. Immunizing substances, or inoculations, are generally given by injection. Intramuscular (IM) injections. Doses over 1 g must be divided between more than one site. Fulvestrant is administered on days 1, 15, and 29, then once monthly at doses of 500 mg. Five milliliters is the maximum volume recommended for a single intramuscular injection. Inject all the air into the vial. If the medicine is outdated, throw it away. Intramuscular (IM) injection site for children and adults. With a quick motion, insert the needle into the skin at a 90-degree angle. 7. Vastus lateralis- 16 to 25 mm Deltoid- 16 to 32 mm (children), 25 to 38 mm(adults) Ventrogluteal- 38 mm Technique The sequential method of IM injection can be summarised as follows[2][1][5] Thorough cleaning of the hands Application of sterile gloves Thorough cleansing surrounding the site of injection with an alcohol-based antiseptic solution Infants and children weighing up to 20 kg (44 pounds)Dose is based on body weight and must be determined by your doctor. -Rapid injection is preferred. The recommended dosage for adult and pediatric patients 6 months of age and older for prevention of nausea and vomiting associated with emetogenic chemotherapy is .15mg/kg per dose for 3 doses (maximum of 16 mg per dose). Choose the injection site that is appropriate to the person's age and . IV . Getting ready Wash your hands with soap and water. The deltoid muscle is the preferred site for IM injection in adults and adolescents >12 years of age. 3. a substance so forced or administered; in pharmacy, a solution of a medicament suitable for injection. After the Injection. IV: 30 mg/kg over 15 min, followed in 45 min by a continuous infusion of 5.4 mg/kg per h for 23 h. Administration within 8 h of injury is optimal. The decision regarding number of injections and maximum volume to be administered at each location should be based on the age and assessed muscle mass of the individual. It is estimated that few women and about 15% of men actually receive the intended intramuscular injection because an improper needle length was used. intradermal injection: [ in-jekshun ] 1. congestion . 5. The maximum single intramuscular dose is 2 g, doses greater than 2 g must be given in two divided doses or by intravenous administration. Maximum Volume per Injection Notes Intramuscular Preterm (<37 weeks GA) (up to 2 months PNA and/or very small infants) 5/8 inch (16 mm); 22-25 gauge Vastus lateralis/ anterolateral thigh 90 0.5 mL -Aspiration for blood return is not necessary. Vial size Volume of water for injections Concentration 1 gram (AFT brand) 9. This is the second article in a two-part series on injection techniques. saphenous v.) vessel. It is one of the fastest ways to get a drug into the body. For injection dosage form: age Needle length injection site Infants (1-12 mos) " Fatty tissue over anterolat-eral thigh muscle Children 12 mos or older, 2. the forcing of a liquid into a part, as into the subcutaneous tissues, the vascular tree, or an organ. The aim of this article was to indicate a safe and effective IM injection technique based on evidenced data derived from ultrasonographic data. When administering vaccine by an intramuscular (IM) injection to an adult: Shoulder injuries related to vaccine administration. By slow intravenous injection. CDC guidelines. Deltoid muscle of the shoulder. Surgical prophylaxisfor gentamicin. A volume of 1 ml to be injected at one site was exceeded 10 (47%) times. Turn the vial and syringe upside down so that the needle points upward. Use a 1 mL or 3 mL syringe, depending on the volume of the vaccine dose. This dose will suffice for sedating most adult patients and ordinarily should not be exceeded in patients over 50 years of age. Sterile water for injection (Maximum recommended volume per dose of sterile water for injection is 50 mL) Dextran 6% in saline . Hold the syringe like a dart in your writing hand. See Figure \(\PageIndex{4}\) [6] for an image of an intramuscular injection being administered at the vastus lateralis site. The maximum amount of medication for a single injection in an adult is 3 mL. The intravenous route is preferred to the oral route for patients at risk for post-contrast acute kidney injury as this route has been more well-studied. The usual dose is 12.5 to 25 mg per kg (5.7 to 11.4 mg per pound) of body weight every six hours; or 16.7 to 33.3 mg per kg (7.6 to 15 mg per pound) of body weight every eight hours. this site is not common for self-injection because its small muscle mass limits the volume of . Rectus femoris muscle on the front of the thigh. Generally only limited injection volumes can be given by intramuscular injection: 2 ml in the deltoid . (4, 10) Intramuscular (IM) injection site for children and adults. injection into the subarachnoid space. Choose the injection site that is appropriate to the person's age and body mass. To decrease the risk of adverse reactions such as paresthesias, pruritus, and hypotension. Inexperience with injection techniques and inaccurate landmarking can result in injection-site pain or injury. Multiple injection sites may be preferable in some cases. Choose and Identify the Correct Location. Keep all medicines out of children's reach, locked up if possible. If a series of injections are to be given, the injection site is usually varied or rotated. Such practices increase the risk for infectious complications and neurovascular and muscle injuries. The administration of 0.5 to 1 mL (ie, maximum 1/10 th of the total syringe