Injections into the deltoid site in the arm can result in unintentional damage to the radial and axillary nerves. In rare cases when not performed properly, the injection may result in shoulder dysfunction. The most frequent complications of a deltoid injection include pain, redness, and inflammation around the injection site, which are almost always mild and last only a few days at most. The dorsogluteal site of injection is associated with a higher risk of skin and tissue trauma, muscle fibrosis or contracture, haematoma, nerve palsy, paralysis, and infections such as abscesses and gangrene. Furthermore, injection in the gluteal muscle poses a risk for damage to the sciatic nerve, which may cause shooting pain or a sensation of burning.
Risks and complications
Intramuscular injection
Intramuscular injection | Risks and complications
Yes, the most frequent complications of a deltoid injection include pain, redness, and inflammation around the injection site, which are almost always mild and last only a few days at most. Yes, the dorsogluteal site of injection is associated with a higher risk of skin and tissue trauma, muscle fibrosis or contracture, haematoma, nerve palsy, paralysis, and infections such as abscesses and gangrene. Injections into the deltoid site in the arm can result in unintentional damage to the radial and axillary nerves include pain, redness, and inflammation around the injection site, which are almost always mild and last only a few days at most. The dorsogluteal site of injection causes skin and tissue trauma, muscle fibrosis or contracture, haematoma, nerve palsy, paralysis, abscesses and gangrene. Injection in the gluteal muscle cause damage to the sciatic nerve, Yes - there is a risk of infection from bacteria or other organisms present in the environment or on the skin prior to the injection.
the three most commonly used sites for intramuscular injections are
user
The deltoid muscle of the upper arm, the gluteal muscle of the buttock, in infants, the vastus lateralis muscle of the thigh
assistant
does this have any complications?
user
Injections into the deltoid site in the arm can result in unintentional damage to the radial and axillary nerves. In rare cases when not performed properly, the injection may result in shoulder dysfunction. The most frequent complications of a deltoid injection include pain, redness, and inflammation around the injection site, which are almost always mild and last only a few days at most. The dorsogluteal site of injection is associated with a higher risk of skin and tissue trauma, muscle fibrosis or contracture, haematoma, nerve palsy, paralysis, and infections such as abscesses and gangrene. Furthermore, injection in the gluteal muscle poses a risk for damage to the sciatic nerve, which may cause shooting pain or a sensation of burning.
Intramuscular injection | Risks and complications
The site is located by dividing the front thigh into thirds vertically and horizontally to form nine squares; the injection is administered in the outer middle square. This site is also the usual site of administration for epinephrine autoinjectors, which are used in the outer thigh, corresponding to the location of the vastus lateralis muscle.
Intramuscular injection | Injection sites
The ventrogluteal (hip) site is used for injections which require a larger volume to be administered, greater than 1 ml, and for medications which are known to be irritating, viscous, or oily. It is also used to administer narcotic medications, antibiotics, sedatives and anti-emetics. The ventrogluteal site is located in a triangle formed by the anterior superior iliac spine and the iliac crest, and may be located using a hand as a guide. The ventrogluteal site is less painful for injection than other sites such as the deltoid site. The vastus lateralis site is used for infants less than 7 months old and people who are unable to walk or who have loss of muscular tone.
Intramuscular injection | Injection sites
Rarely, nerves or blood vessels around the injection site can be damaged, resulting in severe pain or paralysis. If proper technique is not followed, intramuscular injections can result in localized infections such as abscesses and gangrene. While historically aspiration was recommended to prevent inadvertent administration into a vein, it is no longer recommended for most injection sites.
Intramuscular injection | Introduction
The deltoid muscle (upper arm) is used for injections of small volume, usually equal or less than 2 ml. This includes most intramuscular vaccinations. It is not recommended to use the deltoid for repeated injections due to its small area, which makes it difficult to space out injections from each other. The deltoid site is located by locating the lower edge of the acromion process, and injecting in the area which forms an upside down triangle with its base at the acromion process and its midpoint in line with the armpit. An injection into the deltoid muscle commonly uses a 1-inch long needle, but may use a -inch long needle for younger people or very frail elderly people.
Intramuscular injection | Injection sites
An intramuscular injection can be administered in multiple different muscles of the body. Common sites for IM injection include: deltoid, dorsogluteal, rectus femoris, vastus lateralis and ventrogluteal muscles. Sites that are bruised, tender, red, swollen, inflamed or scarred are generally avoided. The specific medication and amount being administered will influence the decision of the specific muscle chosen for injection. The injection site is first cleaned using an antimicrobial and allowed to dry. The injection is performed in a quick, darting motion perpendicular to the skin, at an angle between 72 and 90 degrees. The practitioner will stabilize the needle with one hand while using their other hand to depress the plunger to slowly inject the medication - a rapid injection causes more discomfort.
Intramuscular injection | Technique
In some populations, a change in injection site, needle length, or technique is necessary. For example, in very young people or frail elderly people, a normal length needle may be too long to safely inject in the desired muscle. For this reason, in these people, a shorter needle is recommended to decrease the risk of injecting too deep. It is also recommended to consider using the anterolateral thigh as an injection site in infants under one year old. To help infants and children cooperate with injection administration, the Advisory Committee on Immunization Practices in the United States recommends using distractions, giving something sweet, and slow lateral swaying.
Intramuscular injection | Special populations
Intramuscular injection, often abbreviated IM, is the injection of a substance into a muscle. In medicine, it is one of several methods for parenteral administration of medications. Intramuscular injection may be preferred because muscles have larger and more numerous blood vessels than subcutaneous tissue, leading to faster absorption than subcutaneous or intradermal injections. Medication administered via intramuscular injection also is not subject to the first-pass metabolism effect which affects oral medications. Common sites for intramuscular injections include the deltoid muscle of the upper arm and the gluteal muscle of the buttock. In infants, the vastus lateralis muscle of the thigh is commonly used.
