Chapter 15. Intramuscular, Subcutaneous, and Intradermal Injections

Indications

• • 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.

Contraindications

Relative

• • Known bleeding disorder or thrombocytopenia.

  • Erythema or swelling at the injection site.

Equipment

• • Alcohol wipe.

  • Gauze pad.

  • Syringe with medication or immunization.

  • Appropriate size needle.

  • Bandage.

Risks

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

Pearls and Tips

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

Patient Preparation

• • Position the child and assess the injection site.

  • Clean the injection site with an alcohol wipe.

Anatomy Review

• • 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.

Procedure

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

• • 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.

Monitoring

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

Complications

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

Indications

• • Administration of medications or immunizations.

  • Immunizations commonly administered subcutaneously include the following:

  • • Inactivated polio.

    • Measles, mumps, and rubella.

Contraindications

Relative

• • Erythema or swelling at the injection site.

Equipment

• • Alcohol wipe.

  • Gauze pad.

  • Syringe with medication or immunization.

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