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Indications

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  • • Administration of medications or immunizations.

    • Immunizations commonly administered intramuscularly include the following:

    • • Diphtheria.

      • Tetanus and pertussis.

      Haemophilus influenzae type b.

      • Hepatitis A.

      • Hepatitis B.

      • Pneumococcal conjugate.

      • Influenza.

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Contraindications

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Relative

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  • • Known bleeding disorder or thrombocytopenia.

    • Erythema or swelling at the injection site.

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Equipment

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  • • Alcohol wipe.

    • Gauze pad.

    • Syringe with medication or immunization.

    • Appropriate size needle.

    • Bandage.

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Risks

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  • • Pain, swelling, bleeding, or infection at the injection site.

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Pearls and Tips

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  • • It may be necessary to enlist the help of a second person to hold the child.

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Patient Preparation

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  • • Position the child and assess the injection site.

    • Clean the injection site with an alcohol wipe.

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Anatomy Review

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  • • In infants and toddlers, it is recommended that intramuscular injections be given in the middle one-third of the lateral aspect of the vastus lateralis muscle (anterolateral upper thigh).

    • In older children, intramuscular injections are given in the deltoid muscle.

    • The ventrogluteal site can be used in children over age 2. This site is used less commonly because of the risk of nerve damage.

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Procedure

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  • • Pinch muscle and quickly insert 1-inch 23- or 25-gauge needle at a 90-degree angle (Figure 15–1).

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  • • Larger adolescents and adults may require the use of a 1.5-inch needle.

    • Aspirate to check for possible blood vessel entry.

    • • Aspirate for at least 5 seconds.

      • This ensures that the needle is not in a small blood vessel.

      • If blood is obtained, withdraw the needle, discard the medication and syringe, and start again.

    • If blood is not obtained, slowly inject the medication.

    • Do not recap the needle.

    • Dispose of the needle in the proper container.

    • Apply pressure to the injection site with a gauze pad.

    • Apply bandage and comfort the child.

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Monitoring

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  • • Watch the patient for any reaction to the medication.

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Complications

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  • • Bleeding, pain, or swelling at the injection site.

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Indications

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  • • Administration of medications or immunizations.

    • Immunizations commonly administered subcutaneously include the following:

    • • Inactivated polio.

      • Measles, mumps, and rubella.

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Contraindications

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Relative

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  • • Erythema or swelling at the injection site.

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Equipment

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  • • Alcohol wipe.

    • Gauze pad.

    • Syringe with medication or immunization.

    • Appropriate size needle.

    • Bandage.

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Risks

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