HHC Health & Home Care Clinical Policy And

HHC HEALTH & HOME CARE Section: 11-4
Pediatrics: Intramuscular Injection - Infant __RN
PURPOSE:
To administer a prescribed dose of medication into a
large muscle.
CONSIDERATIONS:
Medications are given by injection to secure a fairly
rapid response and/or to administer medications which
cannot be given by another route:
1. The recommended site for administration in infants
is the vastus lateralis. It is the largest muscle mass
in an infant and has few major blood vessels and
nerves.
2. Gluteal muscles do not develop until the child
begins to walk; this site should be used only when
the child has been walking for at least one year.
3. The amount of injection solution tolerated at the
vastus lateralis site is 0.5cc for infants from birth to
1.5 years. A tuberculin syringe should be utilized to
draw up medication of less than 1cc.
4. Since infants often move unexpectedly, it is a good
idea to have an extra needle available to exchange
for a contaminated one. It is advisable to have an
additional person assist in immobilizing the infant
during the procedure.
5. During the procedure, the infant can be talked to or
given a toy for distraction.
6. Inject the medication slowly to allow the muscle to
distend to accommodate the medication into the
surrounding tissues.
7. A filter needle must be used to draw up medication
from an ampule and then replaced with appropriate
size needle for injection.
8. The needle length must be adequate to permeate
the subcutaneous tissue and deposit the medication
into the body of the selected muscle.
9. Use at least two (2) patient identifiers prior to
administering medications.
EQUIPMENT:
Disposable, sterile syringe with 20- to 25-gauge, 1/2" to
1" needle
Medication
Alcohol wipes
Gauze or cotton balls
Bandaid
Gloves
Impervious trash bag
Puncture-proof container
Extra 20- to 25-gauge, 1/2" to 1" needle
19-gauge filter needle (optional)
PROCEDURE:
1. Adhere to Universal Precautions.
2. Check doctor’s order for dosage, frequency and
route of administration.
3. Explain procedure to caregiver.
4. Locate the site - vastus lateralis. Draw an imaginary
line between the trochanter to just above the knee
on the outer aspect of the thigh. The middle third of
the thigh should be located by visually marking off
the area from the knee to the groin into thirds; the
middle third is used for injection.
5. Administer medication.
a. Check that the needle is securely attached to
syringe.
b. Cleanse top of vial with alcohol wipe or break
ampule with gauze.
c. Draw up correct dosage of medication; expel
any air in syringe.
d. Place infant in comfortable position. You may
need caregiver to hold infant.
e. Prepare selected site with alcohol wipe; allow to
dry.
f. Insert needle and aspirate. If there is no blood
return, inject medication. If there is blood
aspirated, remove needle and syringe and
choose another injection site.
g. Withdraw the needle, keeping slight pressure
over the area to avoid the tissue from pulling
upward as the needle is withdrawn.
h. Hold gauze over injection site. Massage if not
contraindicated. Apply bandaid.
i. Discard soiled supplies in appropriate
containers.
AFTER CARE:
1. Encourage caregiver to comfort infant.
2. Document in the patient's record:
a. Medication administered, date, dose, time,
route, and site.
b. Patient's response to procedure, side effects,
and management.
c. Instructions given to caregiver.
d. Communication with the physician.
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