Intramuscular Medication: Injection (Nursing)

00:04 Now that we've got our injection prepared, we're going to expose the administration site.

00:09 And then, we're gonna clean with an antiseptic pad, moving in a circular motion.

00:13 So, remember to clean thoroughly here to decrease risk of infection.

00:17 Next, we need to remove the needle sheath, and then, position the syringe at a 90-degree angle.

00:23 Okay, so positioning is important here for a lot of different reasons, when you go to give an intramuscular injection, you wanna be head on.

00:31 So I'm not very tall. So, this usually isn't a problem for me.

00:35 But if I'm really tall, and I need to inject a patient with their arm here, you can imagine me going at a 90, it's gonna look more like this.

00:44 So, please make sure you position the patient, you position yourself to get straight on and go at a 90-degree angle for your patient.

00:53 With IM injections, 90 degrees is the preferred method.

00:57 Then once we're in position, we're gonna quickly and smoothly insert the needle into the subcutaneous tissue and into the muscle itself, because remember, this is an intramuscular injection.

01:09 Then after that, we're gonna slowly inject the medication.

01:13 After we've injected the medication, we're gonna withdraw the syringe slowly from the muscle, and then, we're gonna make sure to immediately activate that safety shield on the needle.

01:23 That's really important that we activate that safety so we don't puncture ourselves or the patient.

01:30 Now, after the injection, your patient may bleed a little bit.

01:33 So, please make sure you have a gauze pad, and you can apply that over the injection site if need be.

01:38 Now, most of the time, we can cover that up with a good old BandAid, or maybe a Mickey Mouse band aid or whatever your patient prefers, but usually that's sufficient.

01:47 Then we wanna make sure a patient's okay, they feel alright, we give them a minute to make sure that they are comfortable after that injection.

01:55 Now that we've talked through that, let's take a look at the injection itself.

02:04 Now, let's take a live look at IM injection.

02:07 So, with my patient, positioning is really important.

02:10 So, notice, luckily, I'm not very tall, I've got my patient position to where I'm at a full 90-degree angle.

02:18 So, notice when I go give an injection and I wanna give a 90-degree injection, that I am head on and straight with my patient's arm, that's really important.

02:28 Also, note, I've got my patient relaxed as much as possible, even though there may be some anxiousness, try to have your patient relax, try to have their shoulder relaxed, and notice that his arm is in line with his body and sitting there and supported. So, that's another thing to consider.

02:46 Alright, so today, what I'm gonna do is demonstrate a deltoid injection.

02:50 I've talked previously in regards to injection that this is the most common site that you're gonna use, and it's gonna be in the deltoid, which is the arm. So, let's talk about how we landmark that.

03:01 So, first, when we do that, we're gonna try and take our fingers and find our patient's acromion process, that's gonna feel like the really bony part of the top of the patient's shoulder.

03:14 I like to creep my fingers all the way down to where I can find the edge of the acromion process here with about my third finger. Do about three finger widths down.

03:25 And then right here is where I'm going to inject.

03:29 The other thing you can do is kind of visualize a triangle of the deltoid and you can go anywhere inside that delt -- excuse me, anywhere inside that triangle.

03:37 Alright, so now that I found where I'm going, I'm gonna clean that injection site.

03:44 I'm just gonna use an alcohol pad and make sure that I start in the middle.

03:48 And then, I'm going to clean in a circular motion, the whole area of the patient's deltoid and where I'm gonna be going.

03:57 And then just for reminder, I'm gonna find the edge of their acromion process about three finger widths down, and then go right here in the middle of that.

04:13 Alright, so now that I've cleaned, maybe your patient could bleed after you get done with the injection.

04:19 So, it's always great to have a band aid ready.

04:24 A great tip, you can even put it on the back of your glove, that way it's handy for you.

04:30 Alright, so when I go give an injection, so with the needle that I'm using, there's a safety device which is a great thing.

04:36 We just want this out of the way for injection.

04:39 So, I'm gonna move this device and I'm gonna pull this all the way back so that way it's out of the way of the needle. Then anytime I go give an injection, notice, I've got a firm grip in a dark light grip on the syringe itself.

04:54 So now that we've got that ready, I'm gonna take this sheath of the needle and uncap it I've pulled this away from my body and away for my patient.

05:04 Alright, so when I go to give the injection, I like to give my -- put my other non-dominant hand here, position my patient or, excuse me, position myself straight with the arm, I like to take the non-dominant hand and really support the muscle, which also stabilizes me.

