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Intramuscular Injection PowerPoint Presentation

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Intramuscular Injection Presentation Transcript

Slide 1 - INTRAMUSCULAR INJECTION Dr. Kamlesh R. Lala MBBS, D PED, FCGP AHMEDABAD 1
Slide 2 - HISTORY The first injection was given in 1920, but became popular only after second world war. Now injections are probably the most common percutaneous procedure practiced worldwide 2
Slide 3 - MAGNITUDE An estimated 12 billion injections are administered each year. The average no of injections range from 0.9 to 8.5 per person per year. 3
Slide 4 - DEFINITION Intramuscular injections are a common yet complex technique used to deliver medication deep into the large muscles of the body It may be for curative, diagnostic or recreational purpose 4
Slide 5 - SURVEY An Indian survey found that 96% of all injections given by private doctors were of antibiotics, vitamins, analgesics and chloroquine. Surprisingly 70 to 95 % of such injections were unnecessary. 5
Slide 6 - WHY INJECTIONS ??? Injections are stronger medication Injections work faster and drug is more effective Patient’s non compliance Financial incentives If I won’t give my colleague will give 6
Slide 7 - COMPLICATIONS Giving IM injection is not a benign procedure. It is with risk of disease, disability and even death The most common one is transmission of blood borne infections mainly Hepatitis B, Hepatitis C and HIV These infections may be passed to HCW and even in society Do you know how ??? 7
Slide 8 - Others are Abscess Muscle or fat necrosis Muscle fibrosis and contracture Gangrene Nerve Injury 8
Slide 9 - WHAT IS SAFE INJECTION Does no harm to recipient Does not expose the HCW to any risk Does not result in waste that is dangerous for the community Do you know two third of injections given in our country are UNSAFE !! By reuse of syringe and needle 9
Slide 10 - Indications of injection 10
Slide 11 - Severe and life threatening illness Inability to swallow Profuse vomiting Non availability of effective oral agent 11
Slide 12 - So before giving any injection just ask yourself Is it necessary Is it justified And if “YES” then see that it is “SAFE” 12
Slide 13 - GIVING IM INJECTION 13
Slide 14 - It can be discussed under following heads Site Selection Preparation of Injection Procedure Post Injection Care 14
Slide 15 - Site Selection The most common injection site is anterolateral thigh into Vastus Lateralis muscle Never use gluteal muscle in children The other site in adult and in older children is deltoid muscle 15
Slide 16 - Anterolateral Thigh 16
Slide 17 - Deltoid 17
Slide 18 - Selecting Gluteus Muscle 18
Slide 19 - REMEMBER For giving vaccines including anti rabies vaccine never select gluteal muscle. They are ineffective if injected so. 19
Slide 20 - RISKS OF GLUTEUS INJECTION Injury to sciatic nerve If medication is in fatty tissue then it may result into necrosis and abscess Chloroquine, Diclofenac and oily, viscous or depot injections are always to be injected into gluteus muscle 20
Slide 21 - PREPARATION OF INJECTION 21
Slide 22 - Injection medication may be Available in prefilled syringe Available in liquid form Has to be reconstituted Either in single dose or multidose vial 22
Slide 23 - MULTIDOSE VIAL Where possible use single dose vial rather than a multidose one Never make multiple withdrawals from a single dose vial Why ??? Single dose vials do not contain prophylactic antibiotics, and so there are all chances of contamination 23
Slide 24 - Chances of infection are more common with MD vial Because of Reuse of same syringe for filling medication Permanent insertion of needle into the vial Storage of reconstituted vial Opened vial kept submerged in water or ice Rubber stopper wiped with antiseptic Lack of proper hand hygiene 24
Slide 25 - EQUIPMENT SELECTION Use only new disposable syringe and needle every time Changing only the needle on the same syringe is also not safe Use wide bore needle rather than a narrow one For oily or viscous injection use 20 or 21 no. needle Use longer possible needle For gluteus injections always use 1½ ” needle 25
Slide 26 - Skin preparation Avoid site with oozing dermatitis or infection If the skin is clean than no use of disinfection Clean the site with single use spirit or alcohol swab in a circular motion in an area 5-8 cms Pre wetted cotton swabs are better to be avoided If spirit is not available normal saline can be used Never use Savlon or Dettol Let the site be dry before injection 26
Slide 27 - Preparing Syringe The area for preparing injection should be clean Clean your hands with alcohol based hand wash If you have cut or injury on fingers, cover it with water proof adhesive No need to use gloves routinely 27
Slide 28 - Preparing syringe Remember to use new equipment Observe aseptic precautions No need to change the needle after withdrawing medication Do not ever wipe the needle with swab Do not keep the air bubble inside the syringe 28
Slide 29 - Giving injection We have found giving injection necessary We have selected the site We have prepared the syringe So now comes giving injection 29
Slide 30 - Giving injection Make the patient comfortable and give him a proper position so as to identify the proper site for injection Properly hold the child Hold the syringe in your hand as if holding a pen Remove needle cap immediately before giving injection…not earlier 30
Slide 31 - Giving injection Ensure smooth and steady insertion of the needle at 90 degree with a dart technique No need to aspirate Slowly push the medication allowing muscle fiber to stretch and accommodate the injected volume Wait for a while and remove the needle in the same direction as it was pushed Apply gentle pressure with a dry gauze 31
Slide 32 - Z technique 32
Slide 33 - Preventing Needle Stick Injury Anticipate abrupt movement of the patient and take care More the used needle is handled or carried, the greater is the risk of sharp injury Never try to recap, bend or manually remove needle from syringe Do not move around with used equipment in hand Keep needle destroyer near by only Properly dispose it 33
Slide 34 - Multiple injections Some times multiple injections are to be given in a single visit especially for vaccines Any no of injections can be given in a single visit Use different anatomical site If same limb is to be used than separate two injections by 1-2” 34
Slide 35 - Post Injection Syncope This is known side effect especially in adolescents. So it is better to observe the patient for 10-15 minutes 35
Slide 36 - According to WHO Use injections only when necessary – oral medicines are effective in most cases. 36
 

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