Young generations play an importance role for the future generation in their country. The government always gives priority to these generations including children, adolescents, and young adults. However, young adults acknowledged to have rights to take responsibilities for their own action Newman, B. R, possess the best for developing the country.
No Comments Case 1 A 46 year old morbidly obese diabetic patient arrives in your ED with hypoglycemia, altered mental status and diaphoresis, and no peripheral venous access.
The nurse gives the IM injection using the dorsogluteal site, and attempts at IV access continue. Case 2 A 55 year old woman with metastatic cancer, on an IV Dilaudid pump, is brought to the ED by her son for management of increasing pain that is not managed with the continuous infusion and intermittent boluses of 1 mg Dilaudid.
She is grim and quiet and you can see that she is in severe pain. However, she is extremely cachectic, with no IV access, no fat and very little muscle mass.
You cringe at the thought of a painful IM injection. Your nurse suggests a 2 mg dose of subq Dilaudid. You appreciate the recommendation and write the order. While in most EDs, nurses perform injections, in wilderness, prehospital, and disaster situations, physicians or paramedics must provide injections, so it is important to understand the anatomic principles of injection.
Currently the most commonly used sites for the rapid delivery of rescue medications are the IV, IM, and subcutaneous sites. These routes result in differences in drug absorption, onset of action, and duration of action of rescue medications. Muscles are very vascular structures, and IM absorption occurs by drug diffusion from interstitial fluid and capillary membranes into plasma, and so onset of action is longer than IV injection.
IM absorption depends upon blood flow. For example, if insulin is injected into the thigh, jogging right away may cause a precipitous drop in blood sugar because blood flow is increased in the thigh with running.
Local heat and massage can also increase blood flow and enhance IM absorption. The rate of absorption in the gluteus is slower than injection into the deltoid.
The main components of subcutaneous tissue are fat lobules and loose collagenous connective tissue. Medications injected subcutaneously must diffuse through the subcutaneous tissue to reach capillaries, and then be absorbed into the systemic circulation.
Consequently, onset of action is longer with sq than with IM administration. In addition, lipose-rich subcutaneous tissue is not vascular, so drug absorption is further prolonged if medication is delivered mostly into adipose tissue, and the drug can accumulate in adipose tissue, especially with repetitive dosing.
Rate of absorption is slower in females than in males because females have more fat. Lipophilic agents, such as fentanyl, can also accumulate in adipose tissue, affecting the anticipated onset of action and duration of the drug.
While fentanyl is highly lipophilic, hydromorphone is intermediate, and morphine is hydrophilic. Most notably, epinephrine onset of action varies from between 8 minutes to 34 minutes when given SC as opposed to with an IM auto injector. To prevent these delays and maximize the chances of an injection hitting its intramuscular target, select the appropriate location and needle length to do the job.
Selecting the Most Appropriate Site Choosing one of the approved locations and needle length for an IM injection seems arbitrary, but there is literature available to assist in decision-making.
One of the most popular location choices for IM injections is the dorsogluteal site. This site is located above the line between the greater trochanter and the posterior superior iliac crest, with the injection to be given in the superior lateral position to that line.
One of the inherent flaws with this injection site is its proximity to the sciatic nerve and large blood vessels, as well as the amount of subcutaneous tissue most human beings have at this location. When looking at needle length, patients who had a body mass index BMI of over The ventrogluteal site, rectus femoris and vastus lateralis location are the preferred location for large volume deep muscle IM injections.
These injection locations allow for a high degree of safety, reliability and accessibility when a patient is lying supine, prone or in side lying position.
The sites can support large volumes from 2 to 5mL and absorb quickly into the bloodstream. The deltoid is a small volume muscle and has longer peak plasma concentration times for drugs like epinephrine.
However, the absorption of SQ injections, whether intended or not intended, can be improved by applying heat or massage. While IV opioids have the fastest onset times Morphine: Epinephrine Adrenalin Administration of this drug needs more knowledge than meets the eye.
There are 3 studied routes for epinephrine administration: IM epinephrine administered in the lateral thigh using an autoinjector has the fastest increase in serum epinephrine compare to SQ administration.Deltoid Intramuscular Injection and Obesity.
Introduction According the World Health Organizations and Centers for Disease Control and prevention in United States, approximately one –third of adults are considered obese. An intramuscular, or IM, injection is a procedure used to insert medications into the muscle tissue.
Some medication cannot be taken by mouth because digestive juices can alter their effects.
However, this information cannot be explicitly extrapolated to a syringe used subcutaneously in the upper arm or an intramuscular injection in the deltoid muscle. Additionally, the effects of obesity and other absorption anomalies are not clear. The aim of this essay is to reflect on how I have become competent in a particular clinical skill.
() describe the correct way to give an intramuscular injection in the DG site using the Z tracking technique. into the subcutaneous fat leading to a deficit in the uptake of the drug.
Emerson () reports an increased risk of obesity. Hunter J () Intramuscular injection techniques. Nursing Standard. 22, 24, Date of acceptance: October 29 Summary The administration of intrairiLiscLitar (IM) injections is an important part of medication management and a common nursing intervention in clinical practice, A skilled injection technique can make the patient’s.
Are IM Injections IM in Obese and Overweight Females? A Study in Injection Technique Sara Palma, BSN, RN Needle length for intramuscular injection in deltoid muscle. ). Other factors influencing the injection with a 16 mm needle are obesity (which thickens SC tissue) and whether the needle is inserted fully or if a few millimeters.