The dorsogluteal is not the preferred site due to its proximity to the sciatic nerve and major blood vessels. However, the immunogenicity for persons aged 65 years is inadequate, and varying the recommended route and dose either with the intradermal product licensed through 64 years of age or with other influenza vaccines is not recommended (24). The development of this nursing guideline was coordinated by Mica Schneider, RN Specialist Clinics, and approved by the Nursing Clinical Effectiveness Committee. (c) Do not withdraw more than 0.5 mL from the reconstituted product, even if some product is left in the vial. For confirmation, an imaginary line can be drawn between the posterior superior Also, the vastus lateralis muscle has a larger muscle mass than the gluteal region and therefore has reduced risk of severe local reactions. If the skin is stretched flat, a 1/2 inch needle is sufficient. The maximum amount of medication for a single injection is generally 1 ml. Children (3-11 years) Deltoid Anterolateral thigh 5/8" - 1" needle for deltoid 1" - 1" needle for thigh 23-25 gauge needle . If landmarked correctly however, it is safe to use. 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). If the patients available muscle tissue is limited and the dorsogluteal muscle must be used, volumes of up to 4 ml can be administered into this site. Other persons at increased risk for influenza complications can administer LAIV. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. This website uses cookies to improve your experience while you navigate through the website. Severely immunosuppressed persons (i.e., those who require care in a protected environment, e.g., bone marrow transplant recipients, individuals with severe combined immunodeficiency diseases) should not administer LAIV. These come in different sizes (gauge and length) and are selected based on the patients size and the muscle used. Assess the injection site for complications and apply an adhesive bandage. The IM route allows for rapid absorption of specific medications. AGE NEEDLE LENGTH INJECTION SITE Infants (1-12 mos) " Fatty tissue over antero-lateral thigh muscle Children 12 mos or older, adolescents, and adults " Fatty tissue over . It does not store any personal data. Have the family of an infant begin breastfeeding or feeding breast milk. Repeating doses of vaccine administered by the intramuscular route when recommended to be by the subcutaneous route is not necessary (10). 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. For women who weigh >200 lbs (>90 kg) or men who weigh >260 lbs (>118 kg), a 1.5-inch needle is recommended ( table 6-2) ( 20). formerly Immunization Action Coalition (IAC) . Recognize and immediately treat respiratory distress and circulatory collapse, which are signs of a severe anaphylactic reaction. . Clinical judgement is required when selecting an injection site and needle length. Review the patients history for reactions or allergies to medications, foods, or environmental allergens. NOTE: Values are in ml/kg unless otherwise specified. The most common serious complications of intramuscular injections in children are muscle contractures and nerve injury. Provide the family and patient with self-management techniques (e.g., acetaminophen for fever and cool compresses for pain). Use of longer needles has been associated with less redness or swelling than occurs with shorter needles because of injection into deeper muscle mass (16). If a vaccine and an immune globulin preparation are administered simultaneously (e.g., Td/Tdap and tetanus immune globulin [TIG], hepatitis B and hepatitis B immunoglobulin [HBIG]), separate limbs should be used for each injection (29-30). With a maximum volume of 3 ml, the ventrogluteal muscle can hold up to 2.5 ml. Place the syringe between your thumb and first finger. Learn more about Clinical Skills today! A new generation of jet injectors with disposable cartridges and syringes has been developed since the 1990s. What is a safe amount of medication to inject intramuscularly? Explain the procedure to the patient and family and ensure that they agree to treatment. The only exceptions are medications that are still in their original container or medications that are administered immediately by the person who prepared them. angle. 0.5 mL IM MMRV (ProQuad) 0.5 mL Subcut HepA-HepB (Twinrix) 1.0 mL IM Injection Site and Needle Size Subcutaneous (Subcut) injection the person's age and body mass. Displace the skin and subcutaneous tissue by pulling the skin laterally or downward from the injection site. This cookie is set by GDPR Cookie Consent plugin. Thank you for taking the time to confirm your preferences. (b) If skin is stretched tightly and subcutaneous tissues are not bunched. But opting out of some of these cookies may affect your browsing experience. This cookie is set by GDPR Cookie Consent plugin. Saving Lives, Protecting People, Vaccine Recommendations and Guidelines of the ACIP, Adapted from Immunization Action Coalition, https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6510a2.pdf, List of safety-engineered sharp devices and other products designed to prevent occupational exposures to bloodborne pathogens, National Center for Immunization and Respiratory Diseases, Comprehensive Recommendations and Guidelines, Preventing and Managing Adverse Reactions, Vaccine Recommendations for Emergency Situations, CDC's International Travelers Yellow Book, Clinical Travel Notices, Updates, and Vaccine Shortages, U.S. Department of Health & Human Services. Which is the best muscle for IM injections? To locate the muscle, place the palm of a hand over the greater