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How to do a Intramuscular Injection

Updated on June 13, 2013

How to do Muscular Injections

As with most things in life there are right & wrong, proper & improper, acceptable & unacceptable ways to conduct intramuscular injections. Sound injection protocol (the correct steps to follow) exists to protect the patient from harm (Infection). Following the said protocol, along with proper handling procedures can prevent a variety of minor and major negative effects that can occur during intramuscular injections. Unfortunately many users are either unaware of, do not understand, or simply don't care about the importance of practicing the appropriate injection procedures. As a result, they routinely disregard even the simplest principles, from basic hygiene to determinations of where and how to inject these hormones.

This section will discuss injection methodology along with the very important 'WHY THEY SHOULD BE USED' reasoning, and includes: selecting the proper equipment; rules for practicing safe hygiene; choosing the correct injection sites & specific spots on the body and; the step-by-step principles that should be followed in the practice of safe intramuscular injections. The following is a small informational component of a larger educational website designed to raise awareness. More specifically, it is NOT intended to help readers learn how to inject, but rather to equip them with the truth about the What's, HOWs & WHYs behind injecting protocols.

Equipment

What is needed

Choosing the proper needle (the very thin pin that is stuck into the body) and syringe (the chamber that holds the fluid for injection) is an important usage component, but first it's necessary to learn a little about them.

The gauge represents the diameter or size of a needle, a.k.a. pin.

The larger the gauge number, the thinner the pin.

For example, a 25 gauge needle is a whole lot thinner than a 20 gauge needle.

The types of needles chosen vary in size based on the users': (oil and/or water-based) substances; amount injected (it takes longer to inject with a thinner pin); size of the muscle group being injected (typically larger groups have less residual pain) and; very individualized preferences for all of the above.

For intramuscular injection typically choose sizes they can apply to both water and oil-based injectable oil, thus generally speaking, the most common sizes for intramuscular injection use are 22 & 23 gauge needles.

These needles also come in a variety of lengths which are selected based on how deeply they must penetrate in order to reach the muscle for injection.

For example, a small 1'' needle (and if appropriate even smaller) is often used to inject into the smaller muscle groups like the deltoids/shoulders or pectorals/chest muscles that are covered by very little fatty tissue, whereas longer 1.5 - 2''needles are reserved for the buttocks and other deeper muscle regions.

Syringes also come in a diversity of sizes, or capacities (the amount of fluid they hold) which are measured in milliliters abbreviated 'ml' or cubic centimeters abbreviated 'cc', both of which are equal in measurement . Typical substance being injected ranges from 1 - 3ml, based on how much the user intends to inject at one time. Needles and syringes can be purchased together as unit, or separately for later assembly.

The Importance of Hygiene

Hygiene is a very important issue when it comes to injecting anything into the body. As mentioned earlier, people often overlooked or simply people neglect this component. Nevertheless, much of the world is comprised of open and closed systems. A house during a birthday party, where visitors are constantly going in and out, is an example of an open system into which insects, dirt, pests, germs and other undesirables have access. After the party, when the doors and windows are closed and locked, it becomes a closed system that only the family can access. Other systems like the brake line on a car are more permanently closed in order to resist contaminants such as air, dust and dirt. Similarly, the body is made up of both open systems accessed by upper (on the head), and lower (for elimination) openings that make it (much like the house during a party) susceptible to infection from germs, bacteria and viruses. However, the body also contains closed systems among which is the circulatory system.

Just as the brake line on a car can be opened for repair, so the circulatory system can be injected with medicinal repairs like immunizations, pain-killers, and numerous other medical treatments. Whenever a closed system is accessed there is the potential for contamination. In the case of intramuscular injection, contaminants like germs, dirt and debris can easily be introduced at the patient's injection site along with the needle.

Because of this threat, some very good principles have been put into place to limit the possibility of infection which can swiftly result in the development of abscesses (large, localized collections of pus-filled infection sites, often surrounded by very painful, swollen and inflamed tissue). Abscesses really hurt, I repeat abscesses hurt badly, and unfortunately they can take a long time to go away. Although abscesses are probably the most visible short-term problem, there are a host of far more dangerous long-term ones that can occur from reusing and sharing needles, not properly preparing the skin for injection, and failing to keep both the skin and equipment sanitary throughout the injection process.

About Injecting

Injections of medications that are shot directly into the bloodstream are called intravenous or IV injections. This is often done very deliberately and intentionally. Whether injecting or drawing blood a nurse will usually search for the best vein, and then (so as not to pass through the vein) inject sideways into it. This is NOT the procedure used for intramuscular injection! Medical personnel NEVER inject oil substances and non-intravenous meds intravenously as this can have very immediate negative and possibly fatal (resulting in death) consequences.

