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.
Special populations
Intramuscular injection
Intramuscular injection | Special populations
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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
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.
assistant
why is it taken?
user
In medicine, it is one of several methods for parenteral administration of medications.
assistant
is it meant for any specific populations?
user
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
assistant
which country was it used first?
user
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 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
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
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
However, this is no longer recommended as evidence shows no safety benefit and it lengthens the injection, which causes more pain.
Intramuscular injection | History
In the 1660s, J. D. Major of Kiel and J. S. Elsholtz of Berlin were the first to experiment with injections in humans. These early experiments were generally ineffective and in some cases fatal. Injection fell out of favor for two centuries.
Hypodermic needle | Early use and experimentation
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
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 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
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
The use of tourniquets and injected anesthesia to induce localized anesthesia was first introduced by August Bier in 1908. He used an Esmarch bandage to exsanguinate the arm and injected procaine between two tourniquets to rapidly induce anesthetic and analgesic effects in the site. Though it proved effective, IVRA remained relatively unpopular until C. McK. Holmes reintroduced it in 1963. Today, the technique is common due to its economy, rapid recovery, reliability, and simplicity.
Intravenous regional anesthesia | History
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
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
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
In developing countries, it is still common to draw blood using a syringe or syringes.
Vacutainer | History
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
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 practice of intracardiac injection originated in the 1800s. It was commonly performed during the 1960s, as it was considered the fastest way to get medication to the heart. The practice began declining during the 1970s as more reliable delivery methods (i.e., intravenous, endotracheal, and intraosseous) came into use. Around that time, studies revealed that intravenous injections were equally effective and were less prone to risks and complications.
Intracardiac 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
The ancient Greeks and Romans knew injection as a method of medicinal delivery from observations of snakebites and poisoned weapons. There are also references to "anointing" and "inunction" in the Old Testament as well as the works of Homer, but injection as a legitimate medical tool was not truly explored until the 17th century. Christopher Wren performed the earliest confirmed experiments with crude hypodermic needles, performing intravenous injection into dogs in 1656. These experiments consisted of using animal bladders (as the syringe) and goose quills (as the needle) to administer drugs such as opium intravenously to dogs. Wren and others' main interest was to learn if medicines traditionally administered orally would be effective intravenously.
Hypodermic needle | Early use and experimentation
The Ohio protocol, developed after the incomplete execution of Romell Broom, ensures the rapid and painless onset of anesthesia by only using sodium thiopental and eliminating the use of Pavulon and potassium as the second and third drugs, respectively. It also provides for a secondary fail-safe measure using intramuscular injection of midazolam and hydromorphone in the event intravenous administration of the sodium thiopental proves problematic. The first state to switch to use midazolam as the first drug in a new three-drug protocol was Florida on October 15, 2013. Then on November 14, 2013, Ohio made the same move. In the brief for the U.S.
Lethal injection | New lethal injection protocols
The Netherlands had the first staffed injection room, although they did not operate under explicit legal support until 1996. Instead, the first center where it was legal to inject drug was in Berne, Switzerland, opened 1986. In 1994, Germany opened its first site. Although, as in the Netherlands they operated in a "gray area", supported by the local authorities and with consent from the police until the Bundestag provided a legal exemption in 2000.
Harm reduction | Supervised injection sites (SIS)
On August 29, 1977, Texas adopted the new method of execution, switching to lethal injection from electrocution. On December 7, 1982, Texas became the first U.S. state and territory in the world to use lethal injection to carry out capital punishment, for the execution of Charles Brooks, Jr. The People's Republic of China began using this method in 1997, Guatemala in 1996, the Philippines in 1999, Thailand in 2003, and Taiwan in 2005. Vietnam first used this method in 2013. The Philippines abolished the death penalty in 2006, with their last execution being in 2000. Guatemalan law still allows for the death penalty and lethal injection is the sole method allowed, but no penalties have been carried out since 2000 when the country experienced the live televised execution of Manuel Martínez Coronado.
Lethal injection | Implementation
Ultimately, the vaccine was unsuccessful in the challenging climate of rural Australia, and it was soon superseded by a more robust version developed by local researchers John Gunn and John McGarvie Smith.
