Best vaccination practice and medically attended injection site events following deltoid intramuscular injection

Cook, Ian F.

doi:10.1080/21645515.2015.1017694

Cited by 56 publications

(79 citation statements)

References 83 publications

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“…Besides, literature shows that nurses have not received any kind of training other than basic training of IM injection method, although IM medication administration causes iatrogenic complications. 6,27 Study by Hensel and Springmyer revealed that nurses are not informed about current recommendations issued by professional nursing institutions and they continue their profession with practices taught during their basic training. 28 The nurses witness traditional ritualized injection administration applied by other nurses in many practices and thereby, they do not revise current research about the issue most of the time.…”

Section: Nurses' Features Of Im Injection Administrationmentioning

confidence: 99%

Selection of Site for Administration of Intramuscular Injection to Adult Patients by Nurses: A Cross-Sectional Study

Turan

Aydın

Kaya

2019

Kocaeli Üniversitesi Sağlık Bilimleri Dergisi

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Objective:This study was carried out to determine the sites which are selected by nurses to use in the intramuscular medicine applications and the factors affecting the selection of the injection sites. Methods: The population of this descriptive and cross-sectional type of study was composed of 250 nurses working in two hospitals in Istanbul, the sample was composed of 171 nurses selected by stratified random sampling method. Data were collected with 'Structured Questionnaire Form'. Results: The average age of the nurses was found to be 26.27±7.46 years, it was determined that 40.4% of them applied injection very often and they preferred dorsogluteal site to apply injection with a ratio of 83.6%. When the knowledge level of nurses about the complications that may occur depending injection site, it was seen that some nurses did not consider complications such as pain, nerve, bone and vascular injury, infection, necrosis, tissue irritation, nodules or stiffness, abscess and hematoma in the deltoid site. On the other hand, it was learnt that they had a risk of developing sciatic nerve damage in the ventrogluteal site. The unit, which the nurses work and the experience period in that unit affects the site selection in injection application. As a result, nurses often prefer the dorsogluteal site in injection. Conclusion:The nurses' knowledge about the complications that may ocur in the sites chosen for injection by them is insufficient and there are factors affecting the selection of the site. ÖzAmaç: Bu çalışma hemşirelerin intramusküler ilaç uygulamalarında seçtiği enjeksiyon bölgeleri ile bölge seçimini etkileyen faktörleri belirlemek amacıyla yapıldı. Yöntem: Tanımlayıcı ve kesitsel türdeki bu araştırmanın evreni İstanbul'daki iki hastanede çalışan 250 hemşire; örneklemini ise tabakalı rastgele örnekleme yöntemi ile seçilen 171 hemşire oluşturdu. Veriler, 'Yapılandırılmış Soru Formu' ile toplandı. Bulgular: Hemşirelerin yaş ortalamasının 26,27±7,46 yıl olduğu, %40,4'ünün çok sık intramusküler enjeksiyon uyguladıkları, intramusküler enjeksiyon için %83,6 oranla öncelikli olarak dorsogluteal bölgeyi tercih ettikleri belirlendi. Hemşirelerin intramusküler enjeksiyon bölgesine göre gelişebilecek komplikasyonlar hakkında bilgi düzeyleri incelendiğinde; bazı hemşirelerin ağrı, deltoid bölgede sinir, kemik ve damar yaralanması, enfeksiyon, nekroz, doku tahrişi, nodül veya sertlik, apse ve hematom gibi komplikasyonları bir risk olarak görmedikleri öte yandan ventrogluteal bölgede siyatik sinir hasarı gelişme riskinin bulunduğunu ifade ettikleri görüldü. Hemşirelerin çalıştıkları ünite ve ünitedeki deneyim süresi intramusküler enjeksiyon uygulamasında bölge seçimini etkilemektedir. Sonuç olarak, hemşireler intramusküler enjeksiyon uygulamasında sıklıkla dorsogluteal bölgeyi tercih etmektedir. Sonuç: İntramusküler enjeksiyon için seçtikleri bölgelerde gelişebilecek komplikasyonlar konusundaki bilgileri yetersizdir ve bölge seçimini etkileyen faktörler bulunmaktadır. Anahtar Kelimeler: İntramusküler enjeksiyon, ventroglutea...

