The gauge of the needle is determined by the type of medication administered. ![]() Refer to agency policy for pediatric needle lengths. In general, the recommended needle length for an adult is 1 inch to 1 ½ inches (25 mm to 38 mm), but the needle length is shorter for children. The length of the needle used at the vastus lateralis site is based on the patient’s age, weight, and body mass index. See Figure 18.33 for an image of the vastus lateralis injection site. To help relax the patient, ask the patient to lie flat with knees slightly bent or have the patient in a sitting position. The outer middle third of the muscle is used for injections. This muscle is located on the anterior lateral aspect of the thigh and extends from one hand’s breadth above the knee to one hand’s breadth below the greater trochanter. The vastus lateralis site is commonly used for immunizations in infants and toddlers because the muscle is thick and well-developed. See Figure 18.32 for an image of locating the ventrogluteal site on a patient.įigure 18.32 Ventrogluteal Site Vastus Lateralis Up to 3 mL of medication may be administered in the ventrogluteal muscle of an average adult and up to 1 mL in children. Refer to agency policies regarding needle length for infants, children, and adolescents. Children and infants require shorter needles. ![]() A thin adult may require a 5/8-inch to 1-inch (16 mm to 25 mm) needle, while an average adult may require a 1-inch (25 mm) needle, and a larger adult (over 70 kg) may require a 1-inch to 1½-inch (25 mm to 38 mm) needle. The needle length is based on patient weight and body mass index. ![]() An aqueous solution can be given with a 20- to 25-gauge needle, whereas viscous or oil-based solutions are given with 18- to 21-gauge needles. The needle gauge used at the ventrogluteal site is determined by the solution of the medication ordered. See Figure 18.31 for an image demonstrating how to accurately locate the ventrogluteal site using your hand.įigure 18.31 Locating the Ventrogluteal Site This is the preferred site for all oily and irritating solutions for patients of any age. Insert the needle into the “V” formed between your index and middle fingers. Extend your index finger to the anterior superior iliac spine and spread your middle finger pointing towards the iliac crest. Place the heel or palm of your hand on the greater trochanter, with the thumb pointed toward the belly button. Use your right hand for the left hip or your left hand for the right hip. To locate the ventrogluteal site, place the patient in a supine or lateral position. This site involves the gluteus medius and minimus muscle and is the safest injection site for adults and children because it provides the greatest thickness of gluteal muscles, is free from penetrating nerves and blood vessels, and has a thin layer of fat. Additional information regarding injections in each of these sites is provided in the following subsections. The ventrogluteal site is generally recommended for IM medication administration in adults, but IM vaccines may be administered in the deltoid site. ![]() The vastus lateralis site is preferred for infants because that muscle is most developed. Anatomic SitesĪnatomic sites must be selected carefully for intramuscular injections and include the ventrogluteal, vastus lateralis, and the deltoid. Research has found administering medications at 10 seconds per mL is an effective rate for IM injections, but always review the drug administration rate per pharmacy or manufacturer’s recommendations. Intramuscular injections are administered at a 90-degree angle. Medication fluid amounts up to 0.5-1 mL can be injected in one site in infants and children, whereas adults can tolerate 2-3 mL. Additionally, the muscle mass of infants and young children cannot tolerate large amounts of medication volume. However, if a patient is thin, a shorter needle length is used because there is less fat tissue to advance through to reach the muscle. The length of the needle must be long enough to pass through the subcutaneous tissue to reach the muscle, so needles up to 1.5 inches long may be selected. Muscle has an abundant blood supply that allows medications to be absorbed faster than the subcutaneous route.įactors that influence the choice of muscle to use for an intramuscular injection include the patient’s size, as well as the amount, viscosity, and type of medication. The intramuscular (IM) injection route is used to place medication in muscle tissue. 18.6 Administering Intramuscular Medications
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