Intramuscular injection | Introduction
As with any injection which pierces the skin, there is a risk of infection from bacteria or other organisms present in the environment or on the skin prior to the injection. This risk is lessened with proper aseptic technique and cleansing of the area prior to administration. Intramuscular injections may also cause an abscess or gangrene at the injection site, depending on the specific medication and amount administered. There is also a risk of nerve or vascular injury if a nerve or blood vessel is inadvertently hit during injection. If single-use or sterilized equipment is not used, there is the risk of transmission of infectious disease between users.
Intramuscular injection | Risks and complications
Intramuscular injections began to be used for administration of vaccines for diphtheria in 1923, whooping cough in 1926, and tetanus in 1927. By the 1970s, researchers and instructors began forming guidance on injection site and technique to reduce the risk of injection complications and side effects such as pain. Also in the early 1970s, botulinum toxin began to be injected into muscles to intentionally paralyze them for therapeutic reasons, and later for cosmetic reasons. Until the 2000s, aspiration after inserting the needle was recommended as a safety measure, to ensure the injection was being administered in a muscle and not inadvertently in a vein.
Intramuscular injection | History
Sciatic nerve damage can also affect a person's ability to move their foot on the affected side, and other parts of the body controlled by the nerve. Damage to the sciatic nerve can be prevented by using the ventrogluteal site instead, and by selecting an appropriate size and length of needle for the injection.
Intramuscular injection | Risks and complications
Intramuscular injections, abbreviated as IM, deliver a substance deep into a muscle, where they are quickly absorbed by the blood vessels into systemic circulation. Common injection sites include the deltoid, vastus lateralis, and ventrogluteal muscles. Medical professionals are trained to give IM injections, but people who are not medical professionals can also be trained to administer medications like epinephrine using an autoinjector in an emergency. Some depot injections are also administered intramuscularly, including medroxyprogesterone acetate among others. In addition to medications, most inactivated vaccines, including the influenza vaccine, are given as an IM injection.
Injection (medicine) | Intramuscular injection
The area must be cleaned prior to administering the injection, and the injection should be administered in a fast, darting motion to decrease the discomfort to the individual. The volume to be injected in the muscle is usually limited to 2-5 milliliters, depending on injection site. A site should not be chosen which has signs of infection or muscle atrophy. Intramuscular injections should not be used in people with myopathies or clotting problems. Intramuscular injections commonly result in pain, redness, and swelling or inflammation around the injection site. These side effects are generally mild and last no more than a few days at most.
Intramuscular injection | Introduction
Injection fibrosis is a complication of intramuscular injection, occurring especially often in infants and children. Injections are often delivered to the quadriceps, triceps, and gluteal muscles, and thus the complication often manifests itself in those muscles. Patients are unable to fully flex the affected muscle. The condition is painless but progressively worsens over time. Orthopedic surgery is the typical treatment.
Injection fibrosis | Introduction
However, this is no longer recommended as evidence shows no safety benefit and it lengthens the injection, which causes more pain.
Intramuscular injection | History
Certain substances, including ketamine, may be injected intramuscularly for recreational purposes. Disadvantages of intramuscular administration include skill and technique required, pain from injection, anxiety or fear (especially in children), and difficult proper self-administration of medications. Vaccines, especially inactivated vaccines, are commonly administered via intramuscular injection. However, it has been estimated that for every vaccine injected intramuscularly, over 20 injections are given to administer drugs or other therapy. This can include medications such as antibiotics, immunoglobulin, and hormones such as testosterone and medroxyprogesterone. In a case of severe allergic reaction, or anaphylaxis, a person may use an epinephrine autoinjector to self-administer epinephrine in the muscle.
Intramuscular injection | Uses
Intramuscular administration of medication is contraindicated in people with an active infection at the injection site, and those with thrombocytopenia or clotting problems. It is also not recommended in people who are suffering from hypovolemic shock, myopathies, or muscle atrophy, as these may affect the absorption of the medication. Other forms of administration are preferred in people with a myocardial infarction, as the damage to the muscle from an injection may affect tests used in the evaluation thereof.
Intramuscular injection | Contraindications
The needle is withdrawn at the same angle inserted. Gentle pressure may be applied with gauze if bleeding occurs. Pressure or gentle massage of the muscle following injection may reduce the risk of pain. The CDC does not recommend the practice of aspirating for blood to rule out injecting into a blood vessel, as aspiration may increase the risk of pain. There is no evidence that aspiration is useful to increase safety of intramuscular injections when injecting in a site other than the dorsogluteal site.
Intramuscular injection | Technique
Common injection sites include the inner surface of the forearm and the upper back, under the shoulder blade..
Intradermal injection | Injection sites
Complications from facial autologous muscular injections are very rare. The procedure is minimally invasive and does not require the use of general anesthesia, however, local anesthesia is used to block the patient from feeling pain or discomfort. FAMI procedures are not surgical, it is an outpatient procedure done outside of a hospital. From the 2011 Advanced Techniques in Liposuction and Fat Transfer report, it was noted that in 726 cases over 14 years there were no reports of complications such as cytosteatonecrosis, pseudocyst formation, infections or other issues.
Facial Autologous Muscular Injection | Complications
Injections into muscular tissue may have taken place as early as the year 500. Beginning in the late 1800s, the procedure began to be described in more detail and techniques began to be developed by physicians practicing at the time. In the early days of intramuscular injections, the procedure was performed almost exclusively by physicians. In the mid 1900s, nurses began preparing equipment and patients for intramuscular injections as part of their delegated duties from physicians, and by 1961 they had "essentially taken over the procedure". To this time, there was not uniform procedures or education for nurses in proper administration of intramuscular injections, and complications from improper injection were common.
