Intramuscular injections

Transcription

1 Intramuscular injections

2 BENEFITS OF TREATMENT WITH INJECTION With injections of subcutaneous and intramuscular injection is possible to: - the administration of drugs to patients with impaired consciousness - precise dosage of the drug (independently from the process of assimilation in the gastrointestinal tract), - a much faster effects of the drug, compared with oral (particularly in the case of intravenous administration), - if necessary, extended release of the active substance from a administrated drug - the use of psychological effect, so-called the placebo effect (more effective than the administration of the substance in pills).

3 FAULTS OF TREATMENT WITH INJECTION WARNING! Each injection violates the integrity of the patient - its use is justified only when alternative therapies do not provide the comparable effect (!) Major disadvantages of the injections that must be taken into account are: - no possibility of rapid elimination from the body the event makemistake you a of his administration -an increased risk of complications, such as m.in.: infection, bleeding, nerve damage, - higher costs of treatment (due to equipment, time-consuming, need of a properly trained personnel), - leaving potentially infectious material after completion of the procedure, increasing the risk of infection and generating costs (waste), - increased risk of injury or infection to the medical personnel.

4 HEMATOGENOUS INFECTIONS Please note that even small stabbing with a needle having inner light, may cause transdermal transfer of a small amount of blood potentially contaminated with viruses, bacteria or fungi (approx. 20 different pathogens). Hepatitis B Hepatitis C Human immunodeficiency virus (HIV), malaria plasmodium syphilis Mycobacterium tuberculosis toxoplasma Rubella herpes coryneform bacterium diphtheria Blastomyces dengue PERSONNEL PROTECTION Disposal gloves before each anticipated contact with the patient. Protective clothing. Precaution at work to minimize the risk. Protective mask and goggles when risk of the infected aerosols (eg. during extraction). No eating in rooms intended for work. Use of active or passive immunization.

5 INJECTION ORDER The injection order should be formulated in writing and should include following information 1. The medication info: - Trade name - Concentration - The amount of medication per dose 2. Way of administration (eg. Sc, im, iv) - Time and frequency of administration - necessary assessments (eg. body temperature, blood pressure) - the order authorisation by the signature of the person who ordered! When using a drip (infusion) in request must include the indicated flow rate (eg. in ml per min.) and the duration of infusion (eg. 30 min.)

6 INTRAMUSCULAR INJECTION Intramuscular injection is the administration of the drug to muscle tissue in aseptic conditions. When a person is properly muscled, the largest volume of the drug (up to 5 ml) can be injected in the gluteal region back. If there is a need for a drug volume exceeding 5 ml or the need for simultaneous administration of the two drugs, then the second drug should be injected through the same needle, but prior change of its direction is required. In this way, it is possible to inject up to 10 ml of the drug. With a person well-muscled, administration amounts can be: up to 5 ml of the drug to the quadriceps and gluteus medius muscle and up to 2 ml of the drug in the deltoid muscle. If the patient has a low muscle mass, consider a drug volume reduction or an alternative route of administration. Newborns and infants to three months of age should not be administered to intramuscular, due to the lack of sufficiently developed muscle tissue and therefore existing an increased risk of its damage. The time of drug absorption after intramuscular administration - typically minutes - depends on the injected drug volume (the smaller volume, the more easily absorbed), - depends on the degree of myocardial blood flow (the better it is, the faster absorption) -depends on the drug and the physicochemical properties.

7 ADMINISTERING THE MEDICATION When performing an intramuscular injection, the cleanliness and adequate decontamination of the skin at the injection site mus be provided. Clean skin should be sprayed with disinfectant spray from a distance of approx. 10 cm and then wiped with a gauze from bottom to the top. If there is a need, these steps can be repeated. At that prepared injection site, mist of disinfectant spray (from a distance approx. 30 cm) can be atomized and left on the skin to dry (approx. 60 sec.). Insert the needle at an angle of 90 degrees to the skin, which at this time should be stretched between thumb and forefinger (it gives the shortest the way to muscle). The needle should be inserted to the depth necessary to reach the muscle, but without exceeding 3/4 of its length. DO NOT inject the needle to the cap due to the risk of breaking the needle (usually it breaks at the cap). Stabilising the syringe with one hand, aspirate to make sure the needle is not in the vessel. If not, slowly administer the medication. Withdraw the needle and cover the puncture site with a clean gauze.

8 ADMINISTERING THE MEDICATION INDICATIONS for intramuscular injection. The need for an injection because of medication substance. No other way of administration. CONTRAINDICATIONS (ABSOLUTE) ELIMINATING intramuscular injections Lack of consent Centralization of circulation Increased bleeding tendency, eg. a bleeding disorder therapy with anticoagulants Suspected heart attack (due to possible fibrinolytic treatment ) CONTRA RELATIVE, which may require selection of an other injection site than the most optimal or seek alternative routes are: the lesions at the injection site (eg. redness, swelling, rash, birthmark, scar, infiltration, abscess, wound, fibrosis of muscle tissue after a previous injection, etc.) insufficient skills of the person performing the puncture TYPES OF DRUGS administered intramuscularly analgesics anti-inflammatory antispasmodic drugs antiallergic drugs Antibiotics sedatives Medicines antihemorrhagical Vitamins Other

9 COMPLICATIONS Most common complications of intramuscular injection include: causing infections eg. by insufficient hand hygiene, bad skin disinfection, infected drug or non sterile medical equipment, inadvertent administration of the drug, breaking the needle in the patient s tissues disruption of the tissue under the pressure of the injected drug, as a result of too rapid administration, fibrosis, hardening and tenderness of tissues caused by too frequent injections in the same area, an injury due to a fall from a standing position while taking the injection, improper combinations of drugs in the same syringe, leading to the physical, chemical and therapeutic incompatibility puncture leading to nerve damage, difficult absorption of the drug and the threat of tissue necrosis as a result of accidental administration of the drug to the adipose tissue (e.g.,.: too short needle, or too shallow puncture) inadvertent injection into a blood vessel. Typical set for intramuscular injection should include : disinfectant spray container for needles container for contaminated waste Scissors Adhesive dressing tape Sterile swabs ampoules of drugs needle to take out the drug the needle for intramuscular injections syringe

10 VON HOCHSTETTER METHOD Place the patient in a relaxed position lying on the back or on a side (patient's knee should be slightly bent). Tip of a left index finger should be put on the right anterior superior iliac spine, and then move the middle finger of the same hand along the iliac crest to the back so the fingers are fully extended. In the next stage, move the hand down about 2-3cm(with the index finger on an anterior superior iliac spine as pivot point) until you find the withers at the greater trochanter. The middle finger is now located 2-3 centimeters below the iliac crest. Injection point is in the lower 1/3 of the triangle formed by the index and middle finger. The method of von Hochstetter, although reference is made to the bone point, brings high risk of lack of standardization of a puncture site on the same patient, caused by variations in the length of the hand and fingers of various medical staff.