What is the Best Practice for IM Injections?
Best practices for intramuscular (IM) injections prioritize safe and effective medication delivery while minimizing discomfort and complications. This involves careful site selection, proper technique, and adherence to sterile procedures.
1. Preparation and Sterility:
- Hand Hygiene: Thoroughly clean your hands and wear gloves. [NCBI Bookshelf]
- Skin Disinfection: Use a 70% isopropyl alcohol swab for at least 30 seconds, allowing the skin to dry completely before injection. [NCBI Bookshelf, WHO Best Practices] Do not use methanol or methylated spirits. [WHO Best Practices]
- Needle and Syringe: Use a filter needle (if needed) and a syringe appropriate for the medication volume. [NCBI Bookshelf]
2. Injection Site Selection and Technique:
- Angle of Injection: Inject the syringe at a 90-degree angle to the skin. [Figure 2, Elsevier, Acute Care]. In patients with weak muscles (e.g., older adults), gently bunch the muscle before injection, to create a larger injection area and prevent hitting the bone. Release the muscle after needle withdrawal. [Figure 2]
- Needle Length: Choose a needle long enough to reach the muscle mass and prevent subcutaneous injection but not so long as to reach bone. [CDC Vaccine Administration Guidelines]
- Injection Sites: The specific site depends on the medication volume and patient factors. Common sites include the deltoid (upper arm), vastus lateralis (thigh), and ventrogluteal (hip). Consider using the ventrogluteal site for larger volumes. [Anatomically safe sites for intramuscular injections]
3. Post-Injection:
- Gentle Pressure: Apply gentle pressure to the injection site with a cotton ball or gauze pad, but do not massage the area, as this can increase discomfort and potentially cause bleeding or bruising.
4. Ongoing Review of Best Practices:
Even experienced injectors should periodically review best practices to maintain proficiency and ensure patient safety. [AHRQ Best Practices]
Addressing Specific Medication Types and Patient Populations:
Different medications and patient populations may require adjustments to the standard procedures. For example, older adults or those with limited muscle mass might need modifications to injection technique to avoid hitting bone. Large-volume injections may also require specialized techniques and site selections.
