Published Dec 5, 2000
Hi! Iam a community psychiatric nurse. I am preparing a teaching session for students on placement but |I am having difficulty sorting out evidenced based practice for giving a simple intramuscular injection in the buttocks, and possible adverse effects.
do you change needles after drawing up ?
what size needle do you use, why ?
if a person is overweight, does this influence the needle size ?
How do you know if you have penetrated the fat and are not may be injecting into fat rather than muscle ? Does it matter ?
What are the differences between concentrated and standard anti-psychotic medications on the site ?
What is the best technique? I know of two, do you know others ?
Any evidence on anything to do with IM injections gratefully received
Hi Bryan, I did a brief search at www.cinahl.com This is a service you have to pay for (the right to search) but it is a very good deal and you get quite a bit of bang for your buck. I don't think the search format is that easy to use, but it was easy for your topic. You can also order articles from them directly, which is where they make their real money (ouch!).
Any how, here is a sample of what I found:
Drawing and administering injections: a review of the lit. Rodgers, MA, King, C. J ADV NURS 2000 Mar 31(3) 574-82
Safe injection techniques Workman B NURS STAND 1999 June 16-22, 13(39) 47-54
Clinical dos and don'ts: Administering a z-track injection. McConnell EA NURSING 1999 Jan, 29(1) 26 [only 1 page]
research in brief. Improvements in nursing practice trhough a study comparing IM depot ijection admin tech (MacGabhann L) J PSYCHIATRIC MENTAL HEALTH NURS 1997 Dec 4(6) 436-7
Back to the basics: administering IM injections the right way Beyea SC, Nicholl LH AM J NURS 1996 Jan 96(1) 34-5
Admin of meds via the IM route [a lit review with research based protocol--I assume this article is the basis for the above article] Beyea SC and Nicholl LH APPL NURS RES 1995 Feb 8(1) 23-33
Cannot guarantee I don't have typos here, but I did the best I could.
I was interested in your idea because I have come up with the very problem that you want to teach about. I have a female patient about 300 pounds. She gets haldol 250 mg Im every 4 weeks. Normally, I was giving it in the gluteal area and then was noticing large firm lumps in the injection site that lasted for several weeks. I spoke to the MD about it but he didn't have much to say. I 'm not sure that the patient is getting near the effect that 250 mg should be giving her. I'm concerned that the med is staying in the fatty tissue. I use a Z-track method and give it in the arm now, hoping to get more into the muscle.
WE have also used a warm compress to the site after the injection, for comfort.
This is the only person I have come up against with this problem. I definitely believe that her weight is the factor.
I found in Potter and Perry, Third edition the following.
The nurse uses a longer and heavier-gauge needle to pass through subcutaneous tissue and penetrate deep muscle tissue. Weight and the amount of adipose tissue can influence needle size selection. Foe example, an obese client may reguire a needle 3 inches long. A normal well developed client can tolerate 3 ml of medication into a large muscle without severe muscle discomfort. A larger volume of medication is unlikely to be absorbed properly. Try using the vastus lateralis muscle. It lacks major nerves and blood vessels and has rapid drug absorption. For Z-track you change the needle after drawing up the medication.You do not want any of the solution on the outside of the needle. Hope this helps a little.
We're actually not even allowed to give them in the buttocks anymore because of the risks associated with it. The university in town isn't even teaching it to their students and they certainly shouldn't be "squaring off" to landmark. The last group that went through had to landmark using the greater trochanter and the posterior ileac spine. They drew a line between the 2 and then from about the middle went up and latteral to give it. My friend is an instructor and they've been told not to teach this site anymore.
bryan01 ,we have blunt non bevelled needles for drawing up its safer and reduces any needle stick injury although using this method you do need change the needle for a sharp one of an appropriate gauge.MHN
I'm a bit puzzled by your question regarding changing needles after drawing up medication.
Using the same needle is one of the major causes of abcesses.You are coating the needle with whatever chemical you are drawing up ! Blechhhhh !
I also think it is inhumane to inject someone with an 18g drawing up needle.
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