volume) provides a dose of 50 to 100 mcg and is given over one to 10 minutes, followed by at least three minutes of observation before considering repeat dosing. M. For intramuscular injection, may be mixed with 1% Lidocaine Hydrochloride Injection to reduce pain at intramuscular injection site. 2. the forcing of a liquid into a part, as into the subcutaneous tissues, the vascular tree, or an organ. The appropriate site of injection depends upon the age and size of the child. Packages contain two prefilled syringes of 250 mg/5 mL of fulvestrant, each administered slowly (1 - 2 minutes) at two separate gluteal injection sites. Adult. An intravenous (IV) injection is an injection of a medication or another substance into a vein and directly into the bloodstream. Pediatric Nursing Procedures (pp. The maximum recommended injection volume for a dosing solution that is given rapidly IV is 1 ml/kg body weight for most laboratory animal species. If a series of injections are to be given, the injection site is usually varied or rotated. The administration of 0.5 to 1 mL (ie, maximum 1/10 th of the total syringe volume) provides a dose of 50 to 100 mcg and is given over one to 10 minutes, followed by at least three minutes of observation before considering repeat dosing. & Greenberg, C. S. (2003). the correct syringe and needle Vaccine may be administered using either a 1-mL or 3-mL syringe Generally only limited injection volumes can be given by intramuscular injection: 2 ml in the deltoid . With intramuscular use in children: The maximum single intramuscular dose is 2 g, . Pediatric intramuscular injections: guidelines for best practice MCN Am J Matern Child Nurs. When substances are given by IV infusion, the volume should not exceed 5% of the circulating blood volume over 2 hours or 4 ml/kg/h. By intramuscular injection, or by slow intravenous injection. Adults: For indications other than status epilepticus, fosphenytoin should be administered at a rate less than 150 mg PE/min; (25 to 100 mg PE/min is . Administration Instruction for ZOSYN Injection in GALAXY Containers to Pediatric Patients Weighing up to 40 kg. Make sure that injection sites are at least one hand's width away from any joint. Intramuscular administration. Pierce the skin at an angle of 90 to the skin, so the needle can be safely inserted to the hub. Intramuscular Injection: To avoid the danger of subcutaneous fat atrophy, it is important to ensure that deep intramuscular injection is given into the gluteal site. If administering an IM injection into a child under age 2, the maximum amount that should be administered is 1 mL. A 21 gauge needle is recommended. Haloperidol decanoate injection, 50 mg (base)/mL and haloperidol decanoate injection, 100 mg (base)/mL should be administered by deep intramuscular injection. Term (37 weeks GA) 5/8 inch (16 mm) - 1 inch Intramuscular injection technique 18,19 For intramuscular injection, use a 25 mm needle in most cases (see Table. Figure 4.1 Preferred site for intramuscular and deep subcutaneous injections in older children and adults Figure 4.3 Preferred site for BCG injections in babies and adults Figure 4.2 Preferred site for intramuscular and deep subcutaneous injections in infants under one year of age IM or deep SC injection site Immunisation procedures June 2012 Citation: Shepherd E (2018) Injection technique 2: administering drugs via the subcutaneous route. Children 1 month: 50mg/kg (to a maximum of 500mg) as a IM single dose. Accurate anatomical knowledge is necessary in order to . A smaller gauge needle (22 to 25 gauge) should be used with children. Figure \(\PageIndex{4}\): Intramuscular Injection at Vastus Lateralis Site When monitoring peak concentrations after intramuscular or intravenous administration, dosage should be adjusted so that prolonged levels above 12 mcg/mL are avoided. Part 1 covers the intramuscular route. Nurses may not be aware of the potential consequences associated with poor injection practices, and historically have relied on their basic nursing training or the advice of . the pain associated with injection in children. 3,13,14 . Give in the central and thickest portion of the deltoid muscle - above the level of the armpit The ideal route, rate, and volume for volume expansion therapy are unknown. 4. Draw back the plunger to fill the syringe with the correct amount of medication. Caution: Dilution of Zofran Injection is required in adult and pediatric patients prior to administration. Once you have completed an intramuscular injection using the Z track method, cover the site of the injection with an adhesive bandage. Keep any injection site clean and covered. IM injection site (shaded area) Insert needle at a 90 angle into the anterolateral thigh muscle. *The anterolateral thigh may be used. IV/IM: 1-2 mg/kg initial dose (must use acetate salt for IM route). If a dose of ZOSYN is required that does not equal 2.25 g, 3.375 g, or 4.5 g, ZOSYN injection in GALAXY . Then, using gauze or a cotton ball, apply gentle pressure to the injection site for several seconds. When choosing a needle size, the weight of the patient, age, amount of adipose tissue, medication viscosity, and injection site all influence the needle selection (Hunter, 2008; Perry et al., 2014; Workman, 1999). IM injection site (shaded area) Insert needle at a 90 angle into the anterolateral thigh muscle. 