Intramuscular route of drug administration

Intramuscular route of drug administration

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Intramuscular route of drug administration (IM)

IM injections of drugs into the striated muscle fibers that lie beneath the SC layer provide effects that are less rapid but generally longer lasting than those obtained from IV administration. Aqueous or oleaginous solutions or suspensions of drugs may be administered intramuscularly. Drugs in aqueous solution are absorbed more rapidly than those in oleaginous preparations or in suspensions. An IM medication is injected deep into a large muscle mass, such as the upper arm, thigh, or buttocks. Up to 2 mL of the drug may be injected into the upper arm and 5 mL in the gluteal medial muscle of each buttock.

Numerous dosage forms are administered through this route of administration, including solutions (aqueous- or oil-based), emulsions (o/w or w/o), suspensions (aqueous- or oil-based), colloidal suspensions, and reconstitutable powders. Slow drug absorption leading to a sustained-release (SR) effect can be achieved with highly insoluble drugs or formulations that are oleaginous or particulate. IM injections are often painful and nonreversible, that is, the administered drug cannot be withdrawn if needed. Intramuscular injections are administered at a 90 degree angle with a 22 to 25 guage needle.

Intramuscular injection sites

Deltoid muscle of the arm

The deltoid muscle is the site most typically used for vaccines. However, this site is not common for self-injection, because its small muscle mass limits the volume of medication that can be injected — typically no more than 1 milliliter.

It’s also difficult to use this site for self-injection. A caregiver, friend, or family member can assist with injections into this muscle.

To locate this site, feel for the bone (acromion process) that’s located at the top of the upper arm. The correct area to give the injection is two finger widths below the acromion process. At the bottom of the two fingers, will be an upside-down triangle. Give the injection in the center of the triangle.

Vastus lateralis muscle of the thigh

The thigh may be used when the other sites aren’t available or if you need to administer the medication on your own.

Divide the upper thigh into three equal parts. Locate the middle of these three sections. The injection should go into the outer top portion of this section.

Ventrogluteal muscle of the hip

The ventrogluteal muscle is the safest site for adults and children older than 7 months. It’s deep and not close to any major blood vessels and nerves. This site is difficult for self-injection, and may require the help of a friend, family member, or caregiver.

Place the heel of your hand on the hip of the person receiving the injection, with the fingers pointing towards their head. Position the fingers so the thumb points toward the groin and you feel the pelvis under your pinky finger. Spread your index and middle fingers in a slight V shape, and inject the needle into the middle of that V.

Dorsogluteal muscles of the buttocks

The dorsogluteal muscle of the buttocks was the site most commonly selected by healthcare providers for many years. However, due to the potential for injury to the sciatic nerve, the ventrogluteal is most often used now. This site is difficult to use this site for self-injection and not recommended.

You shouldn’t use an injection site that has evidence of infection or injury. If you’ll be giving the injection more than once, make sure to rotate injection sites to avoid injury or discomfort to the muscles

Advantages of intramuscular route of drug administration

  1. Absorption is more rapid as compared to oral route.
  2. This route causes less pain than the i.v. Route.
  3. Mild irritants, depot injections, soluble substances, and suspensions can be given by this route.
  4. It is convenient route in administering drugs in animals that are difficult to restrain.
  5. It is used in administering aqueous or oleaginous suspensions or solutions.
  6. Muscles are highly vascularized thus, the drug could be absorbed hematologenously or through the lymphatic fluid.

Disadvantages of intramuscular route of drug administration

  1. Intermuscular injection into fascia might lead to erratic absorption of the drug.
  2. There is a possibility of improper deposition of drug preparation in nerves, fats, blood vessels, or between muscle bundles in connective sheaths.
  3. Aseptic conditions are needed.
  4. Intramuscular injections are painful and may cause abscess at the site of injection.
  5. Assistance is always required as the drug is to be injected deep in the muscle.
  6. There may be injury to the nerves leading to paresis of the muscle that the nerve supplies.
  7. Unlike i.v., large volumes cannot be administered.

How to administer an intramuscular injectio

Any person who administers intramuscular injections should receive training and education on proper injection technique.

The needle size and injection site will depend on many factors. These include the age and size of the person receiving the medication, and the volume and type of medication. Your doctor or pharmacist will give you specific guidelines about which needle and syringe are appropriate to administer your medication.

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The needle should be long enough to reach the muscle without penetrating the nerves and blood vessels underneath. Generally, needles should be 1 inch to 1.5 inches for an adult, and will be smaller for a child. They’ll be 22-gauge to 25-gauge thick, noted as 22g on the packaging.

1) Wash your hands

Wash your hands with soap and warm water to prevent potential infection. Be sure to thoroughly scrub between fingers, on the backs of hands, and under fingernails.

2) Gather all needed supplies

Assemble the following supplies:

  • needle and syringe with medication
  • alcohol pads
  • gauze
  • puncture-resistant container to discard the used needles and syringe — typically a red, plastic sharps container
  • bandages

3) Locate injection site

To isolate the muscle and target where you’ll place the injection, spread the skin at the injection site between two fingers. The person receiving the injection should get into a position that’s comfortable, provides easy access to the location, and keeps the muscles relaxed.

4) Clean injection site

Clean the site selected for injection with an alcohol swab and allow the skin to air dry.

5) Prepare syringe with medication

Remove the cap. If the vial or pen is multi-dose, take a note about when the vial was first opened. The rubber stopper should be cleaned with an alcohol swab.

Draw air into the syringe. Draw back the plunger to fill the syringe with air up to the dose that you’ll be injecting. This is done because the vial is a vacuum and you need to add an equal amount of air to regulate the pressure. This also makes it easier to draw the medication into the syringe. Don’t worry — if you forget this step, you can still get the medication out of the vial.

Insert air into the vial. Remove the cap from the needle and push the needle through the rubber stopper at the top of the vial. Inject all of the air into the vial. Be careful to not touch the needle to keep it clean.

Withdraw the medication. Turn the vial and syringe upside down so the needle points upward and pull back on the plunger to withdraw the correct amount of medication.

Remove air bubbles. Tap the syringe to push any bubbles to the top and gently depress the plunger to push the air bubbles out.

6) Self-injection with a syringe

Insert the needle. Hold the needle like a dart and insert it into the muscle at a 90-degree angle. You should insert the needle in a quick, but controlled manner. Do not push the plunger in.

Check for blood. Using the hand that’s holding the skin at the injection site, pick up your index finger and thumb to stabilize the needle. Use your dominant hand — the one that did the injection — to pull back on the plunger slightly, looking for blood in the syringe. Ask your doctor if this is needed for the type of medicine you will be injecting, as it’s not required for all injections.

  • If you see blood going into the syringe, it means the tip of the needle is in a blood vessel. If this happens, withdraw the needle and begin again with a new needle, syringe with medication, and injection site. It’s rare to have this happen.
  • If you don’t see blood going into the syringe, the needle is in the correct place and you can inject the medicine.

7) Inject the medication

Push the plunger slowly to inject the medication into the muscle.

8) Remove the needle

Withdraw the needle quickly and discard it into a puncture-resistant sharps container. Don’t recap the needle.

A sharps container is a red container that you can purchase at any pharmacy. It’s used to collect medical waste, like needles and syringes. You shouldn’t put any of these materials into the regular garbage, as needles can be hazardous to anyone who handles the trash.

9) Apply pressure to the injection site

Use a piece of gauze to apply light pressure to the injection site. You can even massage the area to help the medicine be absorbed into the muscle. It’s normal to see slight bleeding. Use a bandage if necessary.

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