trochanter of the femur, facing the index finger and thumb towards the umbilicus, along the anterior iliac spine. Comfort measures, such as distraction (e.g., playing music or pretending to blow away the pain), cooling of the injection site(s), topical analgesia, ingestion of sweet liquids, breastfeeding, swaddling, and slow, lateral swaying can help infants or children cope with the discomfort associated with vaccination (40-42). (a) Persons aged 11-15 years may be administered Recombivax HB (Merck), 1.0 mL (adult formulation) on a 2-dose schedule. Obtain the medication, check the practitioners order, verify the expiration date, and inspect the medication for particulates, discoloration, or other loss of integrity. Similarly, doses of rabies vaccine administered in the gluteal site should not be counted as valid doses and should be repeated (54). An additional dose of 1 mg or 0.2 mL may be repeated if there has been no response after 15 minutes while waiting for emergency assistance. ACIP discourages variations from the recommended route, site, volume, or number of doses of any vaccine. Deviation from the recommended route of administration might reduce vaccine efficacy (14-15) or increase the risk for local adverse reactions (16-18). Pediatric Nursing Procedures (pp. Poor technique and incorrect landmarking of These cookies track visitors across websites and collect information to provide customized ads. When in doubt about the appropriate handling of a vaccine, vaccination providers should contact that vaccines manufacturer. Please remember to This guideline aims to facilitate the administration of intramuscular injections to maximise the therapeutic effect while minimising potential complications and patient discomfort. For injection into the anterolateral thigh, most adolescents will require a 1-1.5-inch needle to ensure intramuscular administration (27). ACIP discourages the routine practice of providers prefilling syringes for several reasons. Currently the most commonly used sites for the rapid delivery of rescue medications are the IV, IM, and subcutaneous sites. Palpate the muscle below the greater trochanter and above the lateral femoral condyle (knee joint). The maximum volume that can be administered is 0.1 ml of solution for this administration route. Stated, estimated, or historical weight should not be used. 9 mss atrs. Using larger-than-recommended dosages can be hazardous because of excessive local or systemic concentrations of antigens or other vaccine constituents. Anderson, C.E., Herring, R.A. (2022). . Administering volumes smaller than recommended (e.g., inappropriately divided doses) might result in inadequate protection. However, up to 1 mL of any medication may be administrated to this muscle (the maximum volume should never exceed 2 mL). What is maximum safe volume that a neonate can receive in an intramuscular injection? May be the safest and least painful IM injection site. Pediatric Intramuscular Injections Guidelines for Best Practice Author Information . People with specific conditions,. Contraindications Relative Known bleeding disorder or thrombocytopenia. Up to 4mls can be injected into this site. Figure 7.13 TB syringe 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. How many milliliters can be injected intramuscularly? Subcutaneous injections may be administered into the upper-outer triceps area of an infant if necessary. What is the maximum volume for subcutaneous injection? ), Centers for Disease Control and Prevention (CDC). The deltoid muscle is the preferred injection site in children aged 3-18 years when muscle mass is more developed. Digital Edition: SKILLS - INTRAMUSCULAR INJECTIONS 01 July, 2003 An intramuscular (IM) injection is the administration of medication through the cutaneous and subcutaneous layers, into the muscle. Single-dose vials and manufacturer-filled syringes are designed for single-dose administration and should be discarded if vaccine has been withdrawn or reconstituted and subsequently not used within the time frame specified by the manufacturer. For women who weigh 152-200 lbs (70-90 kg) and men who weigh 152-260 lbs (70-118 kg), a 1- to 1.5-inch needle is recommended. Because unused prefilled syringes also typically must be discarded if not used within the same day that they are filled, vaccine wastage might occur. - 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. However, local reactions or injuries (e.g., skin laceration, transient neuropathy, hematoma) are sometimes more frequent on delivery of vaccine by jet injectors compared with needle injection, depending on the inherent irritability of the vaccine and operator technique (33). Open the alcohol wipe: Wipe the area where you plan to give the injection. Erythema or swelling at the injection site. Because the majority of vaccines have a similar appearance after being drawn into a syringe, prefilling might result in administration errors. 6 How many mL can you inject into the deltoid muscle? 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. d. The usual dose is 12.5 to 25 mg per kg (5.7 to 11.4 mg per pound) of body weight every six hours; or 16.7 to 33.3 mg per kg (7.6 to 15 mg per pound) of body weight every eight hours. Using the vastus lateralis muscle avoids the risk of sciatic nerve damage from gluteal injection. Anterolateral: Anterior and lateral position situated in the front and to the side. The site of injection is usually rotated when injections are frequently given. This is the preferred site for anaphylaxis Explain briefly what you are about to do. Intradermal injection: injection of a minimal quantity (0.01 mL to 0.1 mL) of a biological product just under the dermis. The administration of injections is a fundamental nursing skill; however, it is not without risk. 