Intramuscular injection | History
Although there are risks of infections or other complications, with suitable precautions throughout the injection process, chances for these complications could be lowered.
Intravitreal injection | Introduction
The injection is usually done at the inferotemporal quadrant (i.e. the lower quadrant away from the nose) of the eye undergoing the procedure, as it is usually more accessible. However, depending on the eye's condition, patient's and the ophthalmologist's preference, other regions could also be used. Patient with aphakic (without lens due to cataract surgery), or pseudophakic eye (with implanted lens after removal of natural lens) would have the injection 3.0-3.5 mm posterior to the limbus, while injection to the phakic eye (with natural lens) is done 3.5-4.0 mm posterior to the limbus.
Intravitreal injection | Injection Site
In people who are overweight, a 1.5-inch needle may be used to ensure the injection is given below the subcutaneous layer of skin, while a -inch needle may be used for people who weigh under . In any case, the skin does not need to be pinched up prior to injecting when the appropriate length needle is used.
Intramuscular injection | Special populations
The most common side effects from this procedure include itching, rash, nausea, facial flushing/sweating. Some patients experience temporary weight gain due to the steroid. Diabetics may experience an increase in blood sugar. This is a quick and simple procedure, so complications are very rare, but should not be ignored. The risk of complications is decreased when proper aseptic technique is followed, and by the use of the imaging guidance. These complications include an epidural abscess due to infection, temporary increased pain, puncture of the sack containing spinal fluid, excess bleeding, nerve damage, leakage of local anesthetic into the spinal canal, and spondylodiscitis (disc inflammation).
Facet joint injection | Side effects and complications
Injection site reactions are allergic reactions that result in cutaneous necrosis that may occur at sites of medication injection, typically presenting in one of two forms, (1) those associated with intravenous infusion or (2) those related to intramuscular injection. Intra muscular injections may produce a syndrome called livedo dermatitis.
Injection site reaction | Introduction
The two primary complications are injury to the coronary artery and hemorrhage within the pericardium, or tamponade (blood filling the external covering of the heart, called pericardium, causing external pressure on the heart which prevents it from filling). The probability of complications can be reduced by using a narrow gauge of needle. Use of intracardiac injections requires the cessation of cardiopulmonary resuscitation and may be more time-consuming than other delivery methods.
Intracardiac injection | Complications
Intramuscular injection is commonly used for medication administration. Medication administered in the muscle is generally quickly absorbed in the bloodstream, and avoids the first pass metabolism which occurs with oral administration. The medication may not be considered 100% bioavailable as it must still be absorbed from the muscle, which occurs over time. An intramuscular injection can be administered faster and is less invasive than an intravenous infusion, as the site of injection (a muscle versus a vein) is much larger. Medications administered in the muscle may also be administered as depot injections, which provide slow continuing release of medicine over a long period of time.
Intramuscular injection | Uses
Injections into the skin and soft tissue generally do not cause any permanent damage, and the puncture heals within a few days. However, in some cases, injections can cause long-term adverse effects. Intravenous and intramuscular injections may cause damage to a nerve, leading to palsy or paralysis. Intramuscular injections may cause fibrosis or contracture. Injections also cause localized bleeding, which may lead to a hematoma. Intravenous injections may also cause phlebitis, especially when multiple injections are given in a vein over a short period of time. Infiltration and extravasation may also occur when a medication intended to be injected into a vein is inadvertently injected into surrounding tissues.
Injection (medicine) | Others
People who have previously been vaccinated against rabies do not need to receive the immunoglobulin, only the postexposure vaccinations on days 0 and 3. The side effects of modern cell-based vaccines are similar to the side effects of flu shots. The old nerve-tissue-based vaccination required multiple injections into the abdomen with a large needle but is inexpensive. It is being phased out and replaced by affordable World Health Organization intradermal-vaccination regimens. Intramuscular vaccination should be given into the deltoid, not the gluteal area, which has been associated with vaccination failure due to injection into fat rather than muscle. In children less than a year old, the lateral thigh is recommended.
Rabies | After exposure
BCG immunization generally causes some pain and scarring at the site of injection. The main adverse effects are keloids—large, raised scars. The insertion to the deltoid muscle is most frequently used because the local complication rate is smallest when that site is used. Nonetheless, the buttock is an alternative site of administration because it provides better cosmetic outcomes. BCG vaccine should be given intradermally. If given subcutaneously, it may induce local infection and spread to the regional lymph nodes, causing either suppurative (production of pus) and non-suppurative lymphadenitis. Conservative management is usually adequate for non-suppurative lymphadenitis. If suppuration occurs, it may need needle aspiration.
BCG vaccine | Adverse effects
Subconjunctival hemorrhage, "ptosis" (drooping eyelid) and vertical strabismus are the most common complications, most resolving within several weeks. Ptosis and vertical strabismus are caused by spreading of toxin to adjacent muscles, and their risk decreases with lower doses and more accurate injection techniques. Some "overcorrections", such as "exotropia" (eyes deviated outward) following treatment for infantile esotropia, usually lead to good long-term alignment, and is only an apparent complication. Severe complications, such as globe perforation and retrobulbar hemorrhage are rare. No systemic side effects have been reported in patients treated for strabismus, nor has immunity to botulinum toxin developed, even after multiple injections.
Management of strabismus | Complications
Injection in saline is normally conducted intramuscularly (IM) in skeletal muscle, or intradermally (ID), delivering DNA to extracellular spaces. This can be assisted either 1) by electroporation; 2) by temporarily damaging muscle fibres with myotoxins such as bupivacaine; or 3) by using hypertonic solutions of saline or sucrose. Immune responses to this method can be affected by factors including needle type, needle alignment, speed of injection, volume of injection, muscle type, and age, sex and physiological condition of the recipient.
