HINT: How to promote comfort and safety when administering intramuscular injections?
Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.
HINT: How to promote comfort and safety when administering intramuscular injections?
SITUATION:
This QuickHit was developed to promote best practices for comfort and safety when administering intramuscular (IM) injections to children in home and community.
BACKGROUND:
An IM injection involves administration of a medication with a needle into the muscle. Medications can also be given into the skin (intradermal), just below the skin (subcutaneous) or into a vein (intravenous).
With the increasing availability of immunizations for infants and children in the community, including the introduction of a new immunization for respiratory syncytial virus (RSV) prevention, it is important to understand ways to promote best practices for comfort and safety when administering IM injection
ASSESSMENT:
For IM injections, the most appropriate site varies based on the age of the child. The size of the needle depends on the weight of the child and the type of medication. Needle gauge and length should ensure that the medication enters the muscle located deep and below the subcutaneous tissue. The table below outlines appropriate injection sites, needle gauge and needle length based on children's ages
Preferred Injection Sites and Landmarking
As outlined in the table above, there are two possible injection sites for IM injections.
Anterolateral thigh (shown in first image): the front outer side of the thigh. Divide the thigh into thirds; the injection site is in the middle third section.
Deltoid (shown in second image): the top, upper part of the arm.
RECOMMENDATION:
Connected Care recommends the following to promote comfort and safety when administering IM injections:
Select an appropriate injection site, needle gauge and needle size based on the child’s age and weight.
When injecting, hold the shaft of the syringe like a dart and insert the needle directly through the skin at a right angle (90-degree angle) into the muscle. Give the injection quickly, and do not pull back on the plunger before injecting as this causes more pain.
Apply firm pressure with a cotton ball to the injection site for 30 seconds after each injection to reduce the chance of bruising. Do not rub the area as it may irritate the skin.
Utilize appropriate comfort measures to reduce pain. Some options may include:
Medicines: topical anaesthetic agents (e.g., EMLA, lidocaine) can be applied before giving the injection.
Distraction: distraction techniques will vary based on age. For infants and younger children, this may include playing with a toy. For older children, they may choose to be distracted with a video game or music.
Imagery and relaxation: ask the child to try to imagine a pleasant experience and describe it using all their senses. Deep breathing may also be an effective comfort measure.
Positioning: place the child in a position that is most comfortable. For infants and toddlers, consider using the straddle position in which they are facing their caregiver, and their limbs are on each side (as shown in the image below). For older children, let them choose the best position for them (e.g., on a caregiver's lap, sitting upright on a chair).
Special Considerations for Infants: Sugar mixtures (oral sucrose 24%), breastfeeding and swaddling, if age appropriate.
Discard the needle and syringe into a sharps container with a lid. Do not try to put the cap back on the needle or discard needles into a regular garbage.
Review the AboutKidsHeatlh articles on IM injections and reducing pain with comfort positions.
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