Overall, 5 mL has been cited 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. Stated, estimated, or historical weight should not be used. static compliance and maximum expiratory flow at 50% of awake total lung capacity (V max) increase. These side effects are generally mild and last no more than a few days at most. Deviation from the recommended route of administration might reduce vaccine efficacy (14-15) or increase the risk for local adverse reactions (16-18). (2022). What happens if you inject into muscle? Intramuscular injection of high doses of depot formulations of penicillins can lead to painful swelling, especially when over 600 000-1 000 000 units are given at a single site [263, 264].Such reactions occurred in two of 878 patients (0.2%) with intramuscular penicillin G procaine [265]. . The sites most commonly used for IM injection are the deltoid, dorsogluteal, rectus femoris, vastus lateralis, and ventrogluteal muscles. If the skin is stretched flat, a 1/2 inch needle is sufficient. 1 inch] if possible) so that any local reactions can be differentiated (13,29). A medication administered into a muscle is known as an intramuscular (IM) injection. For doses higher than 1gram, the dose must be split between 2 sites. Which site should be used to administer an intramuscular injection for a 6-month-old patient? Anterolateral: Anterior and lateral position situated in the front and to the side. The cookie is used to store the user consent for the cookies in the category "Performance". Such practices increase the risk for infectious complications and neurovascular and muscle injuries. Divide the muscle into thirds and administer the injection into the middle third of the muscle, in the outer anterolateral
IM injection: Maximum recommended single IM dose is 2grams. Maximum volume is 3 mL in adults, 2mL for ages between 6-13 years, 1.5 mL for between 3-6 years, and 1 mL for ages between 1 - 3 years. You also have the option to opt-out of these cookies. In Meyler's Side Effects of Drugs (Sixteenth Edition), 2016. For men and women who weigh 130-152 lbs (60-70 kg), a 1-inch needle is sufficient. In a 2-year carcinogenicity study of rats given hydralazine by gavage at dose levels of 15, 30, and 60 mg/kg/day (approximately 5 to 20 times the . The cookie is used to store the user consent for the cookies in the category "Analytics". It was estimated that needles 38 mm (1.5 inches) or more would be needed for . First published May 2022. The deltoid muscle is preferred for children aged 3-10 years (23); the needle length for deltoid site injections can range from to 1 inch on the basis of technique. Anderson, C.E., Herring, R.A. (2022). 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. reduced attenuation of smallpox vaccine virus (9)]. Avoid moving the syringe. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. Pretreatment (30-60 minutes before injection) with a 5% topical lidocaine-prilocaine emulsion might decrease the pain of vaccination by causing superficial anesthesia (43-44). Doctors frequently use intramuscular injections to administer vaccines and certain other drugs. What is maximum safe volume that a neonate can receive in an intramuscular injection? For a well-developed adult, no more than 5 ml of medication should be administered in a single IM injection because the muscle tissue does not absorb it well. 3,13,14 . Prepare the needle: Hold the syringe with your writing hand and pull the cover off with your other hand. An IM injection should be given only when less painful options are not feasible. The patient can be positioned lying on their stomach or standing up. For the majority of infants, the anterolateral aspect of the thigh is the recommended site for injection because it provides comparatively larger muscle mass than the deltoid (Figure 2) (23). 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. See, Advise patients to remain in the hospital/ on the ward for 1520 minutes following their injection. 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 cookies is used to store the user consent for the cookies in the category "Necessary". However, local reactions or injuries (e.g., skin laceration, transient neuropathy, hematoma) are sometimes more frequent on delivery of vaccine by jet injectors compared with needle injection, depending on the inherent irritability of the vaccine and operator technique (33). The maximum amount of medication for a single injection is 3 ml. Who wrote the music and lyrics for Kinky Boots? What size needle should I use for IM injection? The anterolateral aspect of the thigh, or vastus lateralis muscle, is the preferred IM site for neonates and infants. The FDA does not license administration syringes for vaccine storage. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". The dorsogluteal is not the preferred site due to its proximity to the sciatic nerve and major blood vessels. Use of longer needles has been associated with less redness or swelling than occurs with shorter needles because of injection into deeper muscle mass (16). Instruct the family regarding the potential adverse effects of the medication. Tell them when and how to notify the practitioner about a problem. If the patients available muscle tissue is limited and the dorsogluteal muscle must be used, volumes of up to 4 ml can be administered into this site. These cookies may also be used for advertising purposes by these third parties. Needle sizes most commonly used at the RCH include: The Australian Immunisation Handbook (health.gov.au). Assess the patients and familys understanding of the reasons for and the risks and benefits of the procedure. Pedi- Hands should be cleansed with an alcohol-based waterless antiseptic hand rub or washed with soap and water before preparing vaccines for administration and between each patient contact (1). How many mL can you inject into the deltoid muscle? Visualizaes: 46. Aspiration before injection of vaccines or toxoids (i.e., pulling back on the syringe plunger after needle insertion but before injection) is not necessary because no large blood vessels are present at the recommended injection sites, and a process that includes aspiration might be more painful for infants (22). Learn more about Clinical Skills today! An adjuvant is a vaccine component distinct from the antigen that enhances the immune response to the antigen, but might also increase risk of adverse reactions. Needles and syringes used for vaccine injections must be sterile and disposable. Single-dose vials and manufacturer-filled syringes are designed for single-dose administration and should be discarded if vaccine has been withdrawn or reconstituted and subsequently not used within the time frame specified by the manufacturer. The angle of administration for an ID injection is 5 to 15 degrees. The act directed OSHA to strengthen its existing bloodborne pathogen standards. ACIP discourages variations from the recommended route, site, volume, or number of doses of any vaccine. May be the safest and least painful IM injection site. Like. An additional dose of 1 mg or 0.2 mL may be repeated if there has been no response after 15 minutes while waiting for emergency assistance. Even if the person coughs or sneezes immediately after administration or the dose is expelled any other way, the vaccine dose need not be repeated (5). NOTE: Values are in ml/kg unless otherwise specified. Holding it taut, quickly and smoothly insert the needle into the muscle at a 90-degree
