer intramuscular injections to themselves or another person.
The following steps can help people deliver a safe injection into a muscle:
1). Initial preparation and instructions
It is helpful if, before the injecting anybody, an initial ‘warning’ is said. Nobody like a needle prick, so let the subject know exactly when the ‘prick’ would be.
2). Wash your hands
Giving an intramuscular injection is a sterile procedure. Adequately you’re your hands thoroughly with soap and warm water.
Pay careful attention to the area between the fingers and under the fingernails.
3). Get your materials ready
Before giving the shot, get the following items ready:
- an alcohol wipe (commonly used is Methylated Spirit)
- a sterile gauze pad
- a cotton ball
- a tourniquet
- a puncture-resistant container to dispose of the needle
- the medication
- a new needle and syringe
A doctor should provide advice on the type of needle to use.
It needs to be long enough to reach deep into the muscle tissue.
Most adults would require at least a 1-inch needle but the exact size depends on the person’s body build.
It is essential to ask a doctor or pharmacist which size needle to use before giving an injection.
4). Prepare the injection site
Clean the skin with cotton wool soaked in alcohol and allow to air-dry.
Remember to clean at least three times or clean until there is no dirt-stain on the wet swab.
5). Prepare the vial and injection pack
For most injection pack, a needle and syringe would be enclosed. Gently break the pack and keep on a clean sterile surface.
Now, get the vial.
Some vials are single dose while others are multiple-dose. Clean the rubber stopper with an alcohol swab.
Note the date you open any multiple dose vial.
Remove the cap from the needle and syringe. Draw air into the syringe by pulling back the plunger. Fill the syringe with air up to the same level as the medication dose.
Remove the cap from the needle and push it through the top of the vial. Inject all the air into the vial.
Turn the vial and syringe upside down so that the needle points upward. Draw back the plunger to fill the syringe with the correct amount of medication.
Remove air bubbles by gently tapping the syringe and pressing the plunger. Never inject air bubbles into any person.
Avoid touching the needle to ensure it stays clean.
6). Inject the medication
An intramuscular injection should not cause blood to appear in the syringe.
Insert the needle into the muscle at a 90-degree angle. Use the index finger and thumb to stabilize the syringe while using the other hand to pull back on the plunger slightly to look for blood.
If there is blood, it means the needle is in a blood vessel and not a muscle. Withdraw and start over with a new needle, syringe, and injection site.
If there is no blood, the needle is in the correct position. Press down on the plunger of the syringe to inject the medication.
7). Remove the needle
Quickly remove the needle from the skin and dispose of it in a puncture-resistant container.
8). Press on the injection site
Using gauze, apply light pressure to the injection site. Light bleeding at the injection site is normal, but a person can use a bandage if necessary.
The following tips may reduce discomfort before and after the injection:
- Numb the injection site with ice or a numbing cream before cleaning the skin with the alcohol swab.
- To avoid stinging, ensure the alcohol dries completely.
- Before putting medication into the syringe, warm the vial up by rubbing it between the hands.
- Relax the muscles, as much as possible, when receiving the injection.
- Discuss changing injection sites with a doctor. Too many injections in the same location can cause scarring and skin changes.
- People who find injecting themselves difficult should ask a friend, family member, or caregiver to help them.
Complications of Intramuscular medications
Minor discomfort after an intramuscular injection is normal. Manufacturers of injections keep working around the clock to make the injection process less painful.
Less commonly, more serious complications can arise, including:
- an abscess, or pus collection
- tissue necrosis, or tissue death
- inflammation in the tissue
- muscle fibrosis, or scarring of muscle tissue
- hematoma, where blood seeps out of blood vessels into the surrounding tissue
- injury to blood vessels and nerves
People who notice the following symptoms should call a doctor immediately:
- severe pain at the injection site
- prolonged or excessive bleeding
- tingling or numbness around the muscle
- redness, swelling, or warmth at the injection site
- drainage at the injection site
- signs of an allergic reaction, such as swelling or breathing problems
Intramuscular injections are a common and effective way to deliver medication.
Like earlier said, there are several possible locations for administering intramuscular injections, including the shoulder, hip, and thigh.
People who need to self-administer an injection should ask their doctor for advice and guidance, and familiarize themselves with the process before they inject themselves.
Those who need to give the intramuscular injection to children or younger children should expect the child to cry because due to fear of needles. Parents and caregivers who are feeble-minded should reconsider giving the shot.
Alternatively, a trained family member or caregiver can deliver the shot.
It is essential to seek medical assistance if a person experiences prolonged or severe side effects after their injection.