Cleanse the area with an antiseptic solution and allow the skin to dry. How many milliliters can be injected intramuscularly? NWCommons: Institutional Repository of Northwestern College For the majority of infants, the anterolateral aspect of the thigh is the recommended site for injection because it provides comparatively larger muscle mass than the deltoid (Figure 2) (23). Cover the site with a bandage or gauze. -Rapid injection is preferred. These cookies ensure basic functionalities and security features of the website, anonymously. In E. Hall and others (Eds. Explain which strategies (e.g., breastfeeding, local anesthetic use, distraction), may be used to minimize the patients pain and anxiety during the procedure. Select an appropriate injection site based on the patients age and muscle mass, the medication volume, and the viscosity of the medication (. Document the procedure in the patients record. Assess the patients and familys experiences with IM medication administration. If the patient or family expresses concern regarding the accuracy of a medication, the medication should not be given. Saving Lives, Protecting People, Vaccine Recommendations and Guidelines of the ACIP, Adapted from Immunization Action Coalition, https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6510a2.pdf, List of safety-engineered sharp devices and other products designed to prevent occupational exposures to bloodborne pathogens, National Center for Immunization and Respiratory Diseases, Comprehensive Recommendations and Guidelines, Preventing and Managing Adverse Reactions, Vaccine Recommendations for Emergency Situations, CDC's International Travelers Yellow Book, Clinical Travel Notices, Updates, and Vaccine Shortages, U.S. Department of Health & Human Services. PDF Administering Intramuscular Injections to Children: What Does the You also have the option to opt-out of these cookies. IM injection: Maximum recommended single IM dose is 2grams. (b) If skin is stretched tightly and subcutaneous tissues are not bunched. If injecting into the vastus lateralis, ventrogluteal, gluteus medius, or dorsogluteal muscles of an adult, the volume should not exceed 3 mL. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. 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). Different single-components of combination vaccines should never be mixed in the same syringe by an end-user unless specifically licensed for such use (4). Review medication information pertinent to the medications action, purpose, onset of action and peak action, normal dose, and common side effects and implications. Large-volume injections (3 mL or greater), however, are not frequently administered; and many clinicians may not be familiar with their appropriate use, possible side effects, and potential efficacy. In a 2-year carcinogenicity study of rats given hydralazine by gavage at dose levels of 15, 30, and 60 mg/kg/day (approximately 5 to 20 times the . For deep IM injections, the recommended volume ranges from 2 to 5 ml. Injection Site Injection Angle Maximum Volume per Injection Notes Intramuscular Preterm (<37 weeks GA) (up to 2 months PNA and/or very small infants) 5/8 inch (16 mm); 22-25 gauge Vastus lateralis/ anterolateral thigh 90 0.5 mL -Aspiration for blood return is not necessary. IPV (inactivated poliovirus)-containing combination vaccines combination vaccines containing IPV are given intramuscularly; IPV (IPOL) is given subcutaneously Japanese encephalitis vaccine ( JEspect) 13vPCV (13-valent pneumococcal conjugate vaccine) typhoid Vi polysaccharide vaccine MenB (meningococcal B) vaccine Verify the correct patient using two identifiers. Pediatric intramuscular injections: do you know the procedure and aspect, lateral to the midpoint of the thigh. For a well-developed adult, no more than 5 ml of medication should be administered in a single IM injection because the muscle tissue does not absorb it well. The most common serious complications of intramuscular injections in children are muscle contractures and nerve injury. The maximum volume should not exceed 1 mL. Choosing a muscle is dependent on the medication volume and the age or size of the patient. Smallpox vaccine is accessed by dipping a bifurcated needle directly into the vaccine vial. Be sure to give the injection in the center of the muscles . It does not store any personal data. Erythema or swelling at the injection site. PDF Communicable Disease Control Manual Chapter 2: Immunization Appendix B Overall, 5 mL has been cited for adults as the maximum volume for a single IM injection, with lower maximums proposed for adult patients with less-developed or small muscle mass. Pneumococcal conjugate. However, local reactions or injuries (e.g., skin laceration, transient neuropathy, hematoma) are sometimes more frequent on delivery of vaccine by jet injectors compared with needle injection, depending on the inherent irritability of the vaccine and operator technique (33). A separate needle and syringe should be used for each injection. 