AcknowledgementsĪll images and videos were created by the Royal Children’s Hospital Creative Studios for the purpose of this guideline. The evidence table for this guideline can be accessed here. The Australian Immunisation Handbook () Evidence table How to don and remove Personal Protective Equipment (PPE).Warm or cold compresses can be applied to the area for comfort.Provide education to the patient and their family on signs and symptoms to monitor for, e.g., pain, redness, abscess, bruising at the site or anaphylaxis.The patient may require longer observation periods depending on the medication they receive Advise patients to remain in the hospital/ on the ward for 15–20 minutes following their injection.Kids Health Info: Allergic and anaphylactic reactions for more information Monitor for immediate adverse reactions, e.g., fever, rash, vomiting, shortness of breath.Remove the needle and apply a cotton ball.Inject the medication at a slow and steady pace.Do not aspirate or drawback as this can increase pain and discomfort in children.Inject the needle to the hub at a 90-degree angle.Stretch the skin flat (Z-tracking if applicable).Clean site with an alcohol swab (if required).Consider the use of comfort techniques such as distraction, buzzy bee, ice or a countdown.Position patient in a safe and comfortable position.Draw up or prime medication as per Paediatric.Don PPE if required (particularly for hazardous medications).Complete the six rights of medication administration.Perform the five moments of hand hygiene.Personal Protective Equipment (PPE) for hazardous medications or infectious patients.Alcohol impregnated swab (if area visibly soiled).Drawing up needle and syringe (if medication not pre-filled).Appropriate size needle for administration. ![]() Needle sizes most commonly used at the RCH include: A higher gauge needle refers to a smaller outside diameter of the needle tubing. These come in different sizes (gauge and length) and are selected based on the patient’s size and the muscle used. Needle sizeĪ hypodermic needle is used to administer IM injections. The injection is given in the middle of the ‘V’. Place the middle finger toward the iliac crest creating a To locate the muscle, place the palm of a hand over the greater trochanter of the femur, facing the index finger and thumb towards the umbilicus, along the anterior iliac spine. The patient can be positioned lying on their stomach, side or standing up. Divide the muscle into thirds and administer the injection into the middle third of the muscle, in the outer anterolateralĪspect, lateral to the midpoint of the thigh. Palpate the muscle below the greater trochanter and above the lateral femoral condyle (knee joint). To landmark the vastus lateralis, position the patient lying down or being held by a parent. This is the preferred site for anaphylaxis Up to 1ml can be injected into this site in neonates, up to 3mls in children and up to 5mls in adults. The anterolateral aspect of the thigh, or vastus lateralis muscle, is the preferred IM site for neonates and infants. Selection and land marking Vastus Lateralis Only recommended at The Royal Children's Hospital (RCH) if appropriately trained ![]() (38mm length preferred in larger, overweight or obese patients) AssessmentĬlinical judgement is required when selecting an injection site and needle length. This technique is preferred in adult/ adolescent patients. Holding it taut, quickly and smoothly insert the needle into the muscle at a 90-degreeĪngle. Displace the skin and subcutaneous tissue by pulling the skin laterally or downward from the injection site. Z- tracking: A technique used to prevent medication leakage, particularly for oily injections. Informed practice: ‘Trauma-informed care is a way of approaching interactions with children and families in which providers remain cognizant of the impacts of trauma while also taking actions to prevent potentially traumatic experiences’ (Boles, 2017). Trochanter:A bony prominence at the top of the femur where the hip and thigh muscles are fixed. ![]() Definition of termsĪnterolateral: Anterior and lateral position situated in the front and to the side. This guideline aims to facilitate the administration of intramuscular injections to maximise the therapeutic effect while minimising potential complications and patient discomfort. The injection site can lead to site reactions, sub-optimal medication absorption and adverse events.įor IM immunisation information, please refer to Poor technique and incorrect landmarking of Choosing a muscle is dependent on the medication volume and the age or size of the patient. The IM route allows for rapid absorption of specific medications. A medication administered into a muscle is known as an intramuscular (IM) injection.
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