IM Administration of Immune Globulin

[ILoveMyJobRN]

I am doing a Nursing Refresher course and came across the topic of orchitis post mumps exposure. I had heard in the past about how this causes sterility in males. My text states that if the person "receives gamma globulin immediately, the disease is likely to be less severe, with minimal or no complications.*" In researching the IM administration of Immune Globulin IM (IGIM) quite a volume is required to be administered. (For a 73 kg/160# man the dosage is 0.2 to 0.25 ml/kg for measles exposure, it didn't list mumps exposure....). So to administer 0.25 ml/73kg you would need to give 18.25 cc--ouch! Just how would you go about doing this?? I think the most volume that I have given in one shot IM is 3 cc. {I do see where there is the option of IV administration with different dosages, but was just wondering if anyone had given this IM.}

Thanks for sharing your experiences!!

From an RN who has home schooled for 12 years and is now wanting to get back into the trenches............

* Brunner & Suddarth's Textbook of Medical-Surgical Nursing, Volume 2, page 1769, 2008.

[patrick1rn, MSN, RN, NP]

10 cc in each cheek if you had to, or opt to give IV.

[APRN., DNP, RN, APRN, NP]

Wow. Just off the top of my head (which has one glass of wine in it right now), I thought that the rule of thumb for an intramuscular injection was about 3 mls. Or did things change? I've worked ICU for quite some time, and haven't given an IM injection for quite a while.

[APBT mom, LPN, RN]

Maybe the injections are given over a period of time or like the previous poster said give it IV.

[patrick1rn, MSN, RN, NP]

Wow. Just off the top of my head (which has one glass of wine in it right now), I thought that the rule of thumb for an intramuscular injection was about 3 mls. Or did things change? I've worked ICU for quite some time, and haven't given an IM injection for quite a while.

20 cc is alot to give IM, It feels like a golf ball for several hours after you get the IGG shot IM in the buttocks. I have gotten them several time now to deploy over to the war.

[ILoveMyJobRN]

Thanks for your post "patrick1rn"! I served in the Navy years ago and vaguely remember stories of some sailors getting shots of PCN that were huge volumes in each hip. Hope I never have to give it, but at least I'll have an idea how to do it. Thanks for serving!!!

[NRSKarenRN, BSN, RN]

Complete Immune Globulin IM (IGIM; IG; Gamma Globulin) information ...

• In adults, administer via IM injection, preferably in upper outer quadrant of gluteal region.
  
• Divide doses larger than 10 mL and inject into several muscle sites to reduce local pain and discomfort.
  

[kmoonshine, RN]

I have not given this IM, but I once had to give a total volume of 20mL IM. Another nurse helped me give the shots (2-for-1 special). We divided the volume between the DG, VL, VG, and deltiod sites. Obviously less in the deltoid though...

I'd rather give a pt a few more shots than to give too much volume at one site. You don't want the pt to develop an abcess, tissue damage, etc.

[blondy2061h, MSN, RN]

I have not given this IM, but I once had to give a total volume of 20mL IM. Another nurse helped me give the shots (2-for-1 special). We divided the volume between the DG, VL, VG, and deltiod sites. Obviously less in the deltoid though...

I'd rather give a pt a few more shots than to give too much volume at one site. You don't want the pt to develop an abcess, tissue damage, etc.

So if I'm reading this correctly, the poor guy got 8 IM shots? I am a wimp about IM stuff. That stinks.

[kmoonshine, RN]

So if I'm reading this correctly, the poor guy got 8 IM shots? I am a wimp about IM stuff. That stinks.

Yeah, he got at least 8 shots. But like I said, it wasnt immune globulin (it was fosphenytoin - the guy had a seizure prior to ED arrival, was noncompliant with medications, and was combative and had no IV access). It was much easier to give him the shots, versus putting in a central line!