Anthrax | First vaccination
The first recorded attempt at administering a therapeutic substance via IV injection was in 1492, when Pope Innocent VIII fell ill and was administered blood from healthy individuals. The treatment did not work and resulted in the death of the pope and donors. There was virtually no success with any attempts at injection therapy until the 1800s, when in 1831 Thomas Latta studied the use of IV fluid replacements for cholera treatment. The first solutions which saw widespread use for IV injections were simple "saline-like solutions", which were followed by experiments with various other liquids, including milk, sugar, honey, and egg yolk.
Intravenous therapy | History
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 hypodermic needle and syringe in its current form was invented by the French scientist Charles Pravaz in 1851, and became especially known during the wars of that and the subsequent decade. However, the first well-known attempt to inject drugs into the body was a 1667 attempt to inject a solution of opium into a dog, and some had suspected that parenteral administration of drugs may work better based on the practise of rubbing opium and other drugs into sores or cuts on the skin for the purpose of causing systemic absorption and the beginnings of scientific understanding of the functioning of the lungs.
Drug injection | Origin and early use
1840s), chloral derivatives (1831 et seq.), ephedrine (1836?), nicotine (1828), and many others of all types, psychoactive and not. Morphine in particular was used much more widely after the invention of the hypodermic syringe, and the practise of local anaesthesia by infiltration was another step forward in medicine resulting from the hypodermic needle, discovered at around the same time that it was determined that cocaine produced useful numbing of the mucous membranes and eye.
Drug injection | Origin and early use
Intravitreal injection was first mentioned in a study in 1911, in which the injection of air was used to repair a detached retina. There were also investigations evaluating intravitreal antibiotics injection using sulfanilamide and penicillin to treat endophthalmitis in the 1940s, yet due to the inconsistency of results and safety concerns, this form of drug delivery was only for experimental use and not applied in patients. It was until 1998, that fomivirsen (Vitravene™), the first intravitreal administered medication, was approved by the U.S. Food and Drug Administration (FDA). In 2004, when Aiello et al. published the first guidelines for intravitreal injection in the journal ‘Retina’, fomivirsen was still the only medication licensed by the FDA for intravitreal injection.
Intravitreal injection | History
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
For examples of a real jet injector being called a hypospray: see. Scientists at MIT developed a needle-free injection system in 2012. High pressure air injectors have been used by the military as a common initial entry vaccination method since at least the mid 1980s. They were linked to a bulk drug supply and a sterilized high pressure air supply (air compressor). Far from painless, they pushed in a portion of skin similar to the action of a needle, instead of the fiction of seeping slowly through the pores. Unlike a needle, the hole did not close itself, and usually left a small bleeding wound.
Hypospray | In the real world
Duncan used autotransfusion during the amputation of limbs by removing blood from the amputated limb and returning it to the patient by femoral injection. This method was apparently fairly successful. A German, M. J. Theis, reported the first successful use of intraoperative autotransfusion in 1914, with a ruptured ectopic pregnancy. The earliest report in the American literature on the use of autotransfusion was by Lockwood in 1917 who used the technique during a splenectomy for Banti syndrome. Interest in the unrefined technique of autotransfusion continued through to the early 1940s, and was applied to various procedures including treatment of ectopic pregnancy, hemothorax, ruptured spleen, perforating abdominal injuries, and neurosurgical procedures.
Autotransfusion | History
Jacques Pépin and Annie-Claude Labbé reviewed the colonial health reports of Cameroon and French Equatorial Africa for the period 1921–59, calculating the incidences of the diseases requiring intravenous injections. They concluded that trypanosomiasis, leprosy, yaws, and syphilis were responsible for most intravenous injections. Schistosomiasis, tuberculosis, and vaccinations against smallpox represented lower parenteral risks: schistosomiasis cases were relatively few; tuberculosis patients only became numerous after mid-century; and there were few smallpox vaccinations in the lifetime of each person. The authors suggested that the very high prevalence of the Hepatitis C virus in southern Cameroon and forested areas of French Equatorial Africa (around 40–50%) can be better explained by the unsterile injections used to treat yaws, because this disease was much more prevalent than syphilis, trypanosomiasis, and leprosy in these areas.
History of HIV/AIDS | Other early injection campaigns
Needle exchange programs were first established in 1981 in Amsterdam as a response from the injecting-drug community to an influx of hepatitis B. Spurred to urgency by the introduction of HIV/AIDS, needle syringe programs quickly became an integral component of public health across the developed world. These programs function by providing facilities in which people who use injecting drugs can receive sterile syringes and injection equipment. Preventing the transmission of blood-borne disease requires sterile syringes and injection equipment for each unique injection, which is necessarily predicated upon access and availability of these materials at no cost for those using them.
