Intramuscular injection is the method of installing medications into the depth of the bulk of specifically selected muscles. The basis of this process is that the bulky muscles have good vascularity, and therefore the injected drug quickly reaches the systemic circulation and thereafter into the specific region of action, bypassing the first-pass metabolism. It is one of the most common medical procedures to be performed on an annual basis. However, there is still a lack of uniform guidelines and an algorithm in giving IM among health professionals across the world.
Drugs may be given intramuscularly both for prophylactic as well as curative purposes, and the most common medications include:
Any drugs that are nonirritant and soluble may be given IM during an emergency scenario.
There are specific landmarks to be taken into consideration while giving IM injections so as to avoid any neurovascular complications. The specific landmarks for the most commonly used sites are discussed below
IM is commonly indicated for patients who are :
Prerequisite- ensure the 5 'Rs'
Ask for any adverse reactions in previous such procedures.
Counseling regarding the procedure and preparing the patient- to calm them down and also to minimize the pain associated with the procedure
2 ml or less- deltoid injection
2 to 5 ml - Ventrogluteal injection
Vastus lateralis -16 to 25 mm
Deltoid-16 to 32 mm (children), 25 to 38 mm(adults)
Common complications associated with the intramuscular injection can be summarized as :
The formulation of set guidelines and procedural algorithms for IM injections is of paramount importance in assuring effective pharmacokinetics and the pharmacodynamics of the drugs.
The thorough knowledge pertaining to the specific anatomical landmarks helps in minimize the neurovascular complications that harbinger the IM procedures.
The strict adherence to aseptic precautionary measures and timely disposal of the used equipment helps to minimize the transmission of blood-borne infections.
The ventrogluteal site is considered the safest for IM injection owing to the thin plane of subcutaneous tissues as well as the relatively thick bulk of the underlying muscle.
The pain associated with the intramuscular injection can be reduced by the application of the skin traction and deep pressure over the muscle before the injection.
The simple step of asking the patient to cough vigorously just prior to injection also helps in reducing the pain associated with the procedure. The transmission of the cough impulse is faster than that of the pain impulse traveling through the slow conducting nerve fibers; thereby, it helps in minimizing the impact of the pain threshold perceived by the brain.
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