Injection granulomas. Intramuscle or intrafat?

Haramati, Nogah; Lorans, Roxanne; Lutwin, Michael; Kaleya, Ronald

doi:10.1001/archfami.3.2.146

Cited by 63 publications

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“…Serious complications of intramuscular deltoid injections are rare, whereas abscesses and granulomas are more common with subcutaneous injections. 3,4 In studies comparing adverse effects of the Diphtheria, Pertussis, and Tetanus (DPT) vaccine associated with different needle lengths, use of longer needles was associated with less pain following immunisation of infants in the thigh. 17,18 The use of shorter needles resulted in deposition of vaccine into the subcutaneous tissue, which is well innervated with pain fibres compared to muscle tissue.…”

Section: Discussionmentioning

confidence: 99%

Influence of skin-to-muscle and muscle-to-bone thickness on depth of needle penetration in adults at the deltoid intramuscular injection site

Shankar

Saxena

Lokkur

et al. 2014

Medical Journal Armed Forces India

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Needles Subcutaneous fat a b s t r a c tBackground: The objectives of the study were to estimate the following in adults of Indian origin: a) Gender and side differences in the skin-to-muscle (SM) and muscle-to-bone thickness (MB) at the deltoid intramuscular injection site; b) Correlation of SM thickness with the BMI, age and gender; c) The prevalence of under and over-penetration assuming a standard needle length of 25 mm and following prescribed guidelines for IM injection. Methods: The SM, MB and skin-to-bone (SB) thicknesses were bilaterally estimated in two hundred adult Indian subjects (100 male and 100 female) using an ultrasound probe at a pre-determined point on the upper arms of the subjects. The BMI of each subject was calculated. The unpaired sample 't' test and paired 't' test were used to analyse differences between groups. Pearson's correlation coefficient was used in correlation analysis and suitable linear regression equations were generated. Results: Females had a significantly higher SM thickness and lower MB thickness. The SM thickness was significantly greater on the left side, while the SB and MB thickness were significantly greater on the right. Multiple linear regression equations for both the dominant and non-dominant arms had good model fit properties. Under-penetration would have occurred in 2 (1%) subjects while over-penetration would have occurred in 50% of the subjects. Conclusion: Over-penetration of deltoid IM injections is likely to be more prevalent as compared to under-penetration. Therefore, the technique of IM injection needs to be modified based on the body type of the individual patient.© 2014, Armed Forces Medical Services (AFMS). All rights reserved. m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 0 ( 2 0 1 4 ) 3 3 8 e3 4 3http://dx

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Section: Discussionmentioning

confidence: 99%

Influence of skin-to-muscle and muscle-to-bone thickness on depth of needle penetration in adults at the deltoid intramuscular injection site

Shankar

Saxena

Lokkur

et al. 2014

Medical Journal Armed Forces India

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“…들이 있다 (Burbridge, 2007;Chan et al, 2006;Haramati, Lorans, Lutwin, & Kaleya, 1994;Lippert & Wall, 2008;Newton, Newton, & Fudin, 1992;Nisbet, 2006;Poland et al, 1997;Rai & Nandan, 2006;Zaybak, Gunes, Tamsel, Khorshid, & Eser, 2007).…”

mentioning

confidence: 99%

“…또 피하지방은 근육보다 혈액 공급이 적고 배액이 잘 되지 않아 농양이나 육아종이 더 잘 발 생할 수도 있다 (Chan et al, 2006;Haramati et al, 1994;Poland et al, 1997) (Burbridge, 2007;Chan et al, 2006;Haramati et al, 1994;Lippert & Wall, 2008;Nisbet, 2006;Poland et al, 1997;Rai & Nandan, 2006;Zaybak et al, 2007) …”

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Gluteal Subcutaneous Fat Thickness Measured by Computed Tomography as an Estimate of Proper Gluteal Intramuscular Injections in Korean Adults

