Vaccines should be drawn up in a designated clean medication area that is not adjacent to areas where potentially contaminated items are placed. Whats the maximum volume of an IM injection? 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. Saving Lives, Protecting People, Vaccine Recommendations and Guidelines of the ACIP, Adapted from Immunization Action Coalition, https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6510a2.pdf, List of safety-engineered sharp devices and other products designed to prevent occupational exposures to bloodborne pathogens, National Center for Immunization and Respiratory Diseases, Comprehensive Recommendations and Guidelines, Preventing and Managing Adverse Reactions, Vaccine Recommendations for Emergency Situations, CDC's International Travelers Yellow Book, Clinical Travel Notices, Updates, and Vaccine Shortages, U.S. Department of Health & Human Services. Determine the patients desire for the family to be present during the procedure. 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). 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 will be subject to the destination website's privacy policy when you follow the link. No more than two intramuscular . Use of longer needle (1inch) significantly reduces the local reaction instead of short needle except in neonate, when 16mm needle is suitable. Choosing a muscle is dependent on the medication volume and the age or size of the patient. Place the middle finger toward the iliac crest creating a
The volume of the IM injection should not be more than 1 mL. March/April 2014 - Volume 39 - Issue 2 Previous Abstract; Next Abstract CE Connection. Assess the patients and familys experiences with IM medication administration. Take steps to eliminate interruptions and distractions during medication preparation. Let the area dry. Assess the patients muscle mass and skin condition. Necessary cookies are absolutely essential for the website to function properly. Engineering controls means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate orremove the bloodborne pathogens hazard from the workplace). The injection should be given 3-5cms below the acromion, in the middle of the triangle. This website uses cookies to improve your experience while you navigate through the website. (4, 10) Large-volume injections (3 mL or greater), however, are not frequently administered; and many clinicians may not be familiar with their appropriate use, possible side effects, and potential efficacy. These cookies track visitors across websites and collect information to provide customized ads. The ventrogluteal muscle can accommodate up to 2.5 ml, with a maximum volume of 3 ml. The deltoid muscle has a triangular shape and is easy to locate and access, but is commonly underdeveloped in adults. Live attenuated influenza vaccine is approved for healthy nonpregnant persons aged 2-49 years and is the only vaccine administered by the intranasal route. Hold this position until the medication is injected. Vaccine recommendations and guidelines of the ACIP: Vaccine administration. Comfort measures, such as distraction (e.g., playing music or pretending to blow away the pain), cooling of the injection site(s), topical analgesia, ingestion of sweet liquids, breastfeeding, swaddling, and slow, lateral swaying can help infants or children cope with the discomfort associated with vaccination (40-42). 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. Preferred site: Deltoid muscle in the upper arm Use anatomical landmarks to determine the injection site. The purpose of IM injections is to administer medication safely into the muscle below the subcutaneous layer. If blood appears in the syringe, remove the needle, discard the medication, obtain a new syringe, and try again. Checklist 56 outlines the steps to administer an intradermal injection. Don't even think about delt on little ones, unless it's a tetanus vaccine. What is the maximum volume to inject on a horse if you are giving an intramuscular injection? Providers are sometimes concerned when they have the same contraindications or precautions as their patients from whom they withhold or defer vaccine. 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). Children 1 month: 50mg/kg (to a maximum of 500mg) as a IM single dose. For men and women who weigh 130-152 lbs (60-70 kg), a 1-inch needle is sufficient. 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. A higher gauge needle refers to a smaller outside diameter of the needle tubing. How many mL can be given IM to an infant's? 1,2 Even when alternate routes of administration are available, IM injections may be preferred when a patient cannot tolerate oral, 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.3,13,14 iNTRAMUsCUlAR iNJECTiONs Once administered exclusively by physicians, IM injections became a primary-nurse responsibility during the 1960s.1. The deltoid muscle is the preferred injection site in children aged 3-18 years when muscle mass is more developed. All images and videos were created by the Royal Childrens Hospital Creative Studios for the purpose of this guideline. Inactivated influenza vaccine is immunogenic when administered in a lower-than-standard dose by the intradermal route to healthy adult volunteers. May be the safest and least painful IM injection site. For immunizations, a smaller 22 to 25 gauge needle should be used. Multiple use jet injectors using the same nozzle for consecutive injections without intervening sterilization were used in mass vaccination campaigns from the 1950s through the 1990s (33); however, these were found to be unsafe because of the possibility of bloodborne pathogen transmission (34-37) and should not be used. What is the fastest way to get rid of a tight foreskin? Assess the patient for specific contraindications to receiving the medication and advise the practitioner accordingly. For IM immunisation information, please refer to
