), Institute for Safe Medication Practices (ISMP). Any vaccination using less than the standard dose should not be counted, and the person should be revaccinated according to age unless serologic testing indicates that an adequate response has developed. Pretreatment (30-60 minutes before injection) with a 5% topical lidocaine-prilocaine emulsion might decrease the pain of vaccination by causing superficial anesthesia (43-44). To landmark the vastus lateralis, position the patient lying down or being held by a parent. When to use an intramuscular ( IM ) injection? For infants and younger children, if more than 2 vaccines are injected in a single limb, the thigh is the preferred site because of the greater muscle mass; the injections should be sufficiently separated (separate anatomic sites [i.e. Maximum volumes to be injected intramuscularly: 0.5 mL in a small infant <1month. Chapter 5: Pain assessment and management in children. However, up to 1 mL of any medication may be administrated to this muscle (the maximum volume should never exceed 2 mL). When injecting into the deltoid muscle, for adults a measurement of body mass/weight is allowable prior to vaccination, understanding that resources to measure body mass/weight are not available in all clinical settings. Hands should be cleansed with an alcohol-based waterless antiseptic hand rub or washed with soap and water before preparing vaccines for administration and between each patient contact (1). If administering an IM injection into a child under age 2, the maximum amount that should be administered is 1 mL. 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. For deep IM injections, the recommended volume ranges from 2 to 5 ml. The volume of the IM injection should not be more than 1 mL. For older children and adults, the deltoid muscle can be used for more than one intramuscular injection. (2022). Breastfeeding or giving supplemental breast milk during the injection can reduce pain in infants. *The ventrogluteal site may be used for children greater than 7 months when large volumes or viscous solutions must be . Don appropriate personal protective equipment (PPE) based on the patients need for isolation precautions or the risk of exposure to bodily fluids. 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). The method of administration of injectable vaccines is determined, in part, by the inclusion of adjuvants in some vaccines. Explain to the patient and family the step-by-step procedure for IM medication administration. A decision on needle length and site of injection must be made for each person on the basis of the size of the muscle, the thickness of adipose tissue at the injection site, the volume of the material to be administered, injection technique, and the depth below the muscle surface into which the material is to be injected (Figure 1). The patient may require longer observation periods depending on the medication they receive, Provide education to the patient and their family on signs and symptoms to monitor for, e.g., pain, redness, abscess, bruising at the site or anaphylaxis, Warm or cold compresses can be applied to the area for comfort. Using the vastus lateralis muscle avoids the risk of sciatic nerve damage from gluteal injection. (about 80 times the maximum recommended human dose). Repeating doses of vaccine administered by the intramuscular route when recommended to be by the subcutaneous route is not necessary (10). The deltoid muscle is the preferred injection site in children aged 3-18 years when muscle mass is more developed. An adjuvant is a vaccine component distinct from the antigen that enhances the immune response to the antigen, but might also increase risk of adverse reactions. 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. Provide the family and patient with self-management techniques (e.g., acetaminophen for fever and cool compresses for pain). Do not touch this area until you give the injection. Additional information about implementation and enforcement of these regulations is available from OSHA. Anterolateral: Anterior and lateral position situated in the front and to the side. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. (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. Needle size Gauge 25 (1 inch, in length, 0.6 mm) is the most appropriate size for intramuscular injection to minimize local irritation and pain in children. The microbes in injection substances, injection equipment or already-existing on the skin, can enter the body causing very serious infections. Equipment shoulder. A separate needle and syringe should be used for each injection. 3 mL in an adolescent Maximum volumes to be injected subcutaneously: Recommended maximum volumes to be injected subcutaneously may range from 0.5 mL to 2 mL depending on your patient. Intramuscular (IM) injection site for children and adults IM injection site (shaded area) Insert needle at a 90 angle into the antero-lateral thigh muscle. Vaccine recommendations and guidelines of the ACIP: Vaccine administration. Injectable immunobiologics should be administered where local, neural, vascular, or tissue injury is unlikely. The tip should be inserted slightly into the naris before administration. What is the maximum volume that can be injected intramuscularly? For viscous and large amounts of medication be sure to use larger needles. The concern should be explored, the practitioner notified, and the order verified. Like. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Steps on How to Give an IM Injection. You can review and change the way we collect information below. Influenza. 2 What happens if you inject into muscle? Evidence indicates that this cream does not interfere with the immune response to MMR (45). Don appropriate PPE based on the patients need for isolation precautions or the risk of exposure to bodily fluids. These include persons with underlying medical conditions placing them at higher risk or who are likely to be at risk, including pregnant women, persons with asthma, and persons aged 50 years (2). Evidence does not support use of antipyretics before or at the time of vaccination; however, they can be used for the treatment of fever and local discomfort that might occur following vaccination. 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). First published May 2022. To find the injection site, feel for the bone at the top of your arm where your arm meets your shoulder. Verify the correct patient using two identifiers. The cookie is used to store the user consent for the cookies in the category "Analytics". The needle gauge for intramuscular injection is 22-25 gauge. Best practice guidance for route, site, and dosage of immunobiologics is derived from data from clinical trials, practical experience, normal intervals of health care visits, and theoretical considerations. If less than a full recommended dose of a vaccine is administered because of syringe, applicator, or needle leakage, the dose should be repeated (5). These cookies ensure basic functionalities and security features of the website, anonymously. The capsules should not be opened or mixed with any other substance. Several of the newer devices have been approved by FDA for use with specific vaccines (33). (a) Persons aged 11-15 years may be administered Recombivax HB (Merck), 1.0 mL (adult formulation) on a 2-dose schedule. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. For serious infections, AAP recommends a dose of 100 mg/kg/day IV or IM divided every 12 to 24 hours (Max: 4 g/day). The maximum amount of medication for a single injection is generally 1 ml. 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. Check the accuracy and completeness of the medication administration record (MAR) with the practitioners original order. Engineering controls means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate orremove the bloodborne pathogens hazard from the workplace). However, these tools . trochanter:A bony prominence at the top of the femur where the hip and thigh muscles are fixed. Also, the vastus lateralis muscle has a larger muscle mass than the gluteal region and therefore has reduced risk of severe local reactions. The deltoid site is mostly commonly used for immunizations. In certain circumstances (e.g., physical obstruction to other sites and no reasonable indication to defer doses), the gluteal muscle can be used. 37415 . Use a filter needle if drawing the medication from a glass ampule. Maximum volume is 3 mL in adults, 2mL for ages between 6-13 years, 1.5 mL for between 3-6 years, and 1 mL for ages between 1 - 3 years. Gather supplies: alcohol pads . 2 How many milliliters can be injected intramuscularly? 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. The apparent volume of distribution at steady state (Vss) of ertapenem in adults is approximately 0.12 liter/kg, approximately 0.2 liter/kg in pediatric patients 3 months to 12 years of age and . Persons administering ACAM 2000 smallpox vaccine to laboratory and health care personnel at risk for occupational exposure to orthopoxviruses can decrease the risk for inadvertent infection through recommended infection prevention measures. 6 How many mL can you inject into the deltoid muscle? Smoothly, quickly, and steadily withdraw the needle. However, for DTaP, Hib, and PCV13, there is no evidence related to immunogenicity of these 3 vaccines given subcutaneously. Which is the best muscle for IM injections? Rotavirus vaccines are licensed for infants. Take steps to eliminate interruptions and distractions during medication preparation. Assess the patients and familys experiences with IM medication administration. Unused syringes that are prefilled by the manufacturer and activated (i.e., syringe cap removed or needle attached) should be discarded at the end of the clinic day. Clinical judgement is required when selecting an injection site and needle length. The Z-track method is a method of administrating an IM injection that prevents the medication being tracked through the subcutaneous tissue, sealing the medication in the muscle, and minimizing irritation from the medication. You also have the option to opt-out of these cookies. The deltoid muscle can be used if the muscle mass is adequate. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. The site of injection is usually rotated when injections are frequently given. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. The maximum volume generally accepted for an SC injection is around 1.5 ml , although higher volumes (of up to 4 ml) can be administered if necessary . Response to vaccines recommended by the subcutaneous route is unlikely to be affected if the vaccines are administered by the intramuscular rather than subcutaneous route. An intramuscular injection delivers medication into a muscle. Jet injectors prevent needlestick injuries to health-care providers (2) and can overcome improper, unsterile reuse and other drawbacks of needles and syringes in developing countries (9, 38-39). Intramuscular injection of high doses of depot formulations of penicillins can lead to painful swelling, especially when over 600 000-1 000 000 units are given at a single site [263, 264].Such reactions occurred in two of 878 patients (0.2%) with intramuscular penicillin G procaine [265]. The maximum amount of fluid an adult can safely be given intramuscularly is 3 mL; for a child, the maximum is 1 mL. *The anterolateral thigh may be used. Chapter 6: Vaccine administration. Introduce yourself to the patient and family. You also have the option to opt-out of these cookies. To decline or learn more, visit our cookies page. Assess the patients developmental level and ability to interact. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. The maximum volume for a single IM injection is 1 mL; any volume over this should be divided between multiple injection sites (7) The maximum single intramuscular dose is 2 g, doses greater than 2 g must be given in two divided doses or by intravenous administration. These cookies may also be used for advertising purposes by these third parties. Don't even think about delt on little ones, unless it's a tetanus vaccine. What is the maximum volume to inject on a horse if you are giving an intramuscular injection? The sites most commonly used for IM injection are the deltoid, dorsogluteal, rectus femoris, vastus lateralis, and ventrogluteal muscles. Open the alcohol wipe: Wipe the area where you plan to give the injection. The site of injection is usually rotated when injections are frequently given. ), Centers for Disease Control and Prevention (CDC). Figure 4.1 Preferred site for intramuscular and deep subcutaneous injections in older children and adults Figure 4.3 Preferred site for BCG injections in babies and adults Figure 4.2 Preferred site for intramuscular and deep subcutaneous injections in infants under one year of age IM or deep SC injection site Immunisation procedures June 2012 Instruct the family regarding the potential adverse effects of the medication. But opting out of some of these cookies may affect your browsing experience. Identify the injection site. 4 What is the maximum volume for subcutaneous injection? The purpose of IM injections is to administer medication safely into the muscle below the subcutaneous layer. If landmarked correctly however, it is safe to use. Collaborate with the patient and family to develop a plan for pain management. Follow the organizations practice for emergency response. Pediatric Nursing Procedures (pp. Immune responses generated by jet injectors against both attenuated and non-live viral and bacterial antigens are usually equivalent to, and occasionally greater than, immune responses induced by needle injection.