Medication Administration: Intramuscular Injections (Pediatric)
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Use the intramuscular (IM) injection route in pediatric patients only when it is the recommended route for a prescribed medication.
Take steps to eliminate interruptions and distractions during medication preparation.
The purpose of IM injections is to administer medication safely into the muscle below the subcutaneous layer. Many medications must be injected intramuscularly because of chemical properties, pharmacokinetics, desired onset, intensity and duration of the effect, and certain patient characteristics related to treatment compliance.
The injection site affects how much fluid can be given and how quickly the medication will be absorbed. The most appropriate sites for IM injections are the vastus lateralis (anterolateral thigh) for infants and toddlers and the deltoid muscle for pediatric patients 3 years and older.6 Selection of the injection site is based on the patient’s age, muscle mass, medication volume, and medication viscosity.
Local anesthesia or tactile stimulation should be considered to decrease pain at the injection site. Breastfeeding or giving supplemental breast milk during the injection can reduce pain in infants. The combination of oral sucrose and radiant warmth is effective analgesia for healthy neonates and young infants receiving IM vaccination.3 Diversional activities and education may comfort a patient receiving an IM injection. A child life specialist should be enlisted to support the patient, if available.
Because the recommended sites for pediatric IM injections for vaccines have no large blood vessels, the practice of aspiration for immunization or toxoids is unnecessary.2 However, aspiration is routinely used and is recommended when medications other than vaccines or toxoids are administered.
If the patient and family expresses concern regarding the accuracy of a medication, the medication should not be given. The concern should be explored, the practitioner notified, and the order verified.
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Ensure that parental or legal guardian consent is obtained for immunizations per the organization’s practice.
Tissue or nerve damage, scar tissue, poor muscle mass or tone, and lack of accessibility may be contraindications to using a particular site.
Do not use medication that is cloudy or precipitated unless such is indicated by its manufacturer as being safe.
Rationale: A filter needle prevents glass and large particles from being drawn into the syringe.
Position the patient to relax the muscle. Placing the patient’s hand on the hip relaxes the deltoid muscle. For the vastus lateralis site, the patient can sit on an adult’s lap. Some distraction techniques involve books, cell phones, tablets, music, videos, pictures, bubbles, and toys.
Rationale: A quick, smooth injection requires proper manipulation of the syringe parts.
Rationale: The Z-track technique creates a zigzag path through tissues that seals the needle track to avoid tracking medication. A quick, dart-like injection reduces discomfort. Z-track injections may be used for all IM injections.1
Rationale: Smooth manipulation of the syringe reduces discomfort from needle movement. Skin remains pulled until after medication is injected to ensure Z-track administration.
Rationale: Grasping the muscle body helps ensure that the medication reaches the muscle mass.
Rationale: Aspiration of blood into the syringe indicates possible placement into a vein.
Rationale: There is no definitive research to recommend eliminating aspiration other than for vaccination and toxoids.1
Rationale: Using gauze instead of an alcohol wipe prevents skin irritation.
Rationale: There is no definitive research to recommend eliminating aspiration other than for vaccination and toxoids.
Rationale: Massaging can force the medication into the subcutaneous tissue causing tissue damage and unpredictable absorption.
If the patient is an infant or toddler, a bandage can become a choking hazard. If one is applied, explain to the family that it must be removed before the patient is left alone.
At the completion of the procedure, ensure that all choking hazards (e.g., syringe caps, medication caps, alcohol wrappers, bandages) are removed from the patient’s linens and placed in the appropriate receptacle.
Reportable conditions: Adverse medication, medication-to-medication interaction, or allergic or anaphylactic reaction
Reportable conditions: Profuse bleeding, hematoma, loss of function, signs and symptoms of infection
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