Currently the most commonly used sites for the rapid delivery of rescue medications are the IV, IM, and subcutaneous sites. Open the alcohol wipe: Wipe the area where you plan to give the injection. Apply a topical anesthetic as ordered. The purpose of IM injections is to administer medication safely into the muscle below the subcutaneous layer. 108 volume 39 | number 2 March/April 2014 O ver the past decade, the childhood vaccine schedule has increased in complexity. How many mL can be given IM to an infant's? Variation from the recommended route and site can result in inadequate protection. Providers should address circumstances in which dose(s) of these vaccines have been administered subcutaneously on a case-by-case basis. (0.5-1 ml maximum), are . Hold this position until the medication is injected. The FDA-approved labeling recommends 50 to 75 mg/kg/day IV or IM divided every 12 hours (Max: 2 g/day) for serious infections. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. For viscous and large amounts of medication be sure to use larger needles. In M.J. Hockenberry, C.C. Choosing a muscle is dependent on the medication volume and the age or size of the patient. Different single-components of combination vaccines should never be mixed in the same syringe by an end-user unless specifically licensed for such use (4). https://www.clinicalkey.com/nursing/#!/content/drug_monograph/6-s2.0-5295, https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html, https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2022/npsg_chapter_hap_jan2022.pdf, https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html. Source: Adapted from Minnesota Department of Health. A maximum of 15 mls should be used per site. Necessary cookies are absolutely essential for the website to function properly. 2022-2023 Targeted medication safety best practices for hospitals. The most appropriate sites for IM injections are the vastus lateralis (anterolateral thigh) for infants and toddlers and the deltoid muscle for pediatric patients 3 years and older.6 Selection of the injection site is based on the patients age, muscle mass, medication volume, and medication viscosity. For IM (intramuscular) injections, an adult would use a 21-23 gauge needle 1 to 1.5 inches long. Begin by having the patient relax the arm. Best practice guidance for route, site, and dosage of immunobiologics is derived from data from clinical trials, practical experience, normal intervals of health care visits, and theoretical considerations. If not using the Z-track method, follow these steps for injection. Your deltoid muscle is the large muscle in your upper arm, just below your shoulder. Z- tracking: A technique used to prevent medication leakage, particularly for oily injections. Any vaccination using less than the standard dose should not be counted, and the person should be revaccinated according to age unless serologic testing indicates that an adequate response has developed. Explain briefly what you are about to do. The location of all injection sites with the corresponding vaccine injected should be documented in each patients medical record. Monitor the injection site for tissue injury. Injection Site Injection Angle 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. Drug administration route. This cookie is set by GDPR Cookie Consent plugin. Intramuscular (IM injection is one of many routes for administering medications, including antibiotics, vaccines, hormonal therapies, and corticosteroids. Subcutaneous injections may be administered into the upper-outer triceps area of an infant if necessary. Historic concerns about exposure to vaccine components are limited to non-parenteral vaccines in which some degree of environmental exposure is unavoidable (5, 8), or situations in which self-inoculation is likely due to the nature of the vaccine microbe [e.g. The development of this nursing guideline was coordinated by Mica Schneider, RN Specialist Clinics, and approved by the Nursing Clinical Effectiveness Committee. We also use third-party cookies that help us analyze and understand how you use this website. Response to vaccines recommended by the subcutaneous route is unlikely to be affected if the vaccines are administered by the intramuscular rather than subcutaneous route. The most common serious complications of intramuscular injections in children are muscle contractures and nerve injury. ), Institute for Safe Medication Practices (ISMP). 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. Persons administering vaccinations should follow appropriate precautions to minimize risk for disease exposure and spread. Perform hand hygiene. When all the medicine has been given, remove the needle from the skin at the same angle it went in. Release the skin. All images and videos were created by the Royal Childrens Hospital Creative Studios for the purpose of this guideline. The maximum volume generally accepted for an SC injection is around 1.5 ml , although higher volumes (of up to 4 ml) can be administered if necessary . Chapter 20: Pediatric nursing interventions and skills. I give 3 mL doses ALL THE TIME in DG (and VL on patients that I can talk into it). (about 80 times the maximum recommended human dose). The needle gauge for intramuscular injection is 22-25 gauge. What does it mean that the Bible was divinely inspired? A higher gauge needle refers to a smaller outside diameter of the needle tubing. Muscle contracture occurs most commonly after injections in the anterior and lateral thigh, and sciatic nerve injury is the most frequently reported serious complication of the gluteal area. The administration device is a nasal sprayer with a dose-divider clip that allows introduction of one 0.1-mL spray into each naris. Children 1 month: 50mg/kg (to a maximum of 500mg) as a IM single dose. If giving a larger shot, give 15 mls, pull the needle out until you are almost out if the skin, push it back in at a much different angle, check for blood, then complete the 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.