An IM injection should be given only when less painful options are not feasible. (2022). To decrease risk of local adverse events, non-live vaccines containing an adjuvant should be injected into a muscle. 2022-2023 Targeted medication safety best practices for hospitals. The most common serious complications of intramuscular injections in children are muscle contractures and nerve injury. Assess the patient for specific contraindications to receiving the medication and advise the practitioner accordingly. A volume of 1 ml to be injected at one site was exceeded 10 (47%) times. For an infant who is unable to breastfeed or for an infant who does not breastfeed, consider nonnutritive sucking, sucrose, and warmth. A medication administered into a muscle is known as an intramuscular (IM) injection. Medication administered per the six rights of medication safety, Patient and family able to state the purpose and side effects of the medication, Medication not administered per the six rights of medication safety, No sign of intended response to medication, Patient or family cannot state the purpose and side effects of the medication, Name of the medication, dose, volume, injection site, time of administration, and name of person administering it, Patients response to the medication, including adverse reactions, Pain assessment and interventions provided, Unexpected outcomes and related interventions. The cookie is used to store the user consent for the cookies in the category "Analytics". The injection should be given 3-5cms below the acromion, in the middle of the triangle. Studies of children with previous febrile seizures have not demonstrated antipyretics to be effective in the prevention of febrile seizures (48). Intramuscular injections commonly result in pain, redness, and swelling or inflammation around the injection site. If not using the Z-track method, follow these steps for injection. Live attenuated influenza vaccine is approved for healthy nonpregnant persons aged 2-49 years and is the only vaccine administered by the intranasal route. is it okay to take melatonin after covid vaccine. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. A new generation of jet injectors with disposable cartridges and syringes has been developed since the 1990s. For men and women who weigh 130-152 lbs (60-70 kg), a 1-inch needle is sufficient. Vial size Volume of water for injections Concentration 1 gram (AFT brand) 9. Cookies used to make website functionality more relevant to you. Hepatitis A. (0.5-1 ml maximum), are . For immunizations, a smaller 22 to 25 gauge needle should be used. IM injection site area 12/2018 Sources: Red Book 2018, American Academy of Pediatrics & CDC, General Best Practices for Immunization, accessed 2018 (b) If skin is stretched tightly and subcutaneous tissues are not bunched. Pedi- Hepatitis B. Maximum volumes to be injected intramuscularly: 0.5 mL in a small infant <1month. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Greater ), Centers for Disease Control and Prevention (CDC). Children's Health Queensland disclaims, to the maximum extent permitted by law, all responsibility and all liability (including without limitation, liability in . March/April 2014 - Volume 39 - Issue 2 Previous Abstract; Next Abstract CE Connection. They help us to know which pages are the most and least popular and see how visitors move around the site. 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. Haemophilus influenzae type b. To receive email updates about this page, enter your email address: We take your privacy seriously. What is the maximum volume for subcutaneous injection? Tetanus and pertussis. The method of administration of injectable vaccines is determined, in part, by the inclusion of adjuvants in some vaccines. 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). Subcutaneous injection: injection of a biological product into the layer of fatty tissue between the skin and muscle. Knowledge of body mass can be useful for estimating the appropriate needle length (26). Choosing a muscle is dependent on the medication volume and the age or size of the patient. Intradermal injection: injection of a minimal quantity (0.01 mL to 0.1 mL) of a biological product just under the dermis. 2 How many milliliters can be injected intramuscularly? Injectable immunobiologics should be administered where local, neural, vascular, or tissue injury is unlikely. b. (c) Do not withdraw more than 0.5 mL from the reconstituted product, even if some product is left in the vial. Hellsten, M. (2022). In Meyler's Side Effects of Drugs (Sixteenth Edition), 2016. This cookie is set by GDPR Cookie Consent plugin. Choosing a muscle is dependent on the medication volume and the age or size of the patient. Document the procedure in the patients record. Up to 1ml can be injected into this site in neonates, up to 3mls in children and up to5mls in adults. Assess the patients developmental level and ability to interact. What's the maximum amount you can make on SSI per month? 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]. 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). Palpate the acromion (outer edge of the scapula) and trace an imaginary inverted triangle below the 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). For this reason, laboratory devices and in-process measurement injection molding tools have been developed to measure demolding forces. The revised standards became effective in 2001 (2). (2022). Pediatric Intramuscular Injections Guidelines for Best Practice Author Information . Which is the best muscle for IM injections? Insert the needle at a 90-degree angle (straight up and down) into the injection site. The maximum amount of medication for a single injection is 3 ml. Displace the skin and subcutaneous tissue by pulling the skin laterally or downward from the injection site. What is causing the plague in Thebes and how can it be fixed? If the subcutaneous and muscle tissue are bunched to minimize the chance of striking bone (19), a 1-inch needle or larger is required to ensure intramuscular administration. 