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.
Introduction
Intramuscular injection
Intramuscular injection | Introduction
In medicine, it is one of several methods for parenteral administration of medications. Intramuscular injection is commonly used for medication administration. For medication administration. For medication administration.
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
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 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
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
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
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
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
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
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
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
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
However, this is no longer recommended as evidence shows no safety benefit and it lengthens the injection, which causes more pain.
Intramuscular injection | History
Intradermal injections, abbreviated as ID, consist of a substance delivered into the dermis, the layer of skin above the subcutaneous fat layer, but below the epidermis or top layer. An intradermal injection is often given at a 5 to 15 degree angle with the needle placed almost flat against the skin. Absorption from an intradermal injection takes longer than when the injection is given intravenously, intramuscularly, or subcutaneously. For this reason, few medications are administered intradermally. Intradermal injections are most commonly used for sensitivity tests, including tuberculin skin tests and allergy tests, as well as sensitivity tests to medications a person has never had before.
Injection (medicine) | Intradermal injection
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
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
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 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
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
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
A dart injection is used to give a single intramuscular or subcutaneous injection to livestock without restraining the animal. It can be contrasted with hand injection. These injections are usually administered by a tranquilliser gun, if in the wild, or sometimes a blowgun if in captivity.
Dart injection | Introduction
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 drug is well and rapidly absorbed with a high bioavailability when injected intramuscularly. The T is 20 minutes in healthy individuals and 33.8 minutes in patients with schizophrenia. The mean T is 20.7 hours. The decanoate injectable formulation is for intramuscular administration only and is not intended to be used intravenously. The plasma concentrations of haloperidol decanoate reach a peak at about six days after the injection, falling thereafter, with an approximate half-life of three weeks.
Haloperidol | Intramuscular injections
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
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
It is called so because it is in the shape of the Greek capital letter delta (Δ). Deltoid is also further shortened in slang as "delt". A study of 30 shoulders revealed an average mass of in humans, ranging from to .
Deltoid muscle | Introduction
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
From this extensive origin the fibers converge toward their insertion on the deltoid tuberosity on the middle of the lateral aspect of the shaft of the humerus; the intermediate fibers passing vertically, the anterior obliquely backward and laterally, and the posterior obliquely forward and laterally. Though traditionally described as a single insertion, the deltoid insertion is divided into two or three discernible areas corresponding to the muscle's three areas of origin. The insertion is an arch-like structure with strong anterior and posterior fascial connections flanking an intervening tissue bridge. It additionally gives off extensions to the deep brachial fascia. Furthermore, the deltoid fascia contributes to the brachial fascia and is connected to the medial and lateral intermuscular septa.
Deltoid muscle | Insertion
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
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
Precautions should be taken before, during, and after the injection to lower the chances of complications:
Intravitreal injection | Precautions
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
Td and Tdap are for older children, adolescents, and adults and can be injected into the deltoid muscle. These are boosters and are recommended every ten years. It is safe to have shorter intervals between a single dose of Tdap and a dose of the Td booster.
Tetanus vaccine | Schedule
Common injection sites include the inner surface of the forearm and the upper back, under the shoulder blade..
Intradermal injection | Injection sites
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
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
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
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
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
The placement of the bolus dose depends on the systemic levels of the contents desired throughout the body. An intramuscular injection of vaccines allows for a slow release of the antigen to stimulate the body's immune system and to allow time for developing antibodies. Subcutaneous injections are used by heroin addicts (called 'skin popping', referring to the bump formed by the bolus of heroin), to sustain a slow release that staves off withdrawal symptoms without producing euphoria. A bolus delivered directly to the veins through an intravenous drip allows a much faster delivery which quickly raises the concentration of the substance in the blood to an effective level.
Bolus (medicine) | Placement
Additionally, the body's reaction to substances is more easily visible since it is closer to the surface.
Intradermal injection | Introduction
In medicine, a joint injection (intra-articular injection) is a procedure used in the treatment of inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendinitis, bursitis, Carpal Tunnel Syndrome, and occasionally osteoarthritis. A hypodermic needle is injected into the affected joint where it delivers a dose of any one of many anti-inflammatory agents, the most common of which are corticosteroids. Hyaluronic acid, because of its high viscosity, is sometimes used to replace bursa fluids. The technique may be used to also withdraw excess fluid from the joint.
Joint injection | 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
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
Routine Twinrix vaccination is administered by intramuscular injection in the deltoid area using a schedule of three separate doses at 0, 1, and 6 months ([minimum intervals: 4 weeks between doses 1 and 2, 5 months between doses 2 and 3]). In some circumstances, an accelerated dosing schedule of 0, 7 and 21 to 30 days followed by a booster at 12 months can be used and was shown to have similar efficacy as the traditional schedule.
Hepatitis A and B vaccine | Administration schedule
It may be taken by mouth, as a tablet or elixir, as an injection into a muscle, as an injection into a vein, or via an eye drop.
Dexamethasone | Route
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
Intracardiac injections are injections that are given directly into the heart muscles or ventricles. They are used in emergencies.