05:21 And then I'm going to go in a 90-degree angle.

05:24 Okay, sir, go ahead and deep breath out, and I'm gonna give the injection.

05:29 Notice that I darted in all the way the hub, I'm going to inject the medication.

05:34 Once the medications in, I can pull out the needle, let the patient's arm relax, and I like to use the bedside table to get the needle away from me and my patient.

05:44 I put this here and just let this click, that's the click you wanna hear.

05:50 Now, this is nice and covered and safe.

05:54 So, luckily, my patients done really well, right, he stayed relax.

05:59 Keep in mind where you have your patient when you do this.

06:02 Luckily, he's not bleeding. If he does, we've got our band aid here, we can go ahead and apply.

06:08 But one thing to consider, anytime you have a patient up and you're going to give an injection, some people may get a little woozy.

06:17 So, if you think that person is it, then you may wanna lay them back in the bed.

06:21 Also, with an intramuscular injection, sometimes these are painful, sometimes the medication is thick, this injection is okay to massage the site.

06:31 So, after I've given the injection, I'd like my patient to sit in a waiting room maybe or sit nearby.

06:38 That way we can assess the patient for the medication effectiveness, and also make sure my patient doesn't have any reactions.

06:49 With the intramuscular injection, there's several considerations we can look at.

06:53 So, first of all, what do we don't do? Now, after we give that injection, I know that it's a good accomplishment we get that thing in.

07:00 But once we inject the medicine, don't withdraw it too quickly.

07:05 Give the medication a time to make sure that we've got that in the muscle.

07:09 Then make sure you administer the injection into the intramuscular space, not into the subcutaneous tissue.

07:18 And this is partly important in regards to our needle gauge and our size and lengths for our patient.

07:24 Now, things to make sure we do when we do an injection, an intramuscular is know those landmarks, know those anatomical landmarks that's really important as a nurse, and a nursing student, because if we don't give those appropriately, it can really cause damage to our patient, and really cause pain and discomfort and further complications.

07:44 Also, don't forget, anytime we give a medicine, we wanna prepare the medication immediately before we administer it.

07:53 And if it's applicable, we need to rotate sites if this particular intramuscular injection is routine for that patient, I'd like to take a moment to talk about a few alternative injection details that you may see in clinical practice.

08:09 Now, the two following methods that I'm gonna talk about, you really don't see as much in the clinical setting.

08:15 So, let's talk about one to start. One of those is called a Z-track method.

08:19 Now, it really is best practice to use this method.

08:23 The reason why we use this method is to help prevent any leakage of meds into the subcutaneous tissue.

08:30 The theory is that you're gonna get all of the medication into the muscle, and you're commonly gonna use it for meds that may stain the skin for example, such as an iron intramuscular injection.

08:41 Now, really is best practice, but I'll just be straight with you.

08:45 This is not a method that you're going to see a lot in the clinical setting.

08:50 But let's talk about it. So first here, if you take a look at the image, the whole point is that you're making kind of a zigzag pattern, why we call it the Z-track method.

09:00 So, if you take a look at this first image, you see here that we are pulling the skin slightly to one side before we insert the needle.

09:09 Now, while still holding that skin, we're gonna insert the needle and inject the medication with our 90-degree angle, just like we've talked about previously. And lastly, when we remove the needle, this is when we're gonna allow that skin to bounce back and return to its natural position.

09:28 Next, I'd like to talk to you about aspirating for blood.

09:32 Now, this used to be the most common practice when I started nursing school and used to learn how to do medications or IM injection.

09:41 So, the point of why we use to aspirate for blood is to ensure that the injection is actually in the muscle indeed and not in the vascular system.

09:51 So, do we do this in practice or do we not? Well, really, we have stopped using this technique and this is why.

09:59 Most injection sites don't really have major blood vessels present for this to be concerned.

10:05 The other thing to think about is there's a little bit more risk if while I'm in the muscle that I pull back on the plunger and then, I've got to make sure and kind of handle all this while trying to do the injection.

10:18 There's more risk of moving that needle around in the patient's arm.

10:22 So, we've eliminated this practice.

10:25 So, again this is to ensure that the medication will not be injected in the vasculature but this is a practice that you should no longer see.

10:33 Also, this is not recommended when giving vaccinations and many times when you're giving an intramuscular injection vaccinations are gonna be one of the most common intramuscular injections that you're gonna see.