DNA vaccination | Saline injection
The reactions caused by tests which use intradermal injection are more easily seen due to the location of the injection, and when positive will present as a red or swollen area. Common sites of intradermal injections include the forearm and lower back.
Injection (medicine) | Intradermal injection
Other infections may occur when pathogens enter the body through the injection site, most commonly due to improper cleaning of the site before injection. Infections occurring in this way are mainly localized infections, including skin infections, skin structure infections, abscesses, or gangrene. An intravenous injection may also result in a bloodstream infection (termed sepsis) if the injection site is not cleaned properly prior to insertion. Sepsis is a life-threatening condition which requires immediate treatment.
Injection (medicine) | Infection
Subcutaneous injections, abbreviated as SQ or sub-Q, consist of injecting a substance into the fat tissue between the skin and the muscle. Absorption of the medicine from this tissue is slower than in an intramuscular injection. Since the needle does not need to penetrate to the level of the muscle, a bigger gauge (thinner) and shorter needle can be used. Subcutaneous injections may be administered in the fatty tissue behind the upper arm, in the abdomen, or in the thigh. Certain medications, including epinephrine, may be used either intramuscularly or subcutaneously. Others, such as insulin, are almost exclusively injected subcutaneously.
Injection (medicine) | Subcutaneous injection
Severe injection site necrosis and sepsis has occurred (sometimes requiring amputation of limb) with multiple injection of pentazocine lactate. In addition, animal studies have demonstrated that Pentazocine is tolerated less well subcutaneously than intramuscularly.
Pentazocine | Tissue damage at injection sites
The needle is injected through the bone's hard cortex and into the soft marrow interior which allows immediate access to the vascular system. The IO needle is positioned at a 90 degree angle to the injection site, and the needle is advanced through manual traction, impact driven force, or power driven. Each IO device has different designated insertion locations. The most common site of insertion is the antero-medial aspect of the upper, proximal tibia as it lies just under the skin and is easily located. This is on the upper and inner portion of the tibia. Other insertion sites include the anterior aspect of the femur, the superior iliac crest, proximal humerus, proximal tibia, distal tibia, sternum (manubrium).
Intraosseous infusion | Procedure
Precautions should be taken before, during, and after the injection to lower the chances of complications:
Intravitreal injection | Precautions
Routes of administration of injections in laboratory mice are mainly subcutaneous, intraperitoneal and intravenous. Intramuscular administration is not recommended due to small muscle mass. Intracerebral administration is also possible. Each route has a recommended injection site, approximate needle gauge and recommended maximum injected volume at a single time at one site, as given in the table below: To facilitate intravenous injection into the tail, laboratory mice can be carefully warmed under heat lamps to vasodilate the vessels.
Laboratory mouse | Injection procedures
"Tuberculin" syringes and types of syringes used to inject insulin are commonly used. Commonly used syringes usually have a built-in 28 gauge (or thereabouts) needle typically 1/2 or 5/8 inches long. The preferred injection site is the crook of the elbow (i.e., the Median cubital vein), on the user's non-writing hand. Other users opt to use the Basilic vein; while it may be easier to "hit", caution must be exercised as two nerves run parallel to the vein, increasing the chance of nerve damage, as well as the chance of an arterial "nick".
Drug injection | Procedure
Like many injections, intravitreal injection is commonly performed in the office setting. An operation room may be a better option to provide a more sterile environment for the procedure to lower the chance of infections, yet it will also increase the costs. Since the occurrence of serious post-injection infection (e.g. endophthalmitis) is low, in-office intravitreal injection is preferred.
Intravitreal injection | Location
Botulinum toxin injection is commonly used for small and moderate degrees of infantile "esotropia", acquired adult strabismus, and where it is a consequence of retinal detachment surgery, that is, in cases where there is good potential for binocular vision, so that the corrected alignment can be stabilized by motor fusion. "Sixth nerve palsy," paralysis of the "lateral rectus", the muscle that rotates the eye outwards, is most frequently caused by an ischemic event, from which there is frequently substantial recovery. But during the acute stage of paresis, the lateral rectus is stretched and grows longer, and its antagonist medial rectus shortens.
Management of strabismus | Botulinum toxin
Shoulder injury related to vaccine administration (SIRVA) is "shoulder pain and limited range of motion occurring after the administration of a vaccine intended for intramuscular administration in the upper arm . . . thought to occur as a result of unintended injection of vaccine antigen or trauma from the needle into and around the underlying bursa of the shoulder". SIRVA has been described as under-reported and preventable, and "caused by incorrect technique or landmarking for intramuscular deltoid injections". Because the injury is a result of the injection technique rather than the substance injected, SIRVA can occur irrespective of the vaccine being administered.
Shoulder injury related to vaccine administration | Introduction
Equipment include syringes calibrated in tenths and hundredths of a milliliter. The dosage given is usually less than 0.5 mL, less than given subcutaneously or intramuscularly. A and 26 or 27 gauge thick needle is used.
Intradermal injection | Equipment
Reported adverse events are minor and temporary.
Surgery for temporomandibular joint dysfunction | Intra-articular injections
SIRVA is not caused by any specific medicine that is in an injection. Instead, it is caused by improper insertion of the needle used in injections. It is "a preventable occurrence caused by the injection of a vaccine into the shoulder capsule rather than the deltoid muscle. As a result, inflammation of the shoulder structures causes patients to experience pain, a decreased range of motion, and a decreased quality of life."
