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intramuscular injection. I'm injection Kase lagai. I'm injection technique. • A medication administered into a muscle is known as an intramuscular (IM) injection. The IM route allows for rapid absorption of specific medications. Choosing a muscle is dependent on the medication volume and the age or size of the patient. Poor technique and incorrect landmarking of the injection site can lead to site reactions, sub-optimal medication absorption and adverse events. • @creativemedicalstudio • Dorsogluteal • The dorsogluteal is not the preferred site due to its proximity to the sciatic nerve and major blood vessels. If landmarked correctly however, it is safe to use. Up to 4mls can be injected into this site. • The patient can be positioned lying on their stomach or standing up. The muscle is located in the upper outer quadrant of the buttock, approximately 5-8cm below the iliac crest. For confirmation, an imaginary line can be drawn between the posterior superior iliac spine and the greater trochanter of the femur. • The patient can be positioned lying on their stomach, side or standing up. To locate the muscle, place the palm of a hand over the greater trochanter of the femur, facing the index finger and thumb towards the umbilicus, along the anterior iliac spine. Place the middle finger toward the iliac crest creating a 'V' shape. The injection is given in the middle of the 'V'. • Needle size • A hypodermic needle is used to administer IM injections. These come in different sizes (gauge and length) and are selected based on the patient's size and the muscle used. A higher gauge needle refers to a smaller outside diameter of the needle tubing. • Needle sizes most commonly used at the RCH include: • 25g x 25mm ORANGE • 23g x 25mm BLUE • 21g x 38mm GREEN • Equipment • Appropriate size needle for administration • Drawing up needle and syringe (if medication not pre-filled) • Sharps container • Alcohol impregnated swab (if area visibly soiled) • Cotton ball • Band-Aid (check for allergies) • Personal Protective Equipment (PPE) for hazardous medications or infectious patients • The procedure • Prepare patient and obtain consent • Perform the five moments of hand hygiene • Prepare equipment as per Aseptic Technique • Complete the six rights of medication administration • Don PPE if required (particularly for hazardous medications) • Draw up or prime medication as per Paediatric Injectable Guidelines • Position patient in a safe and comfortable position Procedure Management Guideline • Consider the use of comfort techniques such as distraction, buzzy bee, ice or a countdown • Landmark injection site (see above) • Clean site with an alcohol swab (if required) • Stretch the skin flat (Z-tracking if applicable) • Inject the needle to the hub at a 90-degree angle • Do not aspirate or drawback as this can increase pain and discomfort in children • Inject the medication at a slow and steady pace • Remove the needle and apply a cotton ball • Place the needle in a sharps container • Apply Band-Aid • Remove PPE (if required) • Perform the five moments of hand hygiene • • Special considerations • Monitor for immediate adverse reactions, e.g., fever, rash, vomiting, shortness of breath. • Advise patients to remain in the hospital/ on the ward for 15–20 minutes following their injection. • Provide education to the patient and their family on signs and symptoms to monitor for, e.g., pain, redness, abscess, bruising at the site or anaphylaxis • Warm or cold compresses can be applied to the area for comfort • What is IM injection used for? • An intramuscular injection is a technique used to deliver a medication deep into the muscles. 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