If the skin is stretched flat, a 1/2 inch needle is sufficient. The IM route allows for rapid absorption of specific medications. 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. This is often called an "IM" injection. Position the ulnar side of the nondominant hand just below the site and pull the skin laterally. 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). 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). For live vaccines that require reconstitution, manufacturers typically recommend the vaccine be used as soon as possible after reconstitution and be discarded if not used within 30 minutes after reconstitution. If 2 vaccines are to be administered in a single limb, they should be spaced an inch apart (4, 24). For injection into the anterolateral thigh muscle, a 1.5-inch needle should be used, although a 1-inch needle may be used if the skin is stretched tightly and subcutaneous tissues are not bunched. For injection into the anterolateral thigh, most adolescents will require a 1-1.5-inch needle to ensure intramuscular administration (27). Identify the injection site. 9 mss atrs. Currently the most commonly used sites for the rapid delivery of rescue medications are the IV, IM, and subcutaneous sites. Guidelines for Intramuscular and Subcutaneous In Intramuscular In 'ections .ection Administration SITE Vastus lateralis Ventrogluteal Deltoid Dorsogluteal Infant Needle length: 5/8 inch Volume: 0.5 ml, * *recommended for infants < 7 . transfer to 50 mL 0.9% Sodium Chloride Injection or for intramuscular injection following . This guideline aims to facilitate the administration of intramuscular injections to maximise the therapeutic effect while minimising potential complications and patient discomfort. ). (a) If the gluteal muscle is chosen, injection should be administered lateral and superior to a line between the posterior superior iliac spine and the greater trochanter or in the ventrogluteal site, the center of a triangle bounded by the anterior superior iliac spine, the tubercle of the iliac crest, and the upper border of the greater trochanter. For this reason, laboratory devices and in-process measurement injection molding tools have been developed to measure demolding forces. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Evidence indicates that this cream does not interfere with the immune response to MMR (45). Erythema or swelling at the injection site. If no blood appears, inject the medication. IM injection included poor injection-site selection and not advancing the needle to full length. 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]. These cookies will be stored in your browser only with your consent. ACIP discourages the routine practice of providers prefilling syringes for several reasons. Administering a vaccine containing an adjuvant either subcutaneously or intradermally can cause local irritation, induration, skin discoloration, inflammation, and granuloma formation. Unused syringes that are prefilled by the manufacturer and activated (i.e., syringe cap removed or needle attached) should be discarded at the end of the clinic day. Medication administration: Subcutaneous. Smoothly, quickly, and steadily withdraw the needle and release the skin. Intramuscular injections are administered at a 90-degree angle to the skin, preferably into the anterolateral aspect of the thigh or the deltoid muscle of the upper arm, depending on the age of the patient (Table 6-2). Needles are generally 3/8 to 1 inch in length and 24 to 27 gauge. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. (2022). If not using the Z-track method, follow these steps for injection. These side effects are generally mild and last no more than a few days at most. Knowledge of body mass can be useful for estimating the appropriate needle length (26). 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. Source: Adapted from Immunization Action Coalition. ), Centers for Disease Control and Prevention (CDC). A medication administered into a muscle is known as an intramuscular (IM) injection. 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 . Providers should consult package inserts for details. Such practices increase the risk for infectious complications and neurovascular and muscle injuries. Introduce yourself to the patient and family. The recommended volume ranges from 2 to 5 ml for "deep" IM injections. However, up to 1 mL of any medication may be administrated to this muscle (the maximum volume should never exceed 2 mL). Anterolateral: Anterior and lateral position situated in the front and to the side. Do not touch this area until you give the injection. 2. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. Pediatric Intramuscular Injections Guidelines for Best Practice Author Information . What does it mean that the Bible was divinely inspired? All information these cookies collect is aggregated and therefore anonymous. Per the organizations practice, pull back on the plunger. You also have the option to opt-out of these cookies. Used needles should never be recapped. Explain which strategies (e.g., breastfeeding, local anesthetic use, distraction), may be used to minimize the patients pain and anxiety during the procedure. Evidence does not support use of antipyretics before or at the time of vaccination; however, they can be used for the treatment of fever and local discomfort that might occur following vaccination. b. Administer the injection using the Z-track method, if appropriate. 5 For smaller adults or those with less muscle mass, the volume injected may need to be adjusted. It does not store any personal data. How should I prepare my child? When all the medicine has been given, remove the needle from the skin at the same angle it went in. read the disclaimer. The anterolateral aspect of the thigh, or vastus lateralis muscle, is the preferred IM site for neonates and infants. Analytical cookies are used to understand how visitors interact with the website. Release the skin. In adults (but not in infants) (52), the immunogenicity of hepatitis B is substantially lower when the gluteal rather than the deltoid site is used for administration (8). For IM (intramuscular) injections, an adult would use a 21-23 gauge needle 1 to 1.5 inches long. The maximum volume that can be administered is 0.1 ml of solution for this administration route. Injection technique is the most important parameter to ensure efficient intramuscular vaccine delivery. Several of the newer devices have been approved by FDA for use with specific vaccines (33). Administering volumes smaller than recommended (e.g., inappropriately divided doses) might result in inadequate protection. Vaccinators should be familiar with the anatomy of the area into which they are injecting vaccine. Perform hand hygiene. (d) Some experts recommend a 5/8-inch needle for men and women who weigh <60 kg, if used, skin must be stretched tightly (do not bunch subcutaneous tissue).