2022-2023 Targeted medication safety best practices for hospitals. It is possible that patients will faint during the injection process so nurses should take precautions to prevent any type of injury to the patient while administering the intramuscular injection. Chapter 20: Pediatric nursing interventions and skills. Use a bar code system or compare the MAR to the patients identification band. Many medications must be injected intramuscularly because of chemical properties, pharmacokinetics, desired onset, intensity and duration of the effect, and certain patient characteristics related to treatment compliance. formerly Immunization Action Coalition (IAC) . A decision on needle length and site of injection must be made for each person on the basis of the size of the muscle, the thickness of adipose tissue at the injection site, the volume of the material to be administered, injection technique, and the depth below the muscle surface into which the material is to be injected (Figure 1). ACIP discourages the routine practice of providers prefilling syringes for several reasons. Explain how the family can participate during the procedure. PDF How to administer intramuscular and subcutaneous vaccine injections PDF Medication Administration - Paediatric Intramuscular Injection Choosing a muscle is dependent on the medication volume and the age or size of the patient. With a maximum volume of 3 ml, the ventrogluteal muscle can hold up to 2.5 ml. Figure 4.1 Preferred site for intramuscular and deep subcutaneous injections in older children and adults Figure 4.3 Preferred site for BCG injections in babies and adults Figure 4.2 Preferred site for intramuscular and deep subcutaneous injections in infants under one year of age IM or deep SC injection site Immunisation procedures June 2012 Inactivated influenza vaccine is immunogenic when administered in a lower-than-standard dose by the intradermal route to healthy adult volunteers. The apparent volume of distribution at steady state (Vss) of ertapenem in adults is approximately 0.12 liter/kg, approximately 0.2 liter/kg in pediatric patients 3 months to 12 years of age and . Use the intramuscular (IM) injection route in pediatric patients only when the benefits outweigh the pain of injection or when it is the recommended route for a prescribed medication. what med did you give? Equipment: 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 Activate the needle safety device per the manufacturers instructions. The act directed OSHA to strengthen its existing bloodborne pathogen standards. Palpate the acromion (outer edge of the scapula) and trace an imaginary inverted triangle below the For women who weigh 152-200 lbs (70-90 kg) and men who weigh 152-260 lbs (70-118 kg), a 1- to 1.5-inch needle is recommended. for adults as the maximum volume for a single IM injection, with lower maximums proposed for adult patients with less-developed or small muscle mass. Determine the familys desire to be present during the procedure. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. This can lead to violation of expiration dates and product contamination (6,7). Using reduced doses administered at multiple vaccination visits that equal a full dose or using smaller divided doses is not recommended (4). Z- tracking: A technique used to prevent medication leakage, particularly for oily injections. With a new, sterile dose chamber and nozzle for each patient and correct use, these devices do not have the same safety concerns as multiple-use nozzle jet injectors. Hepatitis A. Needle size Gauge 25 (1 inch, in length, 0.6 mm) is the most appropriate size for intramuscular injection to minimize local irritation and pain in children. Move the dominant hand to the end of the plunger. However, these tools . Verify the patients daily weight in kilograms. The FDA-approved labeling recommends 50 to 75 mg/kg/day IV or IM divided every 12 hours (Max: 2 g/day) for serious infections. How should I prepare my child? Variation from the recommended route and site can result in inadequate protection. Rodgers, D. Wilson (Eds. Pretreatment (30-60 minutes before injection) with a 5% topical lidocaine-prilocaine emulsion