For deep IM injections, the recommended volume ranges from 2 to 5 ml. Other persons at increased risk for influenza complications can administer LAIV. To prevent contamination of the vial, make sure the patient area is clean and free of potentially contaminated equipment. The anterolateral thigh can also be used. If administering an IM injection into a child under age 2, the maximum amount that should be administered is 1 mL. The ventrogluteal site, rectus femoris and vastus lateralis location are the preferred location for large volume deep muscle IM injections. Assess the patients developmental level and ability to interact. Hydralazine hydrochloride injection, USP is an antihypertensive available in a 1 mL vial for intravenous and intramuscular administration. You will be subject to the destination website's privacy policy when you follow the link. The concern should be explored, the practitioner notified, and the order verified. Take steps to eliminate interruptions and distractions during medication preparation. Assess the patients and familys understanding of the reasons for and the risks and benefits of the procedure. If not using the Z-track method, follow these steps for injection. Collaborate with the patient and family to develop a plan for pain management. The cookies is used to store the user consent for the cookies in the category "Necessary". In spite of the fact that large SC injected volumes have been generally associated with pain and adverse events at the injection site [ 29 ], the published data is somewhat conflicting. If no blood appears, inject the medication. the injection site can lead to site reactions, sub-optimal medication absorption and adverse events. 1 mL in an older infant >1month. Don appropriate personal protective equipment (PPE) based on the patients need for isolation precautions or the risk of exposure to bodily fluids. To decline or learn more, visit our cookies page. deficit of literature relating to administering intramuscular injection to children and adolescents. Do not touch this area until you give the injection. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. For women under 60 kg (130 lbs), a -inch (16 mm) needle is sufficient, while for women between 60 kg and 90 kg (130 to 200 lbs) a 1-inch (25 mm) needle is required. Similarly, doses of rabies vaccine administered in the gluteal site should not be counted as valid doses and should be repeated (54). Technically Speaking columns cover practical topics in immunization delivery such as vaccine . We also use third-party cookies that help us analyze and understand how you use this website. Necessary cookies are absolutely essential for the website to function properly. This technique is preferred in adult/ adolescent patients. Jet injectors are needle-free devices that pressurize liquid medication, forcing it through a nozzle orifice into a narrow stream capable of penetrating skin to deliver a drug or vaccine into intradermal, subcutaneous, or intramuscular tissues (32-33). A child life specialist should be enlisted to support the patient, if available. The only exceptions are medications that are still in their original container or medications that are administered immediately by the person who prepared them. reduced attenuation of smallpox vaccine virus (9)]. The cookie is used to store the user consent for the cookies in the category "Analytics". Anderson, C.E., Herring, R.A. (2022). Prepare the needle: Hold the syringe with your writing hand and pull the cover off with your other hand. <2 months), (38mm length preferred in larger, overweight or obese patients). With the exceptions of bacille Calmette-Gurin (BCG) vaccine and smallpox vaccine [ACAM2000] (both administered by the percutaneous route), injectable vaccines are administered by the intramuscular or subcutaneous route. The recommended volume is 1ml; however, up to 2mls can be administered. AGE INJECTION SITE* NEEDLE LENGTH & GAUGE (G) MAXIMUM VOLUME 5 years and under ventrogluteal 5 . Many medications must be injected intramuscularly because of chemical properties, pharmacokinetics, desired onset, intensity and duration of the effect, and certain patient characteristics related to treatment compliance. The Z-track method is a method of administrating an IM injection that prevents the medication being tracked through the subcutaneous tissue, sealing the medication in the muscle, and minimizing irritation from the medication. (2022). The injection is given in the middle of the V. 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. The vastus lateralis is the site of . 2 What happens if you inject into muscle? In which muscle should the nurse select to give a 6-month-old infant an intramuscular injection? 