Nursing guidelines for IM injections.

The intramuscular ( IM )
Drugs administered intramuscularly deeply deposited in muscle tissue. This can be done because the substance is not tolerated or the upper gastrointestinal tract is altered, or when other routes may be contraindicated , as orally in patients who can receive nothing by mouth or by some medications when intravenous access is difficult .

Muscles also have less sensory nerve endings , which may allow a less painful administration of irritating drugs.

The absorption of the medication may be faster than the oral route , but has limited its use in patients with impaired peripheral circulation , such as those in shock .

Some medications are not recommended for administration and IM professionals should follow the guidelines of the manufacturer and local policies.


Anatomy and physiology related.

Five sites have been suggested for IM injections ( Rodger and King, 2000). However, in clinical practice are commonly used three areas ( Jamieson et al, 2002) (Fig. 1 ) :

- The deltoid muscle of the arm ;
- The lateral anterior ( the vastus lateral ) thigh ;
- The upper outer quadrant ( the dorsogluteal muscle) buttock .

Many doctors avoid dorsogluteal muscle because there is well documented evidence of injury to the sciatic nerve (Small, 2004). The doctor should also avoid sites where there is evidence of scar tissue , swelling or other injuries.


Preparation

Informed consent should be obtained before applying the process , and efforts should be made to calm anxiety with honesty and trust.


The following equipment must meet :

- Graph Prescription / patient details ;
- Suitable sterile needle size (based on the depth of the muscle layer is suspected that the patient and the viscosity of the drug to be given) ;
- Sterile Syringes
- Drugs / diluent for administration
- Alcohol Swab ( if recommended in local politics );
- Chiffon .

The procedure

- Determine the patient's allergies may have.
- See Figure

- Wash hands and put on a clean apron and gloves .
- See Figure 3 .
- Remove the amount of drug needed .
- Remove air bubbles from the syringe.
- Change the needle of the syringe to one of the correct size for the patient .
- Clean the skin surface ( if recommended by local policy ) .

- See Figure 4.
- Pull the plunger of the syringe , the observation of a flashback of blood in the syringe. If this happens , do not inject the medication , remove the syringe and needle , prepare and insert a new drug elsewhere, to avoid accidental intravascular administration.
- If no backflow of blood , slowly administer drugs .
- Withdraw the needle quickly and smoothly at an angle of 90 degs .

- See Figure 5 

- Observe all bleeding and apply pressure and a bandage if necessary.

- See Figure 6.

Special considerations

Specialized techniques may be required for certain drugs , including the Z -track technique, which can be used for drugs that are particularly irritating or stain the skin ( Jamieson et al, 2002) . The instructions for this and other techniques can be found in the data sheet that comes with the medicine.

Complications

Failure to rotate injection IM may result in small deposits of unabsorbed , so that rotation of the places must be clearly documented to avoid this. Sterile abscesses may occur as a result of the injection of an irritant drug to the subcutaneous tissues . This can be avoided by selecting an appropriate needle length.

Professional responsibilities
Any nurse who administers the IM medication should be undertaken specialist training and assessment of competence in accordance with protocols and guidelines of the organization in order to minimize risk.

The onus is on the person themselves to ensure that knowledge and skills are maintained, both from a theoretical and practical perspective . Nurses must also adhere to the protocols , policies and guidelines of your organization.