Shoulder injury related to vaccine administration | Cause
Methods to help prevent peripheral nerve injury include injection pressure monitoring. The presence of a high opening injection pressure (> 20 PSI) is a sensitive sign of intrafascicular/intraneural needle tip placement. Extrafascicular needle tip placement is associated with low pressures (< 20 PSI). Also, high pressure injection was associated with neurologic deficits and severe axonal damage after the block. Other methods of preventing peripheral nerve injury include electrical nerve stimulation and ultrasonography. Electrical stimulation with a motor response at < 0.2 mA only can occur with an intraneural/intrafasciular needle tip location.
Nerve injury | Prevention of intraneural injections
The vastus lateralis (), also called the "vastus externus" is the largest and most powerful part of the quadriceps femoris, a muscle in the thigh. Together with other muscles of the quadriceps group, it serves to extend the knee joint, moving the lower leg forward. It arises from a series of flat, broad tendons attached to the femur, and attaches to the outer border of the patella. It ultimately joins with the other muscles that make up the quadriceps in the quadriceps tendon, which travels over the knee to connect to the tibia. The vastus lateralis is the recommended site for intramuscular injection in infants less than 7 months old and those unable to walk, with loss of muscular tone.
Vastus lateralis muscle | Introduction
Side effects of intravitreal injection can be classified into two categories: drug-related side effects and injection-related side effects. For example, in an intravitreal steroid injection, complications could be divided into steroid-related adverse effects and injection-related adverse effects, in which the former most commonly include cataract formation and increase in intraocular pressure (IOP). Other examples of potential adverse effects are listed as follows: A surgery may be required to treat certain severe complications. Some of the above complications could also lead to blindness, or even loss of the eye (in the case of a severe infection).
Intravitreal injection | Possible Risks and Complications
Infection is typically controlled by administering 1 gram of the antibiotic cefazolin (Ancef) prior to surgery. Excessive blood loss and nerve/artery damage are rare occurrences in surgery and can usually be avoided with proper technique and diligence; however, the patient should be warned of these potential complications, especially in patients with severe injuries and scarring.
Posterolateral corner injuries | Complications
It is perforated by the ulnar nerve, the superior ulnar collateral artery, and the posterior branch of the inferior ulnar collateral artery.
Fascial compartments of arm | Intermuscular septa
Although the injury is typically associated with vaccination, it can also occur as the result of any other kind of injection into the shoulder area. However, examination of injury reports suggests that this type of injury is of increased severity when administration of a vaccine is involved, which "may be due either to the antigenic or nonantigenic components of the vaccine". In order to avoid this type of injury, injection administrators are advised to avoid injecting the patient too high, too low, or too far to the side, and to avoid using needles that fail to penetrate deeply into the muscle, or that penetrate too deeply and contact the bone.
Shoulder injury related to vaccine administration | Introduction
In patients with peripheral arterial disease, ligation of inferior epigastric vessels may lead to distal ischemia. Finally, the peritoneum is cut laterally. After the surgery, peritoneum is closed with an absorbable suture. The ties placed on the inferior epigastric vessels are inspected to ensure hemostasis. The rectus fascia is closed with monofilament absorbable suture. The rectus muscle stumps do not require suturing. The skin and subcutaneous tissue are closed with subcuticular suture. The complications associated with Maylard incision are delayed bleeding from cut edges of rectus muscles and from deep epigastric vessels. In some patients, the incision may not offer sufficient exposure of upper abdomen.
Maylard incision | Introduction
Side effects following intratumoral injection are limited to flu-like symptoms and resolve within 24 hours. Toxicology studies in New Zealand White rabbits (3 weekly i.v. doses of 10 PFU) showed that JX-594 was well tolerated, and no toxicologically significant effects were observed. There were no overt clinical signs, with the exception of ~5% of body weight loss by day 6 that was followed by a recovery by day 33.
Jennerex | Safety
Patients who are allergic to or sensitive to medications, contrast dyes, local anesthesia, iodine, or latex should not have this procedure. Potential risks are infections at the puncture site where the radiopaque substance and/or air are injected. Bleeding is also a small risk. Rarely, nephrogenic systemic fibrosis (NSF) can occur in patients with impaired renal function who receive gadolinium, a debilitating and potentially fatal disease affecting skin, muscle, and internal organs.
Arthrogram | Risks
However, in some cases, patients are taught to self-inject, such as SC injection of insulin in patients with insulin-dependent diabetes mellitus. As the drug is delivered to the site of action extremely rapidly with IV injection, there is a risk of overdose if the dose has been calculated incorrectly, and there is an increased risk of side effects if the drug is administered too rapidly.
Route of administration | Parenteral
Risks from drug injection are caused by a variety of factors, including unclean or unsafe injection practices and repeated injections at the same site. Injection drug users that fail to adequately sanitize the skin or use clean injection products are at increased risk for cellulitis, abscesses, and thrombophlebitis; these infections can subsequently result in sepsis and bacteremia, which can be fatal if untreated. Repetitive injections, especially those with unsafe practices, can result in additional medical concerns that include thrombosis formation and infectious endocarditis. In rare cases Osteomyelitis of the chest can be caused by IV drug use. Additional risks from unsafe injection practices result primarily from sharing materials (needles, cookers, syringes) used in injection.
Drug injection | Risks
The term injection encompasses intravenous (IV), intramuscular (IM), subcutaneous (SC) and intradermal (ID) administration. Parenteral administration generally acts more rapidly than topical or enteral administration, with onset of action often occurring in 15–30 seconds for IV, 10–20 minutes for IM and 15–30 minutes for SC. They also have essentially 100% bioavailability and can be used for drugs that are poorly absorbed or ineffective when they are given orally. Some medications, such as certain antipsychotics, can be administered as long-acting intramuscular injections. Ongoing IV infusions can be used to deliver continuous medication or fluids. Disadvantages of injections include potential pain or discomfort for the patient and the requirement of trained staff using aseptic techniques for administration.