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). d. a For nonaqueous injectates, consideration must be given to the time of absorption before redosing. In certain circumstances in which a single vaccine type is being used (e.g., in preparation for a community influenza vaccination campaign), filling a small number (10 or fewer) of syringes may be considered (5). ACIP discourages the routine practice of providers prefilling syringes for several reasons. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. What is the maximum volume that can be injected intramuscularly? Abbreviations: DEN4CYD = dengue vaccine; DT = diphtheria and tetanus toxoids; DTaP = diphtheria and tetanus toxoids and acellular pertussis; HepA = hepatitis A; HepB = hepatitis B; Hib = Haemophilus influenzae type b; HPV = human papillomavirus; IIV = inactivated influenza vaccine; IM = intramuscular; IPV = inactivated poliovirus; LAIV = live, attenuated influenza vaccine; MenACWY = quadrivalent meningococcal conjugate vaccine; MenB = serogroup B meningococcal vaccine; MenCY = bivalent meningococcal conjugate vaccine component; MMR = measles, mumps, and rubella; MMRV = measles, mumps, rubella, and varicella; MPSV4 = quadrivalent meningococcal polysaccharide vaccine; PCV13 = pneumococcal conjugate vaccine; PPSV23= pneumococcal polysaccharide vaccine; RV1 = live, attenuated monovalent rotavirus vaccine; RV5 = live, reassortment pentavalent rotavirus vaccine; RZV = recombinant adjuvanted zoster vaccine; Subcut = subcutaneous; Td = tetanus and diphtheria toxoids; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. What is the maximum volume to inject on a horse if you are giving an intramuscular injection? Introduce yourself to the patient and family. ? The development of this nursing guideline was coordinated by Mica Schneider, RN Specialist Clinics, and approved by the Nursing Clinical Effectiveness Committee. Which injection route utilizes the Z-track technique? Using the vastus lateralis muscle avoids the risk of sciatic nerve damage from gluteal injection. reduced attenuation of smallpox vaccine virus (9)]. What size needle should I use for IM injection? 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. CDC twenty four seven. To landmark the vastus lateralis, position the patient lying down or being held by a parent. Hepatitis B administered by any route other than intramuscular, or in adults at any site other than the deltoid or anterolateral thigh, should not be counted as valid and should be repeated (9). Routes of administration are recommended by the manufacturer for each immunobiologic (Table 6-1). 1 inch] if possible) so that any local reactions can be differentiated (13,29). Assess the patients and familys understanding of the reasons for and the risks and benefits of the procedure. In certain circumstances (e.g., physical obstruction to other sites and no reasonable indication to defer doses), the gluteal muscle can be used. To find the injection site, feel for the bone at the top of your arm where your arm meets your shoulder. <2 months), (38mm length preferred in larger, overweight or obese patients). The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. (Recommended site for all IM Adrenaline), (16mm length can be used for neonates or small infants (b) Note that prefilled syringes of High-Dose Fluzone have a volume of 0.7 cc and the recommended volume of administration is 0.7 ccs. For viscous and large amounts of medication be sure to use larger needles. 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). Let the area dry. Guidelines for subcutaneous and intramuscular injection Click here to proceed to intramuscular injection information . The recommended volume ranges from 2 to 5 ml for "deep" IM injections. Intradermal injection produced antibody responses similar to intramuscular injection in vaccinees aged 18-60 years (57). 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. This is the preferred site for anaphylaxis I give 3 mL doses ALL THE TIME in DG (and VL on patients that I can talk into it). Pediatric Intramuscular Injections Guidelines for Best Practice Author Information . Figure 7.13 TB syringe For injection dosage form: Injections (intramuscular) Your child needs to take a medicine by intramuscular (into the muscle) injection. For men and women who weigh 130-152 lbs (60-70 kg), a 1-inch needle is sufficient. Select an appropriate injection site based on the patients age and muscle mass, the medication volume, and the viscosity of the medication (. 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. What is the maximum volume for intramuscular injection in pediatrics? In M.J. Hockenberry, C.C. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Such practices increase the risk for infectious complications and neurovascular and muscle injuries. The anterolateral thigh can also be used (25). The injection site affects how much fluid can be given and how quickly the medication will be absorbed. Needle sizes most commonly used at the RCH include: The Australian Immunisation Handbook (health.gov.au). Inactivated influenza vaccine is immunogenic when administered in a lower-than-standard dose by the intradermal route to healthy adult volunteers. The demolding of plastic parts remains a challenging aspect of injection molding. With a new, sterile dose chamber and nozzle for each patient and correct use, these devices do not have the same safety concerns as multiple-use nozzle jet injectors. Cover the site with a bandage or gauze. 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. When choosing a needle size, factors to be considered include the weight of the patient, age, amount of adipose tissue, medication viscosity, and injection site (Hunter, 2008; Perry et al., 2018; Workman, 1999). It was estimated that needles 38 mm (1.5 inches) or more would be needed for . For adults, the deltoid muscle is recommended for routine intramuscular vaccinations (23) (Figure 3). It is possible that patients will faint during the injection process so nurses should take precautions to prevent any type of injury to the patient while administering the intramuscular injection. 