Needlestick injury | Needle exchange programs
This vaccine could be administered by scarification, like the smallpox vaccine, and was given in combination to produce immunity to both diseases, but it also had severe systemic and neurologic complications in a few cases. Attempts to attenuate the virus used in the vaccine failed. Scientists at the Rockefeller Foundation developed another vaccine derived from the serum of an African named Asibi in 1927, the first isolation of the virus from a human. It was safer but involved the use of large amounts of human serum, which limited widespread use. Both vaccines were in use for several years, the Rockefeller vaccine in the Western hemisphere and England, and the Pasteur Institute vaccine in France and its African colonies.
Yellow fever vaccine | History
During the 1990s additional legal facilities emerged in other cities in Switzerland, Germany and the Netherlands. In the first decade of 2000, facilities opened in Spain, Luxembourg, Norway, Canada and Australia. Police corruption and street crime in the Kings Cross district of Sydney, prompted the Wood Royal Commission to recommend the opening of an injection facility in the area, with the Sydney Medically Supervised Injecting Centre (MSIC) opening in May, 2001. In Canada: problems with drug use, discarded needles and crime made Downtown Eastside of Vancouver the location for the first facility in North America, when Insite commenced operation in 2003.
Supervised injection site | Europe
Kenneth Biros was executed using the single-drug method. Washington State became the second state in the US to use the single-dose sodium thiopental injections for executions. On September 10, 2010, the execution of Cal Coburn Brown was the first in the state to use a single-dose, single-drug injection. His death was pronounced approximately one and a half minutes after the intravenous administration of five grams of the drug.
Sodium thiopental | Lethal injection
Hunter replied, saying that he had cited Wood and never claimed to have been first, and that his belief in the generalised effect of injected narcotics was correct rather than Wood's belief that morphine only worked locally.
Charles Hunter (physician) | Hypodermic research and debate over injection methods
Naturally occurring cases of cowpox were not common, but it was discovered that the vaccine could be “carried” in humans and reproduced and disseminated human-to-human. Jenner's original vaccination used lymph from the cowpox pustule on a milkmaid, and subsequent “arm-to-arm” vaccinations applied the same principle. As this transfer of human fluids came with its own set of complications, a safer manner of producing the vaccine was first introduced in Italy. The new method used cows to manufacture the vaccine using a process called “retrovaccination,” in which a heifer was inoculated with humanized cowpox virus, and it was passed from calf to calf to produce massive quantities efficiently and safely.
Cowpox | Medical use
Intracardiac injections of drugs were generally used only to provide emergency drugs to a patient if other approaches would be ineffective; for example if drugs could not be administered intravenously due to individual circumstances. The procedure is performed by inserting a long spinal needle into the ventricular chamber. The needle is inserted in the fourth intercostal space between the ribs. Today it is considered obsolete, and other routes to give drugs are preferred (i.e. via an endotracheal tube or intraosseous (direct in the bone))
Intracardiac injection | Procedure
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
The first record of an epidural injection is from 1885, when American neurologist James Corning of Acorn Hall in Morristown, NJ used the technique to perform a neuraxial blockade. Corning inadvertently injected 111 mg of cocaine into the epidural space of a healthy male volunteer, although at the time he believed he was injecting it into the subarachnoid space. Following this, in 1901 Fernand Cathelin first reported intentionally blocking the lowest sacral and coccygeal nerves through the epidural space by injecting local anesthetic through the sacral hiatus. The loss of resistance technique was first described by Achile Dogliotti in 1933, following which Alberto Gutiérrez described the hanging drop technique.
Epidural administration | History
In 2004 with the rise of intravitreal injections, a group of experts established the first general guidelines for administering intravitreal injections. Until an update in 2014 these were consensus guidelines in the US. In 2014 a panel of 16 health professionals with expertise in different aspects of the injection reviewed and revised the original guidelines. Together they released areas of general agreement, areas with no clear consensus, and recommended sequence of steps for intravitreal injection.
Intravitreal administration | Procedure and guidelines
The first hypodermic needle was first used by Dr. Alexander Wood and immediately efforts were made to improve the design. It was not until 1954, with the need for massive syringe distribution of Dr. Salk's polio vaccine, that the first disposable syringes were created. Initially made of glass, in 1961 plastic disposable syringes became available. The advent of the first low dead space syringe occurred with the creation of 1-ml syringes designed specifically for the administration of insulin. Then amongst the scare of HIV and rising concern of other communicable diseases to healthcare workers the creation of safety syringes occurred in 1988.