Route of administration | Parenteral
Autotransplantation
Facial Autologous Muscular Injection | See also
The half-life of intramuscular progesterone is significantly longer when it is injected into the gluteal muscles of the buttocks rather than the deltoid muscle of the upper arm. Intramuscular progesterone has traditionally been the most popular form of progesterone used for luteal support in assisted reproduction in the United States, although vaginal progesterone is also used and effective. With intramuscular injection of 10 mg progesterone in vegetable oil, maximum plasma concentrations (C) are reached at approximately 8 hours after administration, and serum levels remain above baseline for about 24 hours. Doses of 10, 25, and 50 mg via intramuscular injection have been found to result in average maximal concentrations of 7, 28, and 50 ng/mL, respectively.
Pharmacokinetics of progesterone | Oil solutions
Pectoralis major muscle in rare occasions may develop intramuscular lipomas. Such rare tumors may mimic malignant breast tumors as they look like enlargements of the breasts. They are well-encapsulated radiolucent tumours of fat density. Their location can be accurately identified through computed tomography and magnetic resonance imaging (MRI). The treatment in these cases involves complete surgical excision because of the risk of liposarcoma they post especially large intramuscular liposomas. Partial excision is risky because recurrence may occur.
Pectoralis major | Other diseases
Since the great vessels are located ventrally to the vertebral bodies, the needle should be three to five millimeters dorsal to the most ventral portion of the vertebral body. The injection occurs once the correct position has been put in place. The physician should be able to see the coverage of the anterior portion of the vertebral body from L1 to L3. An increase by two or three degrees Celsius in the affected limb indicates a successful injection. Blood vessel dilation may also cause the affected limb to look very flushed.
Lumbar ganglia | Clinical Significance
“Routine botulinum toxin infiltration of the chest wall musculature at the time of mastectomy and immediate reconstruction…would paralyze the muscles and reduce the postoperative pain caused by muscle spasm.”
Lateral pectoral nerve | Clinical significance
Vaccination with Emergent BioSolutions "BioThrax AVA" and "BioThrax IM" intramuscular injections in the deltoid is given at 0 and 4 weeks, with three vaccinations at 6, 12, and 18 months, followed by annual boosters. As of 11 December 2008, the new "BioThrax IM" for intramuscular injections in the deltoid was approved by the US FDA which changes the immunity initialization sequence from 6 to 5 shots given at 0 and 4 weeks and then at 6, 12, and 18 months, followed by annual boosters. This prolonged initialization sequence is required with annual booster shots, because the anthrax vaccine's primary ingredient, the Anthrax Protective Antigen, can impair the life-cycle of the human immune system's memory B-Cells and memory T-cells, through inducing the production of immunoglobulin G (IgG) which sequesters furin.
Anthrax vaccine adsorbed | Vaccination schedule
After immunoglobulin therapy's discovery and description in "Pediatrics" in 1952, weekly intramuscular injections of immunoglobulin (IMIg) were the norm until intravenous formulations (IVIg) began to be introduced in the 1980s. During the mid and late 1950s, one-time IMIG injections were a common public health response to outbreaks of polio before the widespread availability of vaccines. Intramuscular injections were extremely poorly tolerated due to their extreme pain and poor efficacy – rarely could intramuscular injections alone raise plasma immunoglobulin levels enough to make a clinically meaningful difference.
Immunoglobulin therapy | 1950s – intramuscular
Fungal infections associated with nonepidural injections were also reported. They were related to injections in a peripheral joint space, such as a knee, shoulder, or ankle. People injected in peripheral joints were at risk for joint infections but were not believed to be at risk for meningitis.
New England Compounding Center meningitis outbreak | Clinical features
A vaccine administration may be oral, by injection (intramuscular, intradermal, subcutaneous), by puncture, transdermal or intranasal. Several recent clinical trials have aimed to deliver the vaccines via mucosal surfaces to be up-taken by the common mucosal immunity system, thus avoiding the need for injections.
Vaccination | Routes of administration
Serious complications from an MVD include death (0.1%), stroke (1%), hearing loss (3%) and facial weakness (0.5%). Dr. Jannetta has called facial paralysis (as opposed to weakness) a "major and common complication of the MVD." (2 separate depositions under oath: Levy v Jannetta, CCP Allegheny County, GD 81-7689. Other complications include leakage of spinal fluid and wound infection (1%). Most patients will have transient neck pain and stiffness from the surgical incision and from seeding of the spinal fluid with small amounts of blood.
Microvascular decompression | Complications
Regular physiotherapy is recommended to reduce the risk of contractures, shortening and hardening of the muscles. Feeding may become difficult and alternative feeding strategies including nasogastric tubes or percutaneous endoscopic gastrostomies may become necessary due to progressive bulbar dysfunction. The influenza vaccine is used in combination with prophylactic antibiotics to prevent chest infections.
Dopamine transporter deficiency syndrome | Prevention of secondary complications
for CHNO: 370.1681. Found: 370.1692.
Intramolecular Heck reaction | Example Procedure
With extraordinary successes came certain risks and failures. The general risks of the surgery, in addition to standard risks of surgery, include permanent paralysis of the target muscle, recurrence of phantom limb pain, and development of painful neuromas. With the first patient, the ulnar nerve transfer was not successful. The muscle region was not reinnervated as expected, but instead turned bluish after mobilization, possibly due to a congestion of vascular supply. With the left-arm amputation woman mentioned above, her phantom limb pain returned after surgery. Though at a lesser degree and resolved within 4 weeks, it still presented a serious risk because it is unclear whether it will resolve in other future patients.
