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. 2022-2023 Targeted medication safety best practices for hospitals. Ensure a sharp disposal container is close by for disposal of needle after administration. Discard supplies, remove PPE, and perform hand hygiene. 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). Injectable immunobiologics should be administered where local, neural, vascular, or tissue injury is unlikely. Large-volume IM injections: A review of best practices Follow the organizations practice for emergency response. Preparing and Administering Intramuscular Injections - JoVE The ventrogluteal muscle is the preferred and safest site for all adults, children, and infants for medications with larger volumes that may be more viscous and irritating.5 The ventrogluteal site should be used with caution in infants.1 It is recommended that only an experienced pediatric health care team member use this site. What is the maximum volume for a deltoid intramuscular injection? 15. The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Glynda Rees Doyle and Jodie Anita McCutcheon, Clinical Procedures for Safer Patient Care, LandmarkingVentrogluteal Administering an IM InjectionUsing Z-track, Landmarking Vastus Lateralus Administering IM InjectionUsing Z-track, Insertion of an Indwelling Subcutaneous Device aka subcutaneous butterfly, Next: 7.5 Intravenous Medications by Direct IV Route, Creative Commons Attribution 4.0 International License. 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. ACIP discourages variations from the recommended route, site, volume, or number of doses of any vaccine. (2023). 23. 17. Wodi, A.P., Shimabukuro, T. (2021). WebAugmentin (amoxicillin/clavulanic acid) is an antibiotic that is available as a 150 mg/mL strength injection. Vaccines should be drawn up in a designated clean medication area that is not adjacent to areas where potentially contaminated items are placed. Although the deltoid site is easily accessible, the muscle is not well developed in many adults. 18.6: Administering Intramuscular Medications - Medicine The vastus lateralis muscle is another injection site used in adults. Oral typhoid capsules should be administered as directed by the manufacturer. For women under 60 kg (130 lbs), a 16 mm (5/8 inch) needle is sufficient, while for women between 60 and 90 kg (130 to 200 lbs), a 25 mm (1 inch) needle is required. 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). It is suitable for small volume injections. Disclaimer:Always review and follow your hospital policy regarding this specific skill. 22. (2001). In M.J. Hockenberry, C.C. Allow site to dry completely. Occupational Safety and Health Administration (OSHA) regulations do not require gloves to be worn when administering vaccinations, unless persons administering vaccinations have open lesions on their hands or are likely to come into contact with a patients body fluids (2). Vaccine recommendations and guidelines of the ACIP: General best practice guidelines for immunization. Verify expiry date and check for particulates, discoloration, or loss of integrity (sterility). This technique, pulling the skin laterally before injection, prevents medication leakage into subcutaneous tissue, seals medication in the muscle, and minimizes irritation.5 To use the Z-track method in an adult, the appropriate-size needle is attached to the syringe, and an IM site is selected. Immune responses generated by jet injectors against both attenuated and non-live viral and bacterial antigens are usually equivalent to, and occasionally greater than, immune responses induced by needle injection. 20. Allowing the site to dry prevents stinging during 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. If a patient expresses concern or questions the medication, always stop and explore the patients concerns by verifying the order. Vaccinations and immunizations given by IM injections are never aspirated (Centers for Disease Control, 2015). Once medication is completely injected, remove the needle using a smooth, steady motion. Place safety shield or needle guard on needle and discard syringe in appropriate sharps container. To help relax the patient, ask the patient to lie flat with knees slightly bent, or have the patient in a sitting position. Clinical Ch 54 test Flashcards | Quizlet How to Administer an Intramuscular Injection in the Deltoid Allow the skin to dry completely. Chapter 9: Photo atlas of drug administration. If multiple vaccines are administered at a single visit, administer each preparation at a different anatomic site (28). Hepatitis B administered intradermally might result in a lower seroconversion rate and final titer of hepatitis B surface antibody than when administered by the deltoid intramuscular route (53-54). inject Routes of administration are recommended by the manufacturer for each immunobiologic (Table 6-1). Intramuscular injections are WebThe deltoid muscle is the preferred injection site in children aged 3-18 years when muscle mass is more developed. Perform hand hygiene before patient contact. WebEquipment: required for IM injection includes: IM medication ampoule large-bore needle for withdrawing medication from ampoule 1 mL or 2 mL syringe 23 gauge 25 mm needle or 25 gauge 16 mm needle for preterm babies two months or younger (see table below) antiseptic swab if used must be allowed to dry before injection given cotton wool swab The right hand is used for the left hip, and the left hand for the right hip. The vaccine adheres to the sides of the bifurcated needle, and is administered via skin puncture. Retrieved February 11, 2023, from https://www.cdc.gov/vaccines/hcp/admin/admin-protocols.html, Kroger, A., Bahta, L., Hunter, P. (2023). Hold a clean swab or dry gauze between the third and fourth fingers of the nondominant hand. 0. what is the maximum volume for intramuscular injection pediatric Assess the patients knowledge regarding the medication to be received. Locate the injection site again using anatomic landmarks. Retrieved February 11, 2023, from, Lilley, L.L., Rainforth Collins, S., Snyder, J.S. Vaccines Locate correct site using landmarks, and clean area with alcohol or antiseptic swab. However, needle sizes from 22 mm to 25 mm can be used for older children. Can For example, varicella vaccine should be discarded if not used within 30 minutes after reconstitution, whereas MMR vaccine, once reconstituted, must be kept in a dark place at 36F to 46F (2C to 8C) and should be discarded within 8 hours if not used. However, if 2 half-volume formulations of vaccine have already been administered on the same clinic day to a patient recommended for the full volume formulation, these 2 doses can count as one full dose. (2021). Intramuscular (IM) injections deposit medications into the muscle fascia, which has a rich blood supply, allowing medications to be absorbed faster through muscle fibres than they are through the subcutaneous route (Malkin, 2008; Ogston-Tuck, 2014a; Perry et al., 2014). The plunger is used to get medicine into and out of the syringe. Always wear gloves to administer injections. 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. Children and infants will require shorter needles. Movement of the needle once injected can cause additional discomfort for the patient. The recommended If the gluteal muscle must be used, care should be taken to define the anatomic landmarks. The width of the muscle used extends from the mid-line of the thigh to the mid-line of the outer thigh. The needle goes into your skin. For immunizations, a smaller 22to 25 gauge needle should be used. Refer to the agency policies regarding needle length for infants, children, and adolescents. Aqueous solutions can be given with a 20 to 25 gauge needle; oily or viscous medication should be administered with 18 to 21 gauge needles. Assess for any factors that may contraindicate an injection.