Inject-able oils are ONLY intended for intramuscular, also called IM injections! This means that the needle has to go through the skin as well as the fat and tissue layers beneath it, then on into the muscle itself. Pictured in order here are several of the ways to inject into muscle groups. Favorites among these groups include the Buttocks, the outer Quadriceps/Thighs, and the lateral (top outside) surface of the Hips.

Instruction Video on how to give a Intramuscular Injection

Injection Protocol

The ‘Two-Pin’ technique increases sanitation for multiple dose vial drawing. They draw with the first pin, and then shoot/inject into the body with a new one. This procedure prevents any residual contaminants that may have remained on the drawing pin from being transferred into the body via the injection site. It also makes injection less painful since the drawing needle is necessarily dulled during passage through the rubber stopper atop the vial. A dulled needle increases injection pain because it doesn’t pierce the body as cleanly as an unused one. The protocol below is followed by those who draw from multiple dose vials, but steps 4 - 8 are routinely disregarded by those users who draw from ampoules (also called ampules).

1. A shower is STRONGLY recommended. If one is not taken, then wash hands thoroughly with soap and warm water.

2. Thoroughly cleanse (with soap), rinse (with clean warm water), and dry the intended injection area.

3. Sanitize the intended injection area with an alcohol swab.

4. If using a multiple dose vial, be sure to clean the rubber stopper with alcohol.

5. Fill the syringe with an equal amount of air in comparison to the intended dose. Then inject the air into the vial (this practice helps keep a balance of internal/external pressure which makes future withdrawals easier).

6. Holding the vial upside down as depicted in the picture, draw solution into the syringe.

7. Continuing to hold the syringe pointing upwards, replace the needle cover and carefully unscrew the needle.

8. Leaving the protective cover on the new/sterile needle, screw it into place.

9. Relax the injection site, and if possible, stretch the skin taught (tightly) with the thumb and forefinger. This action makes the skin tight and provides for an easier injection. Once the skin is stretched, while holding the needle like a dart, insert it with one swift motion all the way to the end of the needle. This step varies depending on the size of the needle and the depth required for selected injection site). Nevertheless, make sure the needle is long enough to reach the muscle. Do this at a 90 degree angle relative to the muscle being injected as illustrated below. Shooting on a 45 degree angle (also illustrated below) may not permit full passage through the fat and tissue layers and into the muscle fibers.

1. Then aspirate, which means to pull back on the plunger to confirm that blood is NOT entering the syringe. As long as NO blood has entered (signifying that a blood vessel was not hit, and that this is a good injection to continue), proceed by pushing down on the plunger with slow steady pressure.

2. Once the syringe is empty, pull the needle out with one swift motion, and put pressure on the area with a sterile alcohol pad while massaging in a circular motion.

3. Apply a bandage, recap the needle, and dispose of everything in a safe manner to prevent later injury to yourself or others.

It is recommended that you seek a medical professional advice before referencing this material; which is for educational use only.

POPULARLY and LESS POPULAR MUSCLE GROUPS FOR INJECTION

POPULARLY INJECTED MUSCLE GROUPS

Other less popular muscle groups are often injected by experienced professionals who require more frequent shots, and include the Deltoids (Shoulders), Calves, Pectorals (chest/breast muscle area), Lats (Latissimus Dorsi muscle), Biceps & Tricep.

LESS POPULAR INJECTED MUSCLE GROUPS

Medical Personnel single out these locations because they are densely muscled; containing numerous muscle fibers and vast amounts of connective tissue (those that cover, connect and separate the bones from one another and their adjacent muscles). These areas provide excellent conditions for fast diffusion (spreading and absorption). However, very specific 'spots' within even these choice muscle groups must be located in order for users to avoid injecting into large groups of nerves and blood vessels. As a rule, inexperienced person shouldn't inject more than 2cc's of any substance (or combination of substances) at one time, and are careful not to inject the same spot more than once a week. Changing the injected muscle groups, or at least switching to the corresponding group on the other side of the body with every shot, is a practice known as 'Spot Rotation'. By observing the 2cc limit the user prevents discomfort while the substance is being absorbed, whereas rotating spots permits them to resist the building of hardened callous-like tissue beneath the injection site, b.k.a. scar tissue.

Injection Sites

Injection Sites
Injection Sites

Advised Injection Locations

Best Injection Spots

Most medical professionals consider the upper-outer quarter of the buttock, also known as the Dorsogluteal site, to be one of the best areas for intramuscular injections. Another common site for injection is the Ventrogluteal area of the Gluteus/Buttock region. This injection site is located between the index and middle fingers, and is slightly higher and to the outside of the Dorsogluteal site.

These are spots are deemed optimal choices because:

1) the area is massive;

2) they have relatively few nerve endings;

3) the chance of the substance entering a blood vessel is very low here and;

4) by injecting here one lowers the probability of touching the sciatic nerve - a very large nerve network that passes through the lower & median buttock areas, and on into the lower body.

Direct Line Medical Supply

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