Targeted reinnervation | Risks and Complications
Tentative evidence supports the use of bisphosphonates, calcitonin, and ketamine. Nerve blocks with guanethidine appear to be harmful. Evidence for sympathetic nerve blocks generally is insufficient to support their use. Intramuscular botulinum injections may benefit people with symptoms localized to one extremity.
Complex regional pain syndrome | Medications
The presence of the epitrochleoanconeus muscle can lead to ulnar neuropathy, or cubital tunnel syndrome, due to compression of the ulnar nerve. The absence of epitrochleoanconeus muscle or Osborne's ligament can increase the chances of ulnar nerve dislocation.
Epitrochleoanconeus muscle | Clinical significance
EMG guidance generally provides more effective injections, but is only suitable for alert, cooperative adults. Because injection treatment does not result in the scarring that is often a troublesome consequence of conventional strabismus surgery, if therapeutic goals are not achieved with one injection, additional injections or surgical treatments can readily be given. Replacement of strabismus surgery with less invasive procedures began in Alan B Scott’s San Francisco lab with his development of botulinum toxin injection treatment. Some forms of strabismus can be corrected by weakening an extraocular muscle. Botulinum toxin blocks the neuromuscular transmission and thus paralyzes injected muscles. Paralysis is temporary, and it might seem that injections would always need to be repeated, except that muscles adapt to the lengths at which they are chronically held, so that a paralyzed muscle tends to get stretched-out by its antagonist and grows longer by addition of serial "sarcomeres" (the contractile units of skeletal muscles), while the antagonist tends to grow shorter by deletion of sarcomeres, thereby maintaining re-alignment when the toxin-caused paralysis has resolved.
Management of strabismus | Medication
If the IEI or clinical signs are suggestive of vascular injury, the person may undergo surgery or receive further imaging including CT angiography or conventional arteriography.
Gunshot wound | Extremities
Testosterone undecanoate and testosterone buciclate can be injected intramuscularly as infrequently as four times per year.
Pharmacokinetics of testosterone | Intramuscular injection
A 1996 study of blood donors (a larger needle is used in blood donation than in routine venipuncture) found that 1 in 6,300 donors suffered a nerve injury.
Venipuncture | Complications
In contrast to oral administration, which is associated with very low bioavailability (<10%), the bioavailability of both estradiol and estradiol esters like estradiol valerate is complete (i.e., 100%) via intramuscular injection. In addition, estradiol esters like estradiol cypionate and estradiol valerate when given as an injection of oil solution or microcrystalline aqueous suspension have a relatively long duration due to the formation of an intramuscular depot from which they are slowly released and absorbed. Upon intramuscular injection of estradiol cypionate in an oil solution, the solvent (i.e., oil) is absorbed, and a primary microcrystalline depot is formed within the muscle at the site of injection.
Estradiol cypionate | Intramuscular injection
In 2004, the topic of droplet contamination was not addressed. Since then new evidence has come to light showing that streptococcal species cause a disproportionate number of post intravitreal injection endophthalmitis cases compared to other forms of ocular surgery. This is likely due to aerosolized droplet contamination from either the practitioners’ or patients’ mouth. The 2014 guidelines were updated to address these findings recommending both clinicians and patients wear face masks during the procedure.
Intravitreal administration | New Recommendations in 2014
Emergent intramuscular dosing can be given if child is not tolerating oral medications or unable to get IV within 15 minutes. IM hydrocortisone sodium succinate doses are:
Stress dose | Pediatric doses
Intradermal injection, often abbreviated ID, is a shallow or superficial injection of a substance into the dermis, which is located between the epidermis and the hypodermis. This route is relatively rare compared to injections into the subcutaneous tissue or muscle. Due to the more complex use, ID injections are not the preferred route of administration for injection and therefore used for certain therapies only, such as tuberculose tests and allergy tests. Specific benefits are a higher immune responses for vaccinations, immunology and novel cancer treatments and faster drug uptake, since for certain small and well soluble proteins or molecules, ID route of administration is associated with fast uptake systemically compared to subcutaneous injections, applied in novel closed loop insuline infusion systems.
Intradermal injection | Introduction
Complications associated with this block are either ocular or systemic. Local ocular complications include hematoma formation, optic nerve damage and perforation of the globe with possible blindness. Systemic complications include local anesthetic toxicity, brainstem anesthesia, and stimulation of the oculocardiac reflex. Most commonly, patients will report discomfort during the performance of the block, such as the sensation of the needle during insertion and/or pressure behind the eye during injection. In recent years, peribulbar block has become increasingly used because of its lower incidence of complications.
Retrobulbar block | Side effects and complications
Lipohypertrophy is a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action. It is a common, minor, chronic complication of diabetes mellitus. Typical injection site hypertrophy is several inches or cm across, smoothly rounded, and somewhat firmer than ordinary subcutaneous fat. There may be some scar tissue as well, but the major component is adipose tissue, as insulin exerts a hypertrophic effect on adipose cells. To avoid lipohypertrophy, persons with diabetes mellitus who inject insulin daily for an extended period of time are advised to "rotate" their injections among several areas (usually upper, outer arms, outer thighs, abdomen below and around the umbilicus, and the upper parts of the buttocks).
Lipohypertrophy | Introduction
Instances in which the medial epicondyle of the distal humerus is malformed due to the initial fracture at the humeral endplate may result in subluxation (snapping) of the ulnar nerve over the medial epicondyle with active flexion and extension of the elbow. In such instances, conductance of the ulnar nerve may be compromised due to chronic irritation, potentially resulting in irreversible ulnar neuropathy.
Cubitus varus | Complications
Injection without a device such as an ultrasound or fluoroscope to guide the needle can cause pneumothorax, a condition where air enters the cavity surrounding the lung.