Low dead space syringe | History of needle and syringe designs
On May 11, 1977, Oklahoma's state medical examiner Jay Chapman proposed a new, less painful method of execution, known as Chapman's protocol: "An intravenous saline drip shall be started in the prisoner's arm, into which shall be introduced a lethal injection consisting of an ultrashort-acting barbiturate in combination with a chemical paralytic." After the procedure was approved by anesthesiologist Stanley Deutsch, formerly Head of the Department of Anaesthesiology of the Oklahoma University Medical School, the Reverend Bill Wiseman introduced the method into the Oklahoma legislature, where it passed and was quickly adopted (Title 22, Section 1014(A)). Since then, until 2004, 37 of the 38 states using capital punishment introduced lethal injection statutes (the last state, Nebraska, maintaining electrocution as single method until adopting injection in 2009, after its supreme court deemed the electric chair unconstitutional).
Lethal injection | Implementation
MMF was first described in 1998 by a consortium of French myopathologists as an emerging condition of unknown cause characterised by a defining lesion observed upon muscle biopsy. MMF was identified in patients affected by myalgia and fatigue. MMF was judged a consequence of a switch to intramuscular injection and the deltoid muscle being the preferred site of both vaccine injection and biopsy in France (while other sites were preferred for biopsy in other countries) and the commencement of HBV vaccination in French adults. Similar lesions could be detected in babies and children upon biopsy of the quadriceps as this is the site of vaccine administration in this group.
Macrophagic myofasciitis | Description
An alternative to syringes in the 1970s was to use a glass medicine dropper, supposedly easier to manipulate with one hand. A large hairpin was used to make a hole in the skin and the dropper containing the drug (usually heroin) was inserted and the bulb squeezed, releasing it into the tissues. This method was also reported—by William S Burroughs and other sources—for intravenous administration at least as far back as 1930.
Drug injection | Modifications
The first vaccine against TBE was prepared in 1937 in the brains of mice. Some 20 years later TBE vaccines derived from cell cultures (chicken embryo fibroblast cells) were developed and used for active immunization in humans in the former Soviet Union. Later, a purified, inactivated virus vaccine was developed which proved to be more immunogenic than previous TBE vaccines.
Tick-borne encephalitis vaccine | History
Others are used in some countries.
Rotavirus vaccine | Introduction
This may leave some countries unable to obtain the previously expected supply, while other providers get approvals and ramp up production.
Rotavirus vaccine | History
Development of the fully disposable hypodermic needle was spurred on in the 1950s for several reasons. The Korean War created blood shortages and in response disposable, sterile syringes were developed for collecting blood. The widespread immunization against polio during the period required the development of a fully disposable syringe system. The 1950s also saw the rise and recognition of cross-contamination from used needles. This led to the development of the first fully disposable plastic syringe by New Zealand pharmacist Colin Murdoch in 1956. This period also marked a shift in interest from needle specifications to general sterility and safety. The 1980s saw the rise of the HIV epidemic and with it renewed concern over the safety of cross-contamination from used needles.
Hypodermic needle | Modern improvements
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
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
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
Donations of human blood plasma and Factor VIII collected before 1975 often contained infectious levels of hepatitis B virus. Until the late 1960s, hypodermic needles were often reused by medical professionals, and tattoo artists' needles were a common source of infection. In the late 1990s, needle exchange programmes were established in Europe and the US to prevent the spread of infections by intravenous drug users. These measures also helped to reduce the subsequent impact of HIV and hepatitis C virus.
Social history of viruses | Hepatitis viruses
Intravitreal injections were proposed over a century ago however the number performed remained relatively low until the mid 2000s. Until 2001, intravitreal injections were mainly used to treat end-ophthalmitis. The number of intravitreal injections stayed fairly constant, around 4,500 injections per year in the US. The number of injections tripled to 15,000 in 2002 when triamcinolone injections were first used to treat diabetic macular oedema. This use continued to drive an increase to 83,000 injections in 2004. In 2005 bevacizumab and ranibizumab intravitreal injections for the treatment of wet-AMD caused a rise in injections to 252,000. In 2008, over 1 million intravitreal injections were performed.
Intravitreal administration | Epidemiology
Intravenous formulations began to be approved in the 1980s, which represented a significant improvement over intramuscular objections, as they allowed for a sufficient amount of immunoglobulin to be injected to reach clinical efficacy, although they still had a fairly high rate of adverse effects (though the addition of stabilizing agents reduced this further).
