The document discusses the history, prevalence, and proper procedures for intramuscular injections. It notes that while injections became popular after World War II, as many as 70-95% of injections given in India are unnecessary. The document provides guidance on selecting injection sites, preparing syringes safely, administering injections correctly, and disposing of used equipment to avoid infections and other complications. It emphasizes giving injections only when truly needed and ensuring any injection administered is done so safely.
1. Dr. Kamlesh R. Lala
MBBS, D PED, FCGP
NARANPURA
AHMEDABAD
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2. HISTORY
The first injection was given in 1920,
but became popular only after second world war.
Now injections are probably the most common
percutaneous procedure practiced worldwide
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3. MAGNITUDE
An estimated 12 billion injections are administered
each year.
The average no of injections range from 0.9 to 8.5 per
person per year.
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4. DEFINITION
Intramuscular injections are a common yet complex
technique used to deliver medication deep into the large
muscles of the body
It may be for curative, diagnostic or recreational purpose
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5. SURVEY
An Indian survey found that 96% of all injections
given by private doctors were of
antibiotics, vitamins, analgesics and chloroquine.
Surprisingly 70 to 95 % of such injections were
unnecessary.
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6. WHY INJECTIONS ???
Injections are stronger medication
Injections work faster and drug is more effective
Patient’s non compliance
Financial incentives
If I won’t give my colleague will give
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7. COMPLICATIONS
Giving IM injection is not a benign procedure. It is with
risk of disease, disability and even death
The most common one is transmission of blood borne
infections mainly Hepatitis B, Hepatitis C and HIV
These infections may be passed to HCW and even in
society
Do you know how ???
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8. Others are
Abscess
Muscle or fat necrosis
Muscle fibrosis and contracture
Gangrene
Nerve Injury
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9. WHAT IS SAFE INJECTION
Does no harm to recipient
Does not expose the HCW to any risk
Does not result in waste that is dangerous for the
community
Do you know two third of injections given in our
country are UNSAFE !! By reuse of syringe and needle
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14. It can be discussed under following heads
Site Selection
Preparation of Injection
Procedure
Post Injection Care
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15. Site Selection
The most common injection site is anterolateral thigh
into Vastus Lateralis muscle
Never use gluteal muscle in children
The other site in adult and in older children is deltoid
muscle
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19. REMEMBER
For giving vaccines including anti rabies vaccine
never select
gluteal muscle.
They are ineffective if injected so.
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20. RISKS OF GLUTEUS INJECTION
Injury to sciatic nerve
If medication is in fatty tissue then it may result into
necrosis and abscess
Chloroquine, Diclofenac and oily, viscous or depot
injections are always to be injected into gluteus muscle
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22. Injection medication may be
Available in prefilled syringe
Available in liquid form
Has to be reconstituted
Either in single dose or multidose vial
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23. MULTIDOSE VIAL
Where possible use single dose vial rather than a
multidose one
Never make multiple withdrawals from a single dose vial
Why ???
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24. Chances of infection are more common with MD vial
Because of
Reuse of same syringe for filling medication
Permanent insertion of needle into the vial
Storage of reconstituted vial
Opened vial kept submerged in water or ice
Rubber stopper wiped with antiseptic
Lack of proper hand hygiene
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25. EQUIPMENT SELECTION
Use only new disposable syringe and needle every time
Changing only the needle on the same syringe is also
not safe
Use wide bore needle rather than a narrow one
For oily or viscous injection use 20 or 21 no. needle
Use longer possible needle
For gluteus injections always use 1½ ” needle
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26. Skin preparation
Avoid site with oozing dermatitis or infection
If the skin is clean than no use of disinfection
Clean the site with single use spirit or alcohol swab in a
circular motion in an area 5-8 cms
Pre wetted cotton swabs are better to be avoided
If spirit is not available normal saline can be used
Never use Savlon or Dettol
Let the site be dry before injection
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27. Preparing Syringe
The area for preparing injection should be clean
Clean your hands with alcohol based hand wash
If you have cut or injury on fingers, cover it with water
proof adhesive
No need to use gloves routinely
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28. Preparing syringe
Remember to use new equipment
Observe aseptic precautions
No need to change the needle after withdrawing
medication
Do not ever wipe the needle with swab
Do not keep the air bubble inside the syringe
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29. Giving injection
We have found giving injection necessary
We have selected the site
We have prepared the syringe
So now comes giving injection
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30. Giving injection
Make the patient comfortable and give him a proper
position so as to identify the proper site for injection
Properly hold the child
Hold the syringe in your hand as if holding a pen
Remove needle cap immediately before giving
injection…not earlier
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31. Giving injection
Ensure smooth and steady insertion of the needle at
90 degree with a dart technique
No need to aspirate
Slowly push the medication allowing muscle fiber to
stretch and accommodate the injected volume
Wait for a while and remove the needle in the same
direction as it was pushed
Apply gentle pressure with a dry gauze
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33. Preventing Needle Stick Injury
Anticipate abrupt movement of the patient and take
care
More the used needle is handled or carried, the greater
is the risk of sharp injury
Never try to recap, bend or manually remove needle
from syringe
Do not move around with used equipment in hand
Keep needle destroyer near by only
Properly dispose it
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34. Multiple injections
Some times multiple injections are to be given in a
single visit especially for vaccines
Any no of injections can be given in a single visit
Use different anatomical site
If same limb is to be used than separate two injections
by 1-2”
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35. Post Injection Syncope
This is known side effect especially in
adolescents. So it is better to observe the patient
for 10-15 minutes
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36. According to WHO
Use injections only when necessary – oral
medicines are effective in most cases.
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