Intercostal nerve block | Risks
There is some suggestion that birth defects are increased with the use of IVF in general, and ICSI specifically, though different studies show contradictory results. In a summary position paper, the Practice Committee of the American Society of Reproductive Medicine has said it considers ICSI safe and effective therapy for male factor infertility, but may carry an increased risk for the transmission of selected genetic abnormalities to offspring, either through the procedure itself or through the increased inherent risk of such abnormalities in parents undergoing the procedure. There is not enough evidence to say that ICSI procedures are safe in females with hepatitis B in regard to vertical transmission to the offspring, since the puncture of the oocyte can potentially avail for vertical transmission to the offspring.
Intracytoplasmic sperm injection | Complications
The trapezoidal insertion of the infraspinatus onto the humerus is much larger than the equivalent insertion of the supraspinatus, the reason why the infraspinatus is involved in rotator cuff tears about as frequently as the supraspinatus.
Infraspinatus muscle | Structure
When FICB is performed with the loss of resistance technique, the injection site for FICB is found by drawing an imaginary line between the pubic tubercle to the anterior superior iliac spine. The injection site is 1 cm. below the lateral one third and the medial two thirds of this line. Two losses of resistances are felt as the fascia lata and the fascia iliaca is penetrated by a semi-blunt cannula. Aspiration (drawing back the cannula) is performed, after which a local analgesic is injected while compressing on the skin distally to increase cranial distribution. FICB can generally be performed with minimally required training and by non-medical practitioners
Fascia iliaca block | Technique
Diplopia occurs rather frequently in the first few weeks following surgery. Complications that occur rarely or very rarely following surgery include: eye infection, hemorrhage in case of scleral perforation, muscle slip or detachment, or even loss of vision. Eye muscle surgery gives rises to scarring (fibrosis); if scarring is extensive, it may be seen as raised and red tissue on the white of the eye. Fibrosis can be reduced by use of mitomycin C during surgery.
Strabismus surgery | Complications
The rhomboid muscles, trapezius, levator scapulae and latissimus dorsi are transected. The neurovascular bundle consisting of the axillary artery, axillary vein and brachial plexus is ligated and cut. The area of the chest left exposed is then normally covered with a split-thickness skin graft.
Forequarter amputation | Surgical technique
Alternatively, a person can be fitted with custom made footwear which corrects the difference in leg lengths. Other surgery to re-balance muscular agonist/antagonist imbalances may also be helpful. Extended use of braces or wheelchairs may cause compression neuropathy, as well as a loss of proper function of the veins in the legs, due to pooling of blood in paralyzed lower limbs. Complications from prolonged immobility involving the lungs, kidneys and heart include pulmonary edema, aspiration pneumonia, urinary tract infections, kidney stones, paralytic ileus, myocarditis and cor pulmonale.
Polio | Complications
Intravenous infusion or intravitreous injection.
Foscarnet | Administration
Intravitreal injections have vastly improved outcomes for patients with retinal diseases however the risk and patient burden associated with repeated injections has prompted researchers to pursue less invasive methods of application. There has been significant emphasis on finding methods to administer treatments topically over the last 50 years. This research has garnered more attention thanks to the increase in intravitreal injections and the growing evidence linking repeat injections to adverse events.
Intravitreal administration | Potential alternatives
The volume of distribution at steady-state following intravenous administration is approximately 5.4 liters. Intersubject variability is about 40%.
Preotact | Distribution
This is particularly prevalent with injections into the buttocks and in overweight and obese individuals, due to the thicker layer of fat over muscle. Subcutaneous injections of estradiol esters may be easier and less painful to perform than intramuscular injections, and hence may result in improved compliance and satisfaction with therapy.
Pharmacokinetics of estradiol | Subcutaneous injection
Blockade of the lateral pectoral nerve is helpful in cases such as shoulder dislocation and other orthopedic procedures, involving the shoulder. Spasms of the pectoralis major muscle and resulting severe pain (acute or chronic) may be reduced by pectoral nerve block or neuromuscular relaxation. Decreasing the pectoral muscle tone intraoperatively by neuromuscular relaxation (paralytic agents) or by a nerve block (local anesthetic injection), can facilitate better cosmetic results during breast augmentation or post-mastectomy breast implantation. “The skin projection point of the neurovascular bundle (NVB) represents the denervation point (DP).” The NVB (thoracoacromial artery and vein, plus the lateral pectoral nerve) may be the guide for local anesthetic applications in order to achieve pectoral muscle denervation.
Lateral pectoral nerve | Clinical significance
Because DTaP and DT are administered to children less than a year old, the recommended location for injection is the anterolateral thigh muscle. However, these vaccines can be injected into the deltoid muscle if necessary. The World Health Organization (WHO) recommends six doses in childhood starting at six weeks of age. Four doses of DTaP are to be given in early childhood. The first dose should be around two months of age, the second at four months, the third at six, and the fourth from fifteen to eighteen months of age. There is a recommended fifth dose to be administered to four- to six-year-olds.
Tetanus vaccine | Schedule
Additionally, intramuscular injection of polyketals into the leg of rats shows no significant increases in inflammatory cytokines such as IL-6, IL-1ß, TNF-α and IL-12.
Heart nanotechnology | Use in myocardial infarction
Strabismus, otherwise known as improper eye alignment, is caused by imbalances in the actions of muscles that rotate the eyes. This condition can sometimes be relieved by weakening a muscle that pulls too strongly, or pulls against one that has been weakened by disease or trauma. Muscles weakened by toxin injection recover from paralysis after several months, so injection might seem to need to be repeated, but muscles adapt to the lengths at which they are chronically held, so that if a paralyzed muscle is stretched by its antagonist, it grows longer, while the antagonist shortens, yielding a permanent effect.
Botulinum toxin | Other muscle disorders