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Section: Nurses' Features Of Im Injection Administrationmentioning

confidence: 99%

Selection of Site for Administration of Intramuscular Injection to Adult Patients by Nurses: A Cross-Sectional Study

Turan

Aydın

Kaya

2019

Kocaeli Üniversitesi Sağlık Bilimleri Dergisi

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“…[2,11,[44][45][46] Critical assessments of patient weight, BMI, gender and injection site, needle length, volume of medication before administering IM injections is important and therefore should drive practice change.…”

Section: Injection Depthmentioning

confidence: 99%

Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

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Background and Objective: Intramuscular (IM) injections are administered to patients in all health care settings. Even though this procedure is invasive and the evidence supporting the process of administration is extensive, techniques and procedures vary throughout the literature and in practice. The purpose of this descriptive correlational study was to 1) investigate the literature on current evidence-based IM injection procedures pertaining to gender, patient weight, injection site, needle length, and technique, 2) compare surveyed healthcare personnel self-reported IM injection practices, and 3) query respondents on informational resources they access, continuing education they receive, and their years of healthcare experience and higher education. Methods: The Intramuscular Injection Questionnaire (IIQ) was sent via email to various professional healthcare facilities and their respective social media sites. Two hundred and six (206) healthcare personnel of various healthcare backgrounds and educational levels accessed the IIQ via a link to Qualtrics software. SPSS Version 24 was used for data analysis. Results: Most respondents were registered nurses with 4 -15+ years of experience. Seventy-eight percent of respondents considered their IM injection knowledge at above average or expert levels. Gender was not considered an important factor when selecting an injection needle among 75% of participants. Of all respondents, 61% use z-track technique, 59% use the ventrogluteal site and 34% always bunch or stretch the skin during injection. IM injection education was not provided in 75% of healthcare facilities. Conclusions: IM injection practices vary among respondents and in the literature; some reported practices are contrary to current evidence-based practice. While the evidence provides some sound recommendations, some procedures are not well-documented or supported including in nursing texts. Nurses and other healthcare personnel must critically analyze the site, depth, needle, volume, medication, vaccine, and whether to bunch or stretch, according to evidence-based practice. Healthcare facilities should provide IM injection education routinely to ensure safe practices. Future studies (Level 1 and 2) are needed to further demonstrate the best evidence leading to safe and effective IM injections.

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“…However, upper arm and shoulder injury related to vaccine administration is an emerging, and likely under-reported, phenomenon. [12,[15][16][17] The standard deltoid landmark needs to be updated: three fingers below the acromion should be considered the upper (superior) boundary for safe deltoid injections, and an additional lower boundary, at the axillary line, should be added for optimal client safety. The safe injection zone is between these upper and lower boundaries, along the coronal (vertical) axis of the outer aspect of the client's arm.…”

Section: Discussionmentioning

confidence: 99%

Best practice for deltoid intramuscular injections in older adults: Study in cadavers

Davidson

Bertram

2019

JNEP

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Most injectable vaccines are administered via deltoid intramuscular injection (IMI). Nursing students are taught to perform deltoid IMI in their entry-to-practice education program. However, best practice evidence is lacking regarding specific techniques of deltoid IMI, and students are often taught what their instructor was taught in his/her own entry-to-practice (ETP) program. Nursing textbooks provide instructions and diagrams for how to perform deltoid IMI, but rarely cite underpinning empirical evidence. This study tested the injection techniques of bunching (squeezing) or flattening (stretching) the deltoid muscle before administering IMI using medical school donated cadavers. Flattening technique resulted in over-penetration of deltoid injections more than 85% of the time in these older adults, whereas nearly 80% of deltoid IMI are successful using bunching technique. Body mass index (BMI) and needle length are also crucial considerations when administering deltoid IMI. Nurses, and other health professionals who use deltoid IMI to administer vaccines to older adults, should determine the client’s body mass index to select the appropriate needle length. Based on these results, bunching technique is recommended. Flattening technique is not recommended for older adults with a BMI < 30.

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Best vaccination practice and medically attended injection site events following deltoid intramuscular injection

Cited by 56 publications

References 83 publications

Selection of Site for Administration of Intramuscular Injection to Adult Patients by Nurses: A Cross-Sectional Study

Selection of Site for Administration of Intramuscular Injection to Adult Patients by Nurses: A Cross-Sectional Study

Evidence calls for practice change in intramuscular injection techniques

Best practice for deltoid intramuscular injections in older adults: Study in cadavers

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