Immunoglobulin therapy | 1980s – intravenous
Hollywood actor Steve McQueen and his friends Bud Ekins, Dave Ekins, Cliff Coleman and John Steen represented United States at the 1964 ISDT held in East Germany. This would be the first United States team ever, organized by John Penton.
International Six Days Enduro | Trivia
Following ten Americans who received the vaccine in a trial, Ruth Atkins (born 1966) of Oxfordshire, a former nurse with the British National Health Service, was the first British volunteer to receive the experimental vaccine (on September 17, 2014) in a vaccine trial run by Oxford University researchers and funded by the Wellcome Trust and the UK government. This variant was only designed to protect against Ebola virus and not Sudan virus.
CAd3-ZEBOV | First British trial
The 19th century saw the development of medicines that were effective in small doses, such as opiates and strychnine. This spurred a renewed interest in direct, controlled application of medicine. "Some controversy surrounds the question of priority in hypodermic medication." Francis Rynd is generally credited with the first successful injection in 1844. Alexander Wood’s main contribution was the all-glass syringe in 1851, which allowed the user to estimate dosage based on the levels of liquid observed through the glass. Wood used hypodermic needles and syringes primarily for the application of localized, subcutaneous injection (localized anesthesia) and therefore was not as interested in precise dosages.
Hypodermic needle | 19th-century development
After Edward Jenner's 1796 demonstration that the smallpox vaccination worked, the technique became better known and smallpox became less deadly in the United States and elsewhere. Many colonists and natives were vaccinated, although, in some cases, officials tried to vaccinate natives only to discover that the disease was too widespread to stop. At other times, trade demands led to broken quarantines. In other cases, natives refused vaccination because of suspicion of whites. The first international healthcare expedition in history was the Balmis expedition which had the aim of vaccinating indigenous peoples against smallpox all along the Spanish Empire in 1803.
Population history of indigenous peoples of the Americas | Vaccination
The first professionally staffed service where drug injection was accepted emerged in the Netherlands during the early 1970s as part of the "alternative youth service" provided by the St. Paul's church in Rotterdam. At its peak it had two centers that combined an informal meeting place with a drop-in center providing basic health care, food and a laundering service. One of the centers was also a pioneer in providing needle-exchange. Its purpose was to improve the psychosocial function and health of its clients. The centers received some support from law enforcement and local government officials, although they were not officially sanctioned until 1996.
Supervised injection site | Europe
In 1853, he invented the first hypodermic needle that used a true syringe and hollow needle. Wood referred to his invention as "subcutaneous" rather than "hypodermic". The term "hypodermic" was actually invented by Charles Hunter, whose developments of Wood's invention and research into the method of administering pain relief angered Wood. Wood believed that injections should be directly into the area where pain was felt, because the effect could only be local, whereas Hunter argued that the injection could be given anywhere and had a general effect. The medical community supported Hunter's hypothesis, though it is Wood who has been better remembered subsequently.
Alexander Wood (physician) | Life
In the late 1970s, testosterone undecanoate was introduced for oral use in Europe, although intramuscular testosterone undecanoate had already been in use in China for several years. Intramuscular testosterone undecanoate was not introduced in Europe and the United States until much later, in the early to mid 2000s and 2014, respectively. Testosterone undecanoate was approved in the United States after three previous rejections due to safety concerns.
Testosterone undecanoate | History
Lethal injection is the practice of injecting one or more drugs into a person by a government for the express purpose of causing immediate death. While Nazi Germany was known to execute enemies of the state using an injection of lethal drugs, the first country to legalize and formally implement what is referred to today as lethal injection was the United States. The state of Texas adopted it as its form on capital punishment in 1977 and executed the first person by it, Charles Brooks Jr., in 1982. The practice was subsequently adopted by the other U.S. states using capital punishment.
List of people executed by lethal injection | Introduction
As of 2019, at least ten countries currently offer safe injection sites, including Australia, Canada, Denmark, France, Germany, Luxembourg, The Netherlands, Norway, Spain and Switzerland. In total, there are at least 120 sites operating. Although the United States does not currently have any safe injection sites, some cities such San Francisco, Philadelphia, and Denver are considering opening them, and some localities offer needle exchange programs. In 2018, the California State Assembly passed Assembly Bill 186 to launch a three-year pilot program in San Francisco for California's first safe injection sites, but this bill was not signed by the governor. Colorado and Pennsylvania have also expressed interest in offering safe injection sites.