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. Needles are generally 3/8 to 1 inch in length and 24 to 27 gauge. Historic concerns about exposure to vaccine components are limited to non-parenteral vaccines in which some degree of environmental exposure is unavoidable (5, 8), or situations in which self-inoculation is likely due to the nature of the vaccine microbe [e.g. This technique is preferred in adult/ adolescent patients. 7. Needles and syringes used for vaccine injections must be sterile and disposable. Don appropriate PPE based on the patients need for isolation precautions or the risk of exposure to bodily fluids. What's the maximum amount you can make on SSI per month? PPSV23and IPV are recommended by the manufacturer to be administered by the subcutaneous or intramuscular route. Position the patient and initiate developmentally appropriate distraction measures. The cookies is used to store the user consent for the cookies in the category "Necessary". The anterolateral aspect of the thigh, or vastus lateralis muscle, is the preferred IM site for neonates and infants. & Greenberg, C. S. (2003). We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Rodgers, D. Wilson (Eds. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. For men and women who weigh 130-152 lbs (60-70 kg), a 1-inch needle is sufficient. 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 How should I prepare my child? For women who weigh >200 lbs (>90 kg) or men who weigh >260 lbs (>118 kg), a 1.5-inch needle is recommended (table 6-2) (20). If the patient or family expresses concern regarding the accuracy of a medication, the medication should not be given. 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. A volume of 1 ml to be injected at one site was exceeded 10 (47%) times. 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). These federal regulations require the use of engineering and work practice controls to eliminate or minimize employee exposure to bloodborne pathogens. Rotavirus vaccines are licensed for infants. A hypodermic needle is used to administer IM injections. Explain to the patient and family the step-by-step procedure for IM medication administration. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. March/April 2014 - Volume 39 - Issue 2 Previous Abstract; Next Abstract CE Connection. All images and videos were created by the Royal Childrens Hospital Creative Studios for the purpose of this guideline. This cookie is set by GDPR Cookie Consent plugin. https://www.clinicalkey.com/nursing/#!/content/drug_monograph/6-s2.0-5295, https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html, https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2022/npsg_chapter_hap_jan2022.pdf, https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html. Needle-shielding or needle-free devices that might satisfy the occupational safety regulations for administering injectable vaccines are available in the United States (12-13). (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. What is a safe amount of medication to inject intramuscularly? The maximum amount of medication for a single injection is generally 1 ml. I give 3 mL doses ALL THE TIME in DG (and VL on patients that I can talk into it). Necessary cookies are absolutely essential for the website to function properly. For injection dosage form: Drug administration route. Technically Speaking columns cover practical topics in immunization delivery such as vaccine . Which site is most desirable for a 3 ml intramuscular injection? Divide the muscle into thirds and administer the injection into the middle third of the muscle, in the outer anterolateral If not using the Z-track method, follow these steps for injection. Hold this position until the medication is injected. However, if 2 half-volume formulations of vaccine have already been administered on the same clinic day to a patient recommended for the full volume formulation, these 2 doses can count as one full dose. Evidence indicates that this cream does not interfere with the immune response to MMR (45). Live attenuated influenza vaccine is approved for healthy nonpregnant persons aged 2-49 years and is the only vaccine administered by the intranasal route. Tell them when and how to notify the practitioner about a problem. (a) If the gluteal muscle is chosen, injection should be administered lateral and superior to a line between the posterior superior iliac spine and the greater trochanter or in the ventrogluteal site, the center of a triangle bounded by the anterior superior iliac spine, the tubercle of the iliac crest, and the upper border of the greater trochanter. a For nonaqueous injectates, consideration must be given to the time of absorption before redosing. Smoothly, quickly, and steadily withdraw the needle and release the skin. Insert the needle at a 90-degree angle (straight up and down) into the injection site. The administration device is a nasal sprayer with a dose-divider clip that allows introduction of one 0.1-mL spray into each naris. Persons administering vaccinations should follow appropriate precautions to minimize risk for disease exposure and spread. Discard supplies, remove PPE, and perform hand hygiene. read the disclaimer. Perform hand hygiene before patient contact. Volumes of up to 4 ml can be administered to this site if the patient's available muscle tissue is limited and dorsogluteal muscle is required. You also have the option to opt-out of these cookies. Chapter 20: Pediatric nursing interventions and skills.