The administration of intramuscular injections is a common nursing intervention in clinical practice.
This article aims to raise awareness in relation to the injection sites used for intramuscular injection and, to highlight best practice in relation to IM injection administration.
ROUTES OF ANABOLICS & HORMONE ADMINISTRATION:
Anabolic steroid – Gluteal Muscle, intramuscular only.
Growth hormone – Subcutaneous injection (below skin), in front thighs or in abdominal muscles.
Insulin – Subcutaneous injection (below skin), in front thighs or in abdominal muscles.
HCG – Gluteal Muscle, intramuscular.
AVOID THESE INJECTION SITES –
Every body should strictly avoid the following given sites of injection.
Avoid taking Anabolic steroids injection on Thighs, Deltoid, Triceps, Biceps, Abdomen or any other part apart from Gluteal muscle. Means it is taken strictly into Gluteal muscle and deep intramuscular.
All oil based and water based anabolic steroids should be taken intramuscular only. This means the shot must penetrate the skin and subcutaneous tissue to enter the muscle itself. Intramuscular injections are used when prompt absorption is desired.
KNOW YOUR SYRINGE:
There are 3 parts to a syringe: the needle, the barrel, and the plunger. The needle goes into your muscle. The barrel holds the medicine and has markings on it like a ruler. The markings are in milliliters (mL). The plunger is used to get medicine into and out of the syringe.
BEST SITE FOR AN INTRAMUSCULAR INJECTION:
Keep track of where the injections are given: Make a list of the sites you use. Write down the date, time, and the site each time you give an injection.
CHANGE SITES FOR THE INJECTIONS:
It is important to use a different site each time you give an injection. This helps prevent scars and skin changes. The sites where injections are given should be at least 1 inch away from each other. Ask your caregiver if you need to inject the medicine in a certain site.
HOW TO GIVE AN INTRAMUSCULAR INJECTION?
Wash your hands with soap and dry them completely. Put on gloves if necessary.
Open the alcohol wipe: Wipe the area where you plan to give the injection. Let the area dry. Do not touch this area until you give the injection.
Prepare the needle: Hold the syringe with your writing hand and pull the cover off with your other hand. Place the syringe between your thumb and first finger. Let the barrel of the syringe rest on your second finger.
Hold the skin around where you will give the injection: With your free hand, gently press on and pull the skin so that it is slightly tight.
Insert the needle into the muscle: Hold the syringe barrel tightly and use your wrist to inject the needle through the skin and into the muscle at a 90 degree angle.
Check the needle: Let go of the skin with your other hand. Hold the syringe so it stays pointed straight in. Pull back on the plunger a little to make sure you did not hit a blood vessel. If blood comes back, remove the needle immediately. Do not inject the medicine. Dispose of both the syringe and the medicine. Get more medicine in a new syringe. When you give the second injection, give it on the other side.
Inject the medicine: Push down on the plunger to inject the medicine. Do not force the medicine by pushing hard. Some medicines hurt. You can inject the medicine slowly to reduce the pain.
Remove the needle: Once the medicine is injected, remove the needle at the same angle as it went in. Place gauze over the area where you gave the injection.
INTRAMUSCULAR INJECTION ABSORPTION:
Gluteal muscles in the buttock are fairly thick. Because of the large number of muscle fibers and extensive fascia, (fascia is a type of connective tissue that surrounds and separates muscles) the drug has a large surface area for absorption. Absorption is further promoted by the extensive blood supply to muscles. Ideally, intramuscular injections should be given deep within the muscle and away from major nerves and blood vessels.
BEST SITE FOR INTRA MUSCULAR INJECTION:
The best site for steroid injections is in the gluteus medius muscle which is located in the upper outer quadrant of the buttock. The iliac crest serves as a landmark for this quadrant. The spot for an injection in an adult is usually to 7 1/2 centimeters (2 to 3 inches) below the iliac crest. The iliac crest is the top of the pelvic girdle on the posterior (back) side. You can find the iliac crest by feeling the uppermost bony area above each gluteal muscle. The upper outer quadrant is chosen because the muscle in this area is quite thick and has few nerves. The probability of injecting the drug into a blood vessel is remote in this area. Injecting here reduces the chance of injury to the sciatic nerve which runs through the lower and middle area of the buttock. It controls the posterior of each thigh and the entire leg from the knee down. If an injection is too close to this nerve or actually hits it, extreme pain and temporary paralysis can be felt in these areas.