Injection (medicine) | Society and culture
Intramuscular testosterone undecanoate was not introduced in Europe and the United States until much later (in the early to mid 2000s and 2014, respectively). The history of testosterone as a medication has been reviewed.
Testosterone (medication) | History
Needle-exchange programmes can be traced back to informal activities undertaken during the 1970s. The idea is likely to have been rediscovered in multiple locations. The first government-approved initiative (Netherlands) was undertaken in the early to mid-1980s, followed closely by other initiatives. While the initial programme was motivated by an outbreak of hepatitis B, the AIDS pandemic motivated the rapid adoption of these programmes around the world.
Needle and syringe programmes | History
The level of needle sharing among methamphetamine users is similar to that among other drug-injection users.
History and culture of substituted amphetamines | Injection
The earliest known use of muscle relaxant drugs was by natives of the Amazon Basin in South America who used poison-tipped arrows that produced death by skeletal muscle paralysis. This was first documented in the 16th century, when European explorers encountered it. This poison, known today as curare, led to some of the earliest scientific studies in pharmacology. Its active ingredient, tubocurarine, as well as many synthetic derivatives, played a significant role in scientific experiments to determine the function of acetylcholine in neuromuscular transmission. By 1943, neuromuscular blocking drugs became established as muscle relaxants in the practice of anesthesia and surgery.
Muscle relaxant | History
Both techniques are now used to identify when the needle has correctly been placed in the epidural space. In 1921 Fidel Pagés, a military surgeon from Spain, developed the technique of "single-shot" lumbar epidural anesthesia, which was later popularized by Italian surgeon Achille Mario Dogliotti. Later, in 1931 Eugen Aburel described using a continuous epidural catheter for pain relief during childbirth. In 1941, Robert Hingson and Waldo Edwards recorded the use of continuous caudal anesthesia using an indwelling needle, following which they described the use of a flexible catheter for continuous caudal anesthesia in a woman in labor in 1942.
Epidural administration | History
Using a modified Linac, the first patient in the United States was treated in Boston Brigham and Women's Hospital in February 1986.
Radiosurgery | History
By 1954, this vaccination was a mandatory treatment across Canada.
Indian hospital | Diagnosis
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
Simultaneous to Wood's work in Edinburgh, Charles Pravaz of Lyon also experimented with sub-dermal injections in sheep using a syringe of his own design. Pravaz designed a syringe measuring 3 cm (1.18 in) long and 5 mm (0.2 in) in diameter; it was made entirely of silver. Charles Hunter, a London surgeon, is credited with the coining of the term "hypodermic" to describe subcutaneous injection in 1858. The name originates from two Greek words: "hypo", "under", and "derma", "skin". Furthermore, Hunter is credited with acknowledging the systemic effects of injection after noticing that a patient's pain was alleviated regardless of the injection’s proximity to the pained area.
Hypodermic needle | 19th-century development
The axonal subtype was first described in 1986. Diagnostic criteria were developed in the late 1970s after the series of cases associated with swine flu vaccination. These were refined in 1990. The case definition was revised by the Brighton Collaboration for vaccine safety in 2009, but is mainly intended for research. Plasma exchange was first used in 1978, and its benefit was confirmed in larger studies in 1985. Intravenous immunoglobulins were introduced in 1988, and studies in the early 1990s demonstrated that they were no less effective than plasma exchange.
Guillain–Barré syndrome | History
Another method employed was the "arm to arm" method. This involved vaccinating an individual then transferring it to another as soon as the infectious pustule forms, then to another, etc. This method was used as a form of living transportation of the vaccine, and usually employed orphans as carriers. However, this method was problematic due to the possibility of spreading other blood diseases, such as hepatitis and syphilis. As was the case in 1861, when 41 Italian children contracted syphilis after being vaccinated by the "arm to arm" method. In 1913, E. Steinhardt, C. Israeli, and R. A. Lambert grew vaccinia virus in fragments of pig corneal tissue culture.
Vaccinia | History
Common injection sites include the inner surface of the forearm and the upper back, under the shoulder blade..
Intradermal injection | Injection sites
The injective-surjective-bijective terminology (both as nouns and adjectives) was originally coined by the French Bourbaki group, before their widespread adoption.
