![]() Vaccines, especially inactivated vaccines, are commonly administered via intramuscular injection. Disadvantages of intramuscular administration include skill and technique required, pain from injection, anxiety or fear (especially in children), and difficulty in self-administration which limits its use in outpatient medicine. Certain substances, including ketamine, may be injected intramuscularly for recreational purposes. Medications administered in the muscle may also be administered as depot injections, which provide slow, continuous release of medicine over a longer period of time. : 102–103 An intramuscular injection is less invasive than an intravenous injection and also generally takes less time, as the site of injection (a muscle versus a vein) is much larger. The medication may not be considered 100% bioavailable as it must still be absorbed from the muscle, which occurs over time. Medication administered in the muscle is generally quickly absorbed in the bloodstream, and avoids the first pass metabolism which occurs with oral administration. Intramuscular injection is commonly used for medication administration. While historically aspiration, or pulling back on the syringe before injection, was recommended to prevent inadvertent administration into a vein, it is no longer recommended for most injection sites by some countries. If proper technique is not followed, intramuscular injections can result in localized infections such as abscesses and gangrene. Rarely, nerves or blood vessels around the injection site can be damaged, resulting in severe pain or paralysis. These side effects are generally mild and last no more than a few days at most. Intramuscular injections commonly result in pain, redness, and swelling or inflammation around the injection site. Intramuscular injections should not be used in people with myopathies or those with trouble clotting. A site with signs of infection or muscle atrophy should not be chosen. The volume to be injected in the muscle is usually limited to 2–5 milliliters, depending on injection site. The injection site must be cleaned before administering the injection, and the injection is then administered in a fast, darting motion to decrease the discomfort to the individual. In infants, the vastus lateralis muscle of the thigh is commonly used. Medication administered via intramuscular injection is not subject to the first-pass metabolism effect which affects oral medications.Ĭommon sites for intramuscular injections include the deltoid muscle of the upper arm and the gluteal muscle of the buttock. Intramuscular injection may be preferred because muscles have larger and more numerous blood vessels than subcutaneous tissue, leading to faster absorption than subcutaneous or intradermal injections. In medicine, it is one of several methods for parenteral administration of medications. The authors of this article present the current evidence on the dorsogluteal and ventrogluteal intramuscular injection sites in an attempt to assist nurse decision-making and guarantee the integration of evidence-based knowledge in order to improve patient care.Intramuscular injection, often abbreviated IM, is the injection of a substance into a muscle. Advancing the use of the ventrogluteal (located in the hip) injection site is a challenge, primarily owing to nurses' lack of familiarity with its anatomical landmarks and the published evidence on its benefits. Nurses in clinical practice continue to use and instruct student nurses in the use of the dorsogluteal (the large gluteal muscle in the buttocks) injection site as the site of choice for intramuscular injections, despite abundant evidence regarding the complications associated with using this site. This article considers the attitudes of nurses to evidence that challenges traditional practice, focusing in particular on conventional and contemporary best practice regarding injection sites. The nursing literature cites a number of barriers to evidence-based nursing, and notes that the research evidence for clinical practice utilization does not always percolate down to the clinical setting. At times new research and evidence will contradict established or traditional methods and clinical textbooks: this is in the nature of progress, and the challenge lies in disseminating this new evidence throughout the profession as quickly and widely as possible. Evidence-based practice requires the integration of the best available evidence in conjunction with clinical expertise to make decisions about patient care.
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