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way, Kids Health Info: Allergic and anaphylactic reactions, How to don and remove Personal Protective Equipment (PPE), The evidence table for this guideline can be accessed here, Preferred site in neonates and children under walking age but can be used in any age group (up to 5mls can be given in adults), Clinical judgement is used based on the size of the child and their development (see considerations above and below), Can be given in children >12 months if muscle mass is developed, Only recommended at The Royal Children's Hospital (RCH) if appropriately trained, Appropriate size needle for administration, Drawing up needle and syringe (if medication not pre-filled), Alcohol impregnated swab (if area visibly soiled), Personal Protective Equipment (PPE) for hazardous medications or infectious patients, Complete the six rights of medication administration, Don PPE if required (particularly for hazardous medications), Position patient in a safe and comfortable position, Consider the use of comfort techniques such as distraction, buzzy bee, ice or a countdown, Clean site with an alcohol swab (if required), Stretch the skin flat (Z-tracking if applicable), Inject the needle to the hub at a 90-degree angle, Do not aspirate or drawback as this can increase pain and discomfort in children, Inject the medication at a slow and steady pace, Remove the needle and apply a cotton ball, Monitor for immediate adverse reactions, e.g., fever, rash, vomiting, shortness of breath. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. The tip should be inserted slightly into the naris before administration. The ventrogluteal muscle can accommodate up to 2.5 ml, with a maximum volume of 3 ml. Intramuscular injection: injection of a biological product into muscular tissue. This can lead to violation of expiration dates and product contamination (6,7). Jet injectors prevent needlestick injuries to health-care providers (2) and can overcome improper, unsterile reuse and other drawbacks of needles and syringes in developing countries (9, 38-39). Intramuscular (IM injection is one of many routes for administering medications, including antibiotics, vaccines, hormonal therapies, and corticosteroids. Because unused prefilled syringes also typically must be discarded if not used within the same day that they are filled, vaccine wastage might occur. The anterolateral thigh also can be used. For men and women who weigh 130-152 lbs (60-70 kg), a 1-inch needle is sufficient. Adrenaline injection is administered to you by your doctor, nurse or paramedic. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. The volume of the IM injection should not be more than 1 mL. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. For injection into the anterolateral thigh, most adolescents will require a 1-1.5-inch needle to ensure intramuscular administration (27). Intradermal injection: injection of a minimal quantity (0.01 mL to 0.1 mL) of a biological product just under the dermis. AGE NEEDLE LENGTH INJECTION SITE Infants (1-12 mos) " Fatty tissue over antero-lateral thigh muscle Children 12 mos or older, adolescents, and adults " Fatty tissue over . The combination of oral sucrose and radiant warmth is effective analgesia for healthy neonates and young infants receiving IM vaccination.3 Diversional activities and education may comfort a patient receiving an IM injection. They will have . I give 3 mL doses ALL THE TIME in DG (and VL on patients that I can talk into it). Explain which strategies (e.g., breastfeeding, local anesthetic use, distraction), may be used to minimize the patients pain and anxiety during the procedure. For IM (intramuscular) injections, an adult would use a 21-23 gauge needle 1 to 1.5 inches long. De-pending upon the combinations adminis-tered, children now may receive as many as 24 immunizations via intramuscular (IM) injection by 2 years of age (Centers for Disease Control and Prevention [CDC], 2011). Doctors frequently use intramuscular injections to administer vaccines and certain other drugs. However, up to 1 mL of any medication may be administrated to this muscle (the maximum volume should never exceed 2 mL). How should I prepare my child? It is possible that patients will faint during the injection process so nurses should take precautions to prevent any type of injury to the patient while administering the intramuscular injection. This cookie is set by GDPR Cookie Consent plugin. It is suitable for small volume injections. If injecting into the vastus lateralis , ventrogluteal, gluteus medius, or dorsogluteal muscles of an adult, the volume should not exceed 3 mL. The anterolateral aspect of the thigh, or vastus lateralis muscle, is the preferred IM site for neonates and infants. For administration of routinely recommended vaccines, there is no evidence of risk of exposure of vaccine components to the health care provider, so conditions in the provider labeled as contraindications and precautions to a vaccine components are not a reason to withdraw from this function of administering the vaccine to someone else. The cookie is used to store the user consent for the cookies in the category "Analytics". If the skin is stretched flat, a 1/2 inch needle is sufficient. The anterolateral thigh can also be used (25). The deltoid muscle can be used if the muscle mass is adequate. In this type of injection, a short needle is used to inject a drug into the tissue layer . Poor technique and incorrect landmarking of The purpose of IM injections is to administer medication safely into the muscle below the subcutaneous layer. Overall, 5 mL has been cited for adults as the maximum volume for a single IM. The maximum volume for a single IM injection is 1 mL; any volume over this should be divided between multiple injection sites (7) The maximum single intramuscular dose is 2 g, doses greater than 2 g must be given in two divided doses or by intravenous administration.