37415 . The maximum volume per injection site should not exceed 3 mL. For intramuscular (IM) injection, use a 23 gauge 25 mm needle. Dorsogluteal muscle on the upper buttock. Needle length is usually 1"-1", 22-25 gauge, but a longer or shorter needle may be needed depending on the patient's weight. Following intramuscular injection, mean peak plasma ceftriaxone levels are approximately half those observed after intravenous administration of an equivalent dose. The best areas on your body to give yourself a SQ injection are: Upper arms. 4 mL 100mg/mL . The deltoid muscle is most often used as the site for IM injections in adults. volume depends on the age and size of the child. As in leukemic pediatric patients, a wide interindividual variability in the plasma concentrations of methotrexate has been reported in pediatric patients with JRA. Belly area. Adult. While the anterolateral thigh or the deltoid can be used for children >12 months-12 years, the deltoid is often selected as the injection site in these age groups as temporary muscle pain post-vaccination in the Overall, 5 mL has been cited for adults as the maximum volume for a single IM injection, with. The maximum plasma concentration after a single intramuscular dose of 1 g is about 81 mg/l and is reached in 2 - 3 hours after administration. 25-30 micrograms/kg every 6 hours if required; usual dose 1.5-2.5 mg every 6 hours if required, intravenous injection to be administered into a large vein, only use intramuscular route when oral and intravenous routes not possible. It will also review common methods of holding pediatric patients during injection, pain management strategies, distraction techniques, and anaphylaxis. A subcutaneous injection is a method of administering medication. After intramuscular injection, peak serum concentrations occur in 30 to 60 minutes. The best injection site for The injection is painful and the maximum volume that can be injected into each site is 4ml (100mg). An intramuscular (IM) injection is the administration of medication through the cutaneous and subcutaneous layers, into the muscle. The nurse will show you the following steps and give you time to practice before you give an IM injection to your child. Recommended needle size, length and angle for administering vaccines 4. Ventrogluteal 1 1 ml 7/8 -1 25 IM Vastus lateralis 1 ml 7/8 -1 25 Children 1 yr. - 4 yrs. If . Reconstitute each vial with the volume of water for injection in the table below. 18,22 Sciatic nerve pain can occur, though rarely, if a dorsogluteal injection is . 13 In an effort to reduce the volume of fluid injected in children and minimize the number of intramuscular injection sites, Bradley and colleagues 11 have documented the stability of more concentrated ceftriaxone solutions. A 22-25 gauge needle is recommended for vaccine intramuscular (IM) injections. One-inch needles are recommended for children 0 to 24 months of age, but 1 1/2-inch needles were preferred for 13 (30%) of these younger children. for adults as the maximum volume for a single IM injection, with lower maximums proposed for adult patients with less-developed or small muscle mass. For men and women who weigh <130 lbs (<60 kg), a -inch needle is sufficient to ensure intramuscular injection in the deltoid muscle if the injection is made at a 90-degree angle and the tissue is not bunched. Solutions up to a volume of 5ml in large muscles, and 2ml in smaller muscles, may be used. Identify the injection site. If too much or the wrong kind of medicine is taken, call Poison Control (toll-free 1-800-222-1222). IV or IM administered in 1 to 4 injection sites (maximum volume for IM injection is 3 mL) Rate . Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention. Dry them well. Subcutaneous means under the skin. With the other hand, hold the muscle firmly, using the position checked below. An IM site is chosen based on the age and condition of the patient and the volume and type of medication injected. IM injection: Maximum recommended single IM dose is 2grams. It is estimated that few women and about 15% of men actually receive the intended intramuscular injection because an improper needle length was used. Using the correct injection technique and selecting the correct site will minimise the risk of complications. Pull the needle straight out at the same angle that it went in. For doses greater than 100mg daily, the dose may be divided and administered into two sites. Note: An alternate site for IM injection in adults is the anterolateral thigh muscle. Ventrogluteal muscle on the hip just above the dorsogluteal muscle. Adults and Children over 12 Years: Hepatitis A (Hep A) Pediatric 18 yrs: 0.5 mL IM Hepatitis A (Hep A) Adult 19 yrs: 1.0 mL IM Hepatitis B (Hep B) Ped/Adolescent Infants (1 *Persons 11-15 yrs may be given . Suggested techniques with illustrations are included. Always use a new needle and syringe for each injection. Further dilution If injecting into the vastus lateralis, ventrogluteal, gluteus medius, or dorsogluteal muscles of an adult, the volume should not exceed 3 mL. Some . With intravenous use in adults: . Outer side of upper thighs. 6. Large subcutaneous injection volumes are associated with pain. . Injected volumes of up to 0.5-0.8 ml are not expected to increase substantially the pain produced by the needle insertion. These authors found that ceftriaxone concentrations of Medication Administration - Intramuscular Injection There are many reasons infants and children may require an intramuscular injection, including routine vaccinations . HepA-HepB (Twinrix) 18 yrs: 1.0 mL IM Injection Site and Needle Size Subcutaneous (Subcut) injection Use a 23-25 gauge needle.