Joo

Sohng

2010

J Korean Acad Nurs

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Purpose:To study the thickness of gluteal subcutaneous fat (SCF) and propose an adequate length for needle for gluteal intramuscular injections based on computed tomography (CT) measurements. Methods: The thickness of gluteal SCF were measured and studied for 568 patients who visited a tertiary hospital in Seoul, Korea between January 2007 and February 2009 for routine health screening and who had abdominopelvic CT. Results: The average thickness of gluteal SCF was 15.92±4.08 mm in males and 24.90±5.47 mm in females. The thickness of gluteal SCF differed significantly according to gender. The gluteal SCF thickness was greater than 20.4 mm for 54 (12.3%) of the 440 male patients and 99 (77.3%) of the 128 female patients. Conclusion: The most common syringe needle used for gluteal intramuscular injections in Korea is a 23 G, 25.4 mm-needle. The SCF thickness must be less than 20.4 mm in order to reach the dorsogluteal muscles to a depth of at least 5 mm if this 25.4 mm needle is used. In many patients, especially in female patients, the 25.4 mm needles will result in improper intramuscular injections with the injection being into the SCF. Therefore an appropriate needle should be selected by considering the gender and SCF thickness of patients receiving gluteal intramuscular injections.

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“…Logistic regression was conducted to identify risk factors for adverse events while controlling for demographic factors, comorbidities, and injection-related risk factors. For the logistic regression model, variables found to be statistically significant in the univariate analysis and variables that have been identified in the literature to be significant risk factors such as gender, age, vial age at injection, and underlying diabetes were included in the final model [1,8,[13][14][15]. All data in this investigation were analyzed using Epi Info 7.1.2.0 (CDC, Atlanta, GA).…”

Section: Methodsmentioning

confidence: 99%

Polymicrobial Injection-Site Abscesses Associated with Contaminated Methylprednisolone Injections in Florida

Matthias¹

2017

RMES

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Objective: Identify injection-site abscesses and quantify risk factors from injections with subsequently recalled preservative-free Methylprednisolone acetate (pf-MPA) from Main Street Family Pharmacy (MSFP). Design:Outbreak investigation and retrospective cohort study. Setting:Private primary healthcare facility.Patients: Three hundred and seven patients that received pf-MPA injections manufactured by MSFP from December 1, 2012 through February 28, 2013.Methods: Medical records were abstracted for individuals with an adverse event and individuals with known exposure to pf-MPA lots 011413dan and 120612dan. Records were analyzed for factors related to injection-site adverse events using logistic regression. Facility records from 2006 through 2013 were queried for International Classification of Diseases, 9 th edition, Clinical Modification (ICD-9-CM) diagnosis codes 682.5 and 680.5 to identify additional adverse events. Results:Sixteen of 307 injected individuals (attack rate = 5.2%) were identified with adverse events consisting of soft tissue infections at the injection site. Increasing body mass index (BMI) (odds ratio [OR] =1.17; 95% CI=1.04-1.33), age of vial at injection (OR=1.13; 95% CI=1.00-1.27), and date of injection (OR=10.01; 95% CI=1.49-67.11) were associated with adverse events. Conclusion:Risk of soft tissue infections following injection of recalled MSFP pf-MPA was greater among persons with higher BMI, receiving older product, and receiving injections from February 5 through February 15, 2013. Appropriate needle length was not used for patients with a greater BMI. A written protocol for pf-MPA injections including needle length and gauge should be created and trainings on this protocol provided to staff administering injections. Compounded pharmaceuticals, especially preservative-free formulations, should not be utilized for multiple injections.

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Injection granulomas. Intramuscle or intrafat?

Cited by 63 publications

References 0 publications

Influence of skin-to-muscle and muscle-to-bone thickness on depth of needle penetration in adults at the deltoid intramuscular injection site

Influence of skin-to-muscle and muscle-to-bone thickness on depth of needle penetration in adults at the deltoid intramuscular injection site

Gluteal Subcutaneous Fat Thickness Measured by Computed Tomography as an Estimate of Proper Gluteal Intramuscular Injections in Korean Adults

Polymicrobial Injection-Site Abscesses Associated with Contaminated Methylprednisolone Injections in Florida

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