might decrease the pain of vaccination by causing superficial anesthesia (43-44). Give in the central and thickest portion of the deltoid muscle - above the level of the armpit and approximately 2-3 fingerbreadths (~2") Intradermal injection: injection of a minimal quantity (0.01 mL to 0.1 mL) of a biological product just under the dermis. The maximum volume generally accepted for an SC injection is around 1.5 ml , although higher volumes (of up to 4 ml) can be administered if necessary . What is maximum safe volume that a neonate can receive in an intramuscular injection? In certain circumstances in which a single vaccine type is being used (e.g., in preparation for a community influenza vaccination campaign), filling a small number (10 or fewer) of syringes may be considered (5). Using the vastus lateralis muscle avoids the risk of sciatic nerve damage from gluteal injection. The cookie is used to store the user consent for the cookies in the category "Performance". The maximum amount of medication that can be subcutaneously injected is about 2 ml. For men and women who weigh <130 lbs (<60 kg), a -inch needle is sufficient to ensure intramuscular injection in the deltoid muscle if the injection is made at a 90-degree angle and the tissue is not bunched. PDF MCN0314 Cover Amit - CEConnection Currently the most commonly used sites for the rapid delivery of rescue medications are the IV, IM, and subcutaneous sites. b. 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. You will be subject to the destination website's privacy policy when you follow the link. Centers for Disease Control and Prevention. This site is commonly . March/April 2014 - Volume 39 - Issue 2 Previous Abstract; Next Abstract CE Connection. Mix and draw up the exact volume of medication. Avoid moving the syringe. The deltoid muscle is preferred for children aged 3-10 years (23); the needle length for deltoid site injections can range from to 1 inch on the basis of technique. Explain how the patient can assist by holding still. For an infant who is unable to breastfeed or for an infant who does not breastfeed, consider nonnutritive sucking, sucrose, and warmth. PDF Vaccine Administration: Intramuscular (IM) Injection Children 7 through In general, for an adult male weighing 60 kg to 118 kg (130 to 260 lbs), a 1-inch (25 mm) needle is sufficient. Hepatitis A vaccine and meningococcal conjugate vaccine do not need to be repeated if administered by the subcutaneous route (55-56). Take steps to eliminate interruptions and distractions during medication preparation. Local anesthesia or tactile stimulation should be considered to decrease pain at the injection site. 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). Retrieved May 23, 2022, from. This website uses cookies to improve your experience while you navigate through the website. Begin by having the patient relax the arm. IM injection site area 12/2018 Sources: Red Book 2018, American Academy of Pediatrics & CDC, General Best Practices for Immunization, accessed 2018 PDF Midazolam - Food and Drug Administration Office of Research Acceptable Volumes for Drug Administration - Office Subcutaneous injections may be administered into the upper-outer triceps area of an infant if necessary. However, if 2 half-volume formulations of vaccine have already been administered on the same clinic day to a patient recommended for the full volume formulation, these 2 doses can count as one full dose. Overall, 5 mL has been cited for adults as the maximum volume for a single IM injection, with lower maximums proposed for adult patients with less-developed or small muscle mass. Intramuscular (IM injection is one of many routes for administering medications, including antibiotics, vaccines, hormonal therapies, and corticosteroids. When choosing a needle size, factors to be considered include the weight of the patient, age, amount of adipose tissue, medication viscosity, and injection site (Hunter, 2008; Perry et al., 2018; Workman, 1999). (c) Do not withdraw more than 0.5 mL from the reconstituted product, even if some product is left in the vial. 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. What does it mean that the Bible was divinely inspired? You also have the option to opt-out of these cookies. Follow the manufacturers instructions for application and time to peak effect. PDF How to Administer IM (Intramuscular) Injections The cookie is used to store the user consent for the cookies in the category "Analytics". In general, for an adult male weighing 60 kg to 118 kg (130 to 260 lbs), a 1-inch (25 mm) needle is sufficient.