Bijection, injection and surjection | History
Over time, pen needles designed for insulin pens have become shorter, and it is now thought that a 4mm long needle is sufficient for most people to administer subcutaneously correctly. In 1989, an injector pen form of human growth hormone was licensed in New Zealand. In the US, a pen form of octreotide was approved by the FDA in 2020, under the trade name Byfenzia.
Injector pen | History
Hunter was very early in his career when he became interested in using syringes to administer injections of pain relief. In the 1860s, he improved on the design of the syringe that had been invented by Alexander Wood by adding the needle point and lateral opening. He also created a locking mechanism to prevent the needle from becoming detached when the plunger was pushed. Hunter initially followed Wood's method of using syringes to inject morphine locally, into the area where pain was located. However, when this area became infected for one of his patients, he injected elsewhere and realised that the results were still effective.
Charles Hunter (physician) | Hypodermic research and debate over injection methods
Hingson and Edwards studied the caudal region to determine where a needle could be placed to deliver anesthetic agents safely to the spinal nerves without injecting them into the cerebrospinal fluid.
History of neuraxial anesthesia | 20th century
Another nurse recalled that these were said to be vitamin injections, and it was also clear that the amounts of opiated injected were constant until September 1950, when another doctor first increased the dosage.
John Bodkin Adams | Trial
The first description of a subcutaneous route of administration for immunoglobulin therapy dates back to 1980, but for many years subcutaneous administration was considered to be a secondary choice, only to be considered when peripheral venous access was no longer possible or tolerable. During the late 1980s and early 1990s, it became obvious that for at least a subset of patients the systemic adverse events associated with intravenous therapy were still not easily tolerable, and more doctors began to experiment with subcutaneous immunoglobulin administration, culminating in an "ad hoc" clinical trial in Sweden of 3000 subcutaneous injections administered to 25 adults (most of whom had previously experienced systemic adverse effects with IMIg or IVIg), where no infusion in the "ad hoc" trial resulted in a severe systemic adverse reaction, and most subcutaneous injections were able to be administered in non-hospital settings, allowing for considerably more freedom for the people involved.
Immunoglobulin therapy | 1990s - subcutaneous
Buserelin was first described in 1976 and was introduced for medical use in 1984. Intranasal buserelin was the first GnRH agonist demonstrated to achieve medical castration in humans. This was initially observed via a marked decrease in circulating testosterone levels in a single patient in 1980.
Buserelin | History
IV drug use is a relatively recent phenomenon arising from the invention of re-usable syringes and the synthesis of chemically pure morphine and cocaine. It was noted that administering drugs intravenously strengthened their effect, and—since such drugs as heroin and cocaine were already being used to treat a wide variety of ailments—many patients were given injections of "hard" drugs for such ailments as alcoholism and depression.
Drug injection | History
In 1968, an improved and even weaker measles vaccine began to be distributed and has been the only measles vaccine used in the United States since 1968. About 85% of children globally have received this vaccine as of 2013. In 2015, at least 160 countries provided two doses in their routine immunization. The measles vaccine was first introduced in 1963. It is on the World Health Organization's List of Essential Medicines. As outbreaks easily occur in under-vaccinated populations, the disease is seen as a test of sufficient vaccination within a population.
Measles vaccine | Introduction
Despite being known citrate anticoagulation, its use is not widespread and during World War II, at most, a few hundred transfusions and always in an "almost" directly were performed: citrate donor blood was extracted and immediately transfused to the recipient. Early attempts to preserve blood for transfusion were made in Russia. The doctor Sergei Yudin first used in 1930 in Moscow Sklifosovsky Institute, a specialized emergency hospital, blood transfusion corpse coming to create a small reservoir with citrated blood kept at 4°C. By 1938 he had injected blood from this source 2 500 people, of which seven died and 125 experienced mild reactions such as fever and chills.
Frederic Durán-Jordà | Precedents
courts written by accessories, the State of Ohio implies that they were unable to find any physicians willing to participate in development of protocols for executions by lethal injection, as this would be a violation of medical ethics, such as the Geneva Promise, and such physicians would be thrown out of the medical community and shunned for engaging in such deeds, even if they could not lawfully be stripped of their license. On December 8, 2009, Kenneth Biros became the first person executed using Ohio's new single-drug execution protocol. He was pronounced dead at 11:47 am EST, 10 minutes after receiving the injection.
Lethal injection | New lethal injection protocols
EMP was originally introduced for use by intravenous injection. Subsequently, an oral formulation was introduced, and the intravenous preparation was almost abandoned in favor of the oral version.
