IM Injections: Is There A Safer Way???? By Jackie Rothermel, RN
PICO CO Question tion? • If nurses on 5B medical- surgical unit at UPMC St. Margaret Hospital received current evidence regarding safer IM injections, will they consider changing practice?
Pre Pre-Survey vey Questions tions 1.How many years have you been a nurse? 0-10 11-20 21-30 30< 2. What is your educational level? Diploma--Associate--BSN--MSN< 3. What is your preferred site for IM injections? Dorso-gluteal---Ventro-gluteal 4. Which IM injection site do you feel is safest for the patient? Dorso-gluteal---Ventro-gluteal 5. Which IM site were you taught as the preferred site during your nursing education? Self explanation answer
Pre Pre-Survey vey Re Results lts of 18 Re Respond ndents ents 1.How many years have you been a nurse? 0-10 (58.8%) 11-20 (29.4%) 21-30 (5.9%) >30 (5.9%) 2. What is your educational level? Diploma (88.9%)--Associate- (5.6%)-BSN (0)--MSN<(5.6%) 3. What is your preferred site for IM injections? Dorso-gluteal (55.6%) ---Ventro-gluteal (44.4%) 4. Which IM injection site do you feel is safest for the patient? Dorso-gluteal (50%) ---Ventro-gluteal (50%) 5. Which IM site were you taught as the preferred site during your nursing education? Self explanation answer : Dorso: 10 Ventro: 4 Other: 4
Go Goal als • To educate nurses regarding current evidence for safe IM injections. • To change practice from dorso- gluteal site to the safer ventro- gluteal site for better patient outcomes.
Potential Complications of IM Injections • Infection • Injection fibrosis • Muscle Contracture • Sciatic nerve injury • Hemorrhage/hematoma in patients with bleeding disorders • Pain • Abscesses/gangrene
Fo Forme mer Practice tice • Dorsogluteal: Upper Outer Quadrant of Gluteus maximus (buttocks)
Ne Newe wer Practic tice • Ventro-gluteal: Upper outer lateral hip area/ the Gluteus medius *Place heel of right hand over patient’s left greater trochanter (or visa versa) and position your index finger toward the anterior superior iliac spine. Stretch your middle finger away from your index finger. The center of the resulting triangle formed by your fingers and the iliac crest is your injection site- move away hand prior to injection to avoid self-injury!
Pros and Co Cons for Each Site Sites Pros Cons Cons Dorso-gluteal • Needle aspiration should be uddertaken • Unnecessary/unacceptable risk • Traditionally favored • Close proximity to sciatic and major • Observed in clinical practice blood vessels/damage risk • Easy to locate landmarks • Poor absorption of vaccine/meds • Dorso-gluteal muscle atrophy in the emaciated patient • Greater rate of abscesses Ventro-gluteal • Safe for all ages and first choice; no major • Small area for injection complication have been attributed; taught in • Difficulty locating the site nursing programs • What was taught vs. educating nurses • Increased muscle thickness makes it less on current evidence likely to inject into thinner SUB Q • Obvious deformities/scarring • Free from major nerves and blood vessels • Difficult to locate site on obese or thin • Used for volumes up to 5ml patients • Bony landmarks are easy to palpate for • Paralysis of the tensor fasciae latae accuracy of IMI muscle- very rare
Will Nurses Change Their Practice? • After exposure to current evidence regarding the safest IM site, will nurses consider changing their practice? • Results will be measured by a post- survey after multi-modal educational efforts are completed .
Results of Post-Survey (15) 1. 1. How w many ny years ars have ve you ou been en a nurse? rse? 0-10 years (12 or 80.0%) 11-20 years (0.0%) 21-30 years (0.0%) 30 or more years ( 3 or 20.0%) 2. What at is is your ur educ ucational ional le level? el? Diploma-10 (66.7%) Associate Degree-2 (13.3%) BSN-3 (13.3%) MSN or higher-1 (6.7%) 3.Would ould you u chan ange ge pra ractice ctice after er the education ucation based sed on new w evidence idence regarding egarding safer fer IM in inje jections? ions? A. Yes -14 (93.3%) B. No (0.0%) C. N/A – already prefer ventro-gluteal -1 (6.7%)
The Next Step! 1.Disseminate information 2.Present to Clinical Practice Council 3.Change current policy to correlate with current evidence 4.Policy refers to Lippincott- already recommends ventro- gluteal
References Cocoman, A., & Murray, J. (2008). Intramuscular injections: A review of best practice for mental health nurses. Journal of Psychiatric and Mental Health Nursing, 15 (5), 424-434. doi:10.1111/j.1365-2850.2007.01236.x Greenway, K. (2004). Using the ventrogluteal site for intramuscular injection. Nursing Standard (Royal College of Nursing (Great Britain) : 1987), 18 (25), 39-42. Hunt, C. W. (2008). Which site is best for an I.M. injection? Nursing, 38 (11), 62. doi:10.1097/01.NURSE.0000341089.14071.1e Jacobson, A. (1996). The right site for IM injections. The American Journal of Nursing, 96(4), 53. Malkin, B. (2008). Are techniques used for intramuscular injection based on research evidence? Nursing Times, 104 (50-51), 48-51. Mishra, P., & Stringer, M. D. (2010). Sciatic nerve injury from intramuscular injection: A persistent and global problem. International Journal of Clinical Practice, 64 (11), 1573-1579. doi:10.1111/j.1742-1241.2009.02177.x; 10.1111/j.1742- 1241.2009.02177.x Wynaden, D., Landsborough, I., McGowan, S., Baigmohamad, Z., Finn, M., & Pennebaker, D. (2006). Best practice guidelines for the administration of intramuscular injections in the mental health setting. International Journal of Mental Health Nursing, 15 (3), 195-200. doi:10.1111/j.1447-0349.2006.00423.x Zimmermann, P. G. (2010). Revisiting IM injections. The American Journal of Nursing, 110 (2), 60-61. doi:10.1097/01.NAJ.0000368058.72729.c6
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