Intracardiac injection | Introduction
There are two major techniques used to gain elbow extension. Deltoid-to-triceps transfer: For this transfer, the posterior part of the deltoid muscle is released from its origin and attached to the triceps muscle (usually by means of a tendon graft or a synthetic graft) leaving the rest of the deltoid muscle intact. This transfer is usually very successful because the line of pull of the posterior deltoid muscle is in the same direction as the triceps muscle. Also, there is hardly any loss of function. The deltoid muscle is usually innervated by the fifth and sixth cervical nerve roots and is therefore often functional in patients with tetraplegia, though the triceps muscle, which is innervated by the seventh cervical root, is paralysed.
Upper-limb surgery in tetraplegia | Elbow
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 deltoid muscle is the muscle forming the rounded contour of the human shoulder. It is also known as the 'common shoulder muscle', particularly in other animals such as the domestic cat. Anatomically, it appears to be made up of three distinct sets of fibers, namely 1. anterior or clavicular part (pars clavicularis) 2. posterior or scapular part (pars scapularis) 3. intermediate or acromial part (pars acromialis). However, electromyography suggests that it consists of at least seven groups that can be independently coordinated by the nervous system. It was previously called the deltoideus (plural "deltoidei") and the name is still used by some anatomists.
Deltoid muscle | Introduction
The axillary nerve is sometimes damaged during surgical procedures of the axilla, such as for breast cancer. It may also be injured by anterior dislocation of the head of the humerus.
Deltoid muscle | Nerve supply
An injection (often referred to as a "shot" in US English, or a "jab" in UK English) is the act of administering a liquid, especially a drug, into a person's body using a needle (usually a hypodermic needle) and a syringe. An injection is considered a form of administering drugs via the parenteral route, which refers to routes of administration which do not involve absorption in the digestive tract. This allows the medication to be absorbed more rapidly and avoid the first pass effect. There are many types of injection, which are generally named after the body tissue the injection is administered into.
Injection (medicine) | Introduction
Depo-Provera is the brand name for a 150 mg microcrystalline aqueous suspension of DMPA that is administered by intramuscular injection. The shot must be injected into thigh, buttock, or deltoid muscle four times a year (every 11 to 13 weeks), and provides pregnancy protection instantaneously after the first injection. Depo-subQ Provera 104 is a variation of the original intramuscular DMPA that is instead a 104 mg microcrystalline dose in aqueous suspension administered by subcutaneous injection. It contains 69% of the MPA found in the original intramuscular DMPA formulation. It can be injected using a smaller injection needle inserting the medication just below the skin, instead of into the muscle, in either the abdomen or thigh.
Medroxyprogesterone acetate | Available forms
An induction dose of thiopental wears off after a few minutes because the thiopental redistributes from the brain to the rest of the body very quickly. Also thiopental has a long half-life and needs time for the drug to be eliminated from the body. If a very large initial dose is given, little or no redistribution takes place because the body is saturated with the drug; thus recovery of consciousness requires the drug to be eliminated from the body. Because this process is not only slow (taking many hours or days), but also unpredictable in duration, barbiturates are unsatisfactory for the maintenance of anesthesia.
Lethal injection | Anesthesia awareness
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
Consequently, there will typically be not as much increase in muscle strength observed after edrophonium injection, if any with LEMS. The Tensilon test may also be used to predict if neurotoxic paralysis caused by snake envenomation is presynaptic or postsynaptic. If it is a postsynaptic then paralysis will be temporally reversed, indicating that can be reversed by adequate antivenom therapy. If the neurotoxic is presynaptic then the Tensilon test will show no response and antivenom will not reverse such paralysis. In this instance reversal of paralysis will not occur until the damaged terminal axons at the neuromuscular junction have recovered, this may take days or weeks.
Edrophonium | Clinical uses
Daunorubicin should only be administered in a rapid intravenous infusion. It should not be administered intramuscularly or subcutaneously, since it may cause extensive tissue necrosis. It should also never be administered intrathecally (into the spinal canal), as this will cause extensive damage to the nervous system and may lead to death. Daunorubicin has been used intravitreally (inside the eye) for the purposes of preventing proliferative vitreoretinopathy, a common complication following retinal detachment surgery, but has not been found to be effective and is not used for any other ophthalmic purposes at this time.
Daunorubicin | Route of administration
Intravenous injections, abbreviated as IV, involve inserting a needle into a vein, allowing a substance to be delivered directly into the bloodstream. An intravenous injection provides the quickest onset of the desired effects because the substance immediately enters the blood, and is quickly circulated to the rest of the body. Because the substance is administered directly into the bloodstream, there is no delay in the onset of effects due to the absorption of the substance into the bloodstream. This type of injection is the most common and is used frequently for administration of medications in an inpatient setting. Another use for intravenous injections includes for the administration of nutrition to people who cannot get nutrition through the digestive tract.
Injection (medicine) | Intravenous injections
During abduction most of these latter components (except VI and VII which always act as adductors) are displaced laterally and progressively start to abduct.
