Injections--Some Comments
-The IM route is chosen when a systemic effect is desired and the drug is irritating to other tissues.
-In general, the point of injection should be as far as possible from major nerves and blood vessels, and the recipient area selected should be capable of holding a large volume of injected fluid.
-Complications: paralysis, staining of the skin, neuropathy (damage to the nerve), myelopathy (damage to the muscle), embolism, abscess, cyst and scar formation, necrosis and sloughing of the skin. In most instances, the injury appears to have been directly related to the point of insertion and where the medication was deposited. Published reports make it clear that complications may be avoided in most cases by better technique and more careful selection of sites.
-The upper outer quadrant of the gluteal area is the most commonly used site. This area is remote from the sciatic nerve and the superior gluteal artery and therefore safe for IM injections.
--The generally recommended position of the patient is lying face down on a bed, with toes in and arms hanging over the side. Research findings indicate this position rotates the femur internally, thus relaxing the gluteus maximus muscle and subsequently reduce the discomfort of the injection. Contracted muscle, unable to accomodate the injected fluid, may force it back along the needle track into the subcutaneous tissue.
-Clean injection site with 70% alcohol or providone-iodine. Needle of adequate length must be used (I like 1 1/2"). If injection into subcutaneous fat does occur, deep SC necrotic nodules can cause persistent pain for the patient.
--Aspirate (draw back to check for blood) before injecting.
--The needle should not be introduced to the hub..a margin of a half-inch should be left to prevent its complete disappearance in case of breakage.
--Inject slowly and smoothly.
--Drive the needle home like a dart to minimize pain.
I hope this info helps those who need to develop injection technique. Given my experience, I hope all of you are doing gluteal injections. I would hope that many of you have someone doing the injection for you.