Drawing up and administering intramuscular injections: a review of the literature

Abstract

Drawing up and administering intramuscular injections: a review of the literature Intramuscular (IM) injections have been an integral part of drug administration in nursing practice for almost half a century. However, there are some conflicting practices which warrant investigation to determine their effectiveness in this aspect of patient care. To this end, this paper presents the results of a literature review which was carried out in order to establish current understanding of present day knowledge, procedures and guidelines for the administration of IM injections. Areas addressed within this review include injection sites used, injuries associated with IM injections, issues surrounding needle selection and volume administered through IM injections, injection techniques and nursing skills associated with IM injections. Synthesis of the research reviewed allows the development of research-based guidelines for this skill. These guidelines offer a framework for nurses who wish to provide practice in line with current research into the process of drawing up and administration of intramuscular injections.

Betamethasone Pharmacokinetics After Two Prodrug Formulations in Sheep: Implications for Antenatal Corticosteroid Use

“…This dose is higher than that recommended by the National Institutes of Health in humans (0.17 mg/kg), but has been found to be the dosage in sheep that consistently produces preterm fetal lung maturation (Moss et al, 2001). This is also the highest dose level that can be investigated because it is associated with an injection size of 4 to 6 ml, which is the maximum recommended intramuscular administration volume (Rodger and King, 2000). The use of a high dose is necessary to capture the low-level betamethasone release that could occur from the acetate prodrug.…”

Upper limb nerve injuries caused by intramuscular injection or routine venipuncture

“…Excessive proximal site could lead to bursa injection, while excessive distal site could lead to nerve damage or injection into vessels [11,12]. However, cadaver studies indicated that the distance from the tip of the acromion to the axillary nerve had as wide a range of 4-8 cm, with an average distance of 5-6 cm.…”

“…Additionally, the number and volume of injections should be limited due to its small muscle mass. The suggested maximum injection volume at a deltoid site is 1-2 ml [10,12].…”

“…Careful monitoring and observation of the injection site is also important for an early detection of nerve damage. Two to four hourly postinjection observation of the injection site is recommended [12].…”

An evidence based protocol for the prevention of upper arm injury related to vaccine administration (UAIRVA)

“…[13][14][15][16] However, with this method there is no agreement on the position of injection, with variable distances below the acromion being recommended, measured as centimeters or finger breadths/ widths. Another technique, also with strong nursing support, [17][18][19][20][21][22] involves location of the acromion and a line drawn laterally across the deltoid muscle from the apex of the anterior axilla. All authors place the apex of a triangle on the latter line, with some authors 18,21 placing the base of the triangle on the acromion and others [17][18][19][20]22 placing it two to three finger breadths below the acromion.…”