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. Verify the patients daily weight in kilograms. Palpate the muscle below the greater trochanter and above the lateral femoral condyle (knee joint). The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. This guideline aims to facilitate the administration of intramuscular injections to maximise the therapeutic effect while minimising potential complications and patient discomfort. Source: Adapted from Minnesota Department of Health. In E. Hall and others (Eds. . These injection locations allow for a high degree of safety, reliability and accessibility when a patient is lying supine, prone or in side lying position. Instruct the family regarding the potential adverse effects of the medication. A medication administered into a muscle is known as an intramuscular (IM) injection. Identify the injection site. 108 volume 39 | number 2 March/April 2014 O ver the past decade, the childhood vaccine schedule has increased in complexity. While in most EDs, nurses perform injections, in wilderness, prehospital, and disaster situations, physicians or paramedics must provide injections, so it is important to understand the anatomic principles of injection. Needles and syringes used for vaccine injections must be sterile and disposable. Also, the vastus lateralis muscle has a larger muscle mass than the gluteal region and therefore has reduced risk of severe local reactions. The maximum volume for a single IM injection is 1 mL; any volume over this should be divided between multiple injection sites (7) The maximum single intramuscular dose is 2 g, doses greater than 2 g must be given in two divided doses or by intravenous administration. 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. Dorsogluteal site: Gather supplies: alcohol pads . General Best Practice Guidelines for Immunization. There is no evidence the cream interferes with other vaccines (46-49). 4 What is the maximum volume for subcutaneous injection? The administration device is a nasal sprayer with a dose-divider clip that allows introduction of one 0.1-mL spray into each naris. Figure 4.1 Preferred site for intramuscular and deep subcutaneous injections in older children and adults Figure 4.3 Preferred site for BCG injections in babies and adults Figure 4.2 Preferred site for intramuscular and deep subcutaneous injections in infants under one year of age IM or deep SC injection site Immunisation procedures June 2012 The deltoid muscle can be used if the muscle mass is adequate. Source: Adapted from Immunization Action Coalition. Assess the injection site for complications and apply an adhesive bandage. Additional information about implementation and enforcement of these regulations is available from OSHA. How should I prepare my child? May be the safest and least painful IM injection site. To decline or learn more, visit our cookies page. 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. If injecting medication into the deltoid muscle of an adult, the volume of solution should not exceed 1 mL. Bloodborne diseases (e.g., hepatitis B, hepatitis C, human immunodeficiency virus [HIV]) are occupational hazards for clinicians and other health-care providers. Z- tracking: A technique used to prevent medication leakage, particularly for oily injections. (4, 10) The microbes in injection substances, injection equipment or already-existing on the skin, can enter the body causing very serious infections. Collaborate with the patient and family to develop a plan for pain management. Doctors frequently use intramuscular injections to administer vaccines and certain other drugs. In this case the needle length should be 1 inch to 1.25 inches. V shape. Open the alcohol wipe: Wipe the area where you plan to give the injection. 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. Stated, estimated, or historical weight should not be used. It is suitable for small volume injections. A separate needle and syringe should be used for each injection. Don't even think about delt on little ones, unless it's a tetanus vaccine. The IM route allows for rapid absorption of specific medications. The tip should be inserted slightly into the naris before administration. What is the maximum volume for subcutaneous injection? What is the intramuscular injection angle? In this type of injection, a short needle is used to inject a drug into the tissue layer . 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. Chapter 20: Pediatric nursing interventions and skills. The site of injection is usually rotated when injections are frequently given. You can review and change the way we collect information below. If the skin is stretched flat, a 1/2 inch needle is sufficient. Move the dominant hand to the end of the plunger. Intramuscular (IM) administration is by injection into the striated muscle ( Hopkins and Arias, 2013 ). NWCommons: Institutional Repository of Northwestern College People with specific conditions,. The cookie is used to store the user consent for the cookies in the category "Analytics". 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. deficit of literature relating to administering intramuscular injection to children and adolescents. *Multiply the appropriate number above times the animal's body weight in kg to obtain the maximum volume of administration. Providers should consult package inserts for details. Checklist 56 outlines the steps to administer an intradermal injection. Vaccine recommendations and guidelines of the ACIP: Vaccine administration. The volume of the IM injection should not be more than 1 mL. IM injection: Maximum recommended single IM dose is 2grams. 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. Do you need underlay for laminate flooring on concrete? IPV (inactivated poliovirus)-containing combination vaccines combination vaccines containing IPV are given intramuscularly; IPV (IPOL) is given subcutaneously Japanese encephalitis vaccine ( JEspect) 13vPCV (13-valent pneumococcal conjugate vaccine) typhoid Vi polysaccharide vaccine MenB (meningococcal B) vaccine 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. Avoid moving the syringe. - 5-mL syringe; 2-inch (5-cm), 20-gauge needle - 1 mL syringe; -inch (1.25-cm), 26-gauge needle -insulin syringe; 1-inch (2.5-cm), 16-gauge needle - 1 mL syringe; -inch (1.25-cm), 26-gauge needle A nurse is using the Z-track technique to administer an injection to a client. Analytical cookies are used to understand how visitors interact with the website. The location of all injection sites with the corresponding vaccine injected should be documented in each patients medical record.