Estramustine phosphate | History
George's Medical School library (now in Tooting). Phipps was the 17th case described in Jenner's first paper on vaccination.
Edward Jenner | Invention of the vaccine
This was the first time that its use was noted on the continent.
Ambleteuse | History
The first vaccine for passive immunology was discovered by a group of German scientists under the leadership of Emil von Behring in 1890. The first inactive tetanus toxoid was discovered and produced in 1924. A more effective adsorbed version of the vaccine, created in 1938, was proven to be successful when it was used to prevent tetanus in the military during World War II. DTP (which is the combined vaccine for diphtheria, tetanus, and pertussis) was first used in 1948, and was continued until 1991, when it was replaced with an acellular form of the pertussis vaccine due to safety concerns.
Tetanus vaccine | History
Injection drug use is a major risk factor for in many parts of the world. Of 77 countries reviewed, 25 (including the United States) were found to have a prevalence of of between 60% and 80% among people who use injection drugs. Twelve countries had rates greater than 80%. It is believed that ten million intravenous drug users are infected with ; China (1.6 million), the United States (1.5 million), and Russia (1.3 million) have the highest absolute totals. Occurrence of among prison inmates in the United States is 10 to 20 times that of the occurrence observed in the general population; this has been attributed to high-risk behavior in prisons such as IDU and tattooing with nonsterile equipment.
Hepatitis C | Drug use
This technique was first practiced by Herman Knapp in 1884. Here, 2% xylocaine is introduced into the muscle cone behind the eyeball. The injection is usually given through the inferior fornix of the skin of the outer part of the lower lid when the eye is in primary gaze. The ciliary nerves, ciliary ganglion, oculomotor nerve and abducens nerve are anesthetized in retrobulbar block. As a result, global akinesia, anaesthesia and analgesia are produced. The superior oblique muscle, which is outside the muscle cone, is not usually paralyzed. The complications of retrobulbar block are globe perforation, optic nerve injury, retrobulbar haemorrhage and extraocular muscle palsy.
Anesthesia for eye surgery | Retrobulbar block
Contrary to extracts, flashcards are reviewed with active recall. This means that extracts such as "George Washington was the first U.S. President" must ultimately be converted into questions such as "Who was the first U.S. President?" (Answer: George Washington), or "Who was George Washington?" (Answer: the first U.S. President), etc., or cloze deletions such as "[BLANK] was the first U.S. President", "George Washington was [BLANK]", etc.
Incremental reading | Method
As heroin grew in popularity in Chinese border regions, injections with used needles became more common, greatly accelerating the rate of infection. The disease spread over the next several years, confined mainly to drug using populations of ethnic minorities in poorer, rural areas, reaching other high-risk groups and provinces by 1995. Sichuan and Xinjiang first reported HIV outbreaks among injection drug users in 1995, the first two provinces besides Yunnan to do so. The following year, cases were confirmed in Guangdong, Guangxi, Beijing, Shanghai, and Guizhou. Additionally, an independent outbreak of a separate sub-strain of HIV among IDUs began in 1997 in the city of Pingxiang, Guangxi.
HIV/AIDS in China | Southern intravenous drug users
Further confusion was caused when, in 1891, Louis Pasteur honoured Jenner by widening the terms "vaccine/vaccination" to refer to the artificial induction of immunity against any infectious disease. "Inoculation" is used synonymously with "injection" in connection with the use of vaccines or other biopharmaceuticals, but has other meanings in e.g. laboratory work.
Variolation | Terminology
The first long-acting (depot) injections were antipsychotics fluphenazine and haloperidol. The concept of a depot injection arose before 1950, and originally was used to describe antibiotic injections that lasted longer to allow for less frequent administration.
Depot injection | Discovery
The animals of one group were injected with an anthrax vaccine prepared by Pasteur twice, at an interval of 15 days; the control group was left unvaccinated. Thirty days after the first injection, both groups were injected with a culture of live anthrax bacteria. All the animals in the unvaccinated group died, while all of the animals in the vaccinated group survived. After this apparent triumph, which was widely reported in the local, national, and international press, Pasteur made strenuous efforts to export the vaccine beyond France. He used his celebrity status to establish Pasteur Institutes across Europe and Asia, and his nephew, Adrien Loir, travelled to Australia in 1888 to try to introduce the vaccine to combat anthrax in New South Wales.
Anthrax | First vaccination