Deltoid muscle | Structure
A depot injection is an injection, usually subcutaneous, intradermal, or intramuscular, that deposits a drug in a localized mass, called a depot, from which it is gradually absorbed by surrounding tissue. Such injection allows the active compound to be released in a consistent way over a long period. Depot injections are usually either solid or oil-based. Depot injections may be available as certain forms of a drug, such as decanoate salts or esters. Examples of depot injections include haloperidol decanoate, medroxyprogesterone acetate, and naltrexone.
Injection (medicine) | Depot injection
These derivatives are hydrolyzed to release free testosterone at the site of injection; absorption rate (and thus injection schedule) varies among different esters, but medical injections are normally done anywhere between semi-weekly to once every 12 weeks. A more frequent schedule may be desirable in order to maintain a more constant level of hormone in the system. Injectable steroids are typically administered into the muscle, not into the vein, to avoid sudden changes in the amount of the drug in the bloodstream. In addition, because estered testosterone is dissolved in oil, intravenous injection has the potential to cause a dangerous embolism (clot) in the bloodstream.
Anabolic steroid | Routes of administration
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
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
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
Because of the location at the back of the arm, the posterior part of the deltoid muscle can give strength in the same direction as the triceps muscle and is therefore theoretically a good donor to regain elbow extension. Not only the direction of the strength provided by the donormuscle is important, Smith "et al." showed that the matching between the original functional properties of the donor and recipient muscles affects the outcome of the transfer. Therefore, Fridén studied the architectural properties of the deltoid and triceps muscle in cadavers and concluded that the posterior deltoid would be a very suitable transfer to provide elbow extension.
Upper-limb surgery in tetraplegia | Elbow
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
Intraperitoneal injection or IP injection is the injection of a substance into the peritoneum (body cavity). It is more often applied to animals than to humans. In general, it is preferred when large amounts of blood replacement fluids are needed or when low blood pressure or other problems prevent the use of a suitable blood vessel for intravenous injection. In animals, it is used predominantly in veterinary medicine and animal testing for the administration of systemic drugs and fluids because of the ease of administration compared with other parenteral methods. In humans, the method is widely used to administer chemotherapy drugs to treat some cancers, particularly ovarian cancer.
Intraperitoneal injection | Introduction
When all its fibers contract simultaneously, the deltoid is the prime mover of arm abduction along the frontal plane. The arm must be medially rotated for the deltoid to have maximum effect. This makes the deltoid an antagonist muscle of the "pectoralis major "and "latissimus dorsi" during arm adduction. The anterior fibers assist the "pectoralis major" to flex the shoulder. The anterior deltoid also works in tandem with the subscapularis, pecs and lats to internally (medially) rotate the humerus. The intermediate fibers perform basic shoulder abduction when the shoulder is internally rotated, and perform shoulder transverse abduction when the shoulder is externally rotated.
Deltoid muscle | Function
Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle and a syringe, which is pierced through the skin into the body (usually intravenously, but also at an intramuscular or subcutaneous location). , there were 13.2 million people worldwide who used injection drugs, of which 22% are from developed countries. A wide variety of drugs are injected, often opioids: these may include legally prescribed medicines and medication such as morphine, as well as stronger compounds often favored in recreational drug use, which are often illegal. Although there are various methods of taking drugs, injection is favoured by some people as the full effects of the drug are experienced very quickly, typically in five to ten seconds.
Drug injection | Introduction
It is primarily given once or twice weekly by intramuscular injection for moderate-severe rheumatoid arthritis although it has also proven itself effective in treating tuberculosis.
Sodium aurothiomalate | Medical uses
The deltoid is innervated by the axillary nerve. The axillary nerve originates from the anterior rami of the cervical nerves C5 and C6, via the superior trunk, posterior division of the superior trunk, and the posterior cord of the brachial plexus. Studies have shown that there are seven neuromuscular segments to the deltoid muscle. Three of these lie in the anatomical anterior head of the deltoid, one in the anatomical middle head, and three in the anatomical posterior head of the deltoid. These neuromuscular segments are supplied by smaller branches of the axillary nerve, and work in coordination with other muscles of the shoulder girdle include pectoralis major and supraspinatus.
Deltoid muscle | Nerve supply
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
The half-life of this drug is about 11.5 hours, and the concentration in the brain remains at around 5–10% of the total dose during that time. When a 'mega-dose' is administered, as in state-sanctioned lethal injection, the concentration in the brain during the tail phase of the distribution remains higher than the peak concentration found in the induction dose for anesthesia, because repeated doses—or a single very high dose as in lethal injection—accumulate in high concentrations in body fat, from which the thiopental is gradually released. This is the reason why an ultra-short acting barbiturate, such as thiopental, can be used for long-term induction of medical coma.
Lethal injection | Sodium thiopental
In the movie "Pulp Fiction", an intracardiac injection of epinephrine is used to treat a heroin overdose (far from the normal medical treatment for this condition, an intravenous or intramuscular injection of naloxone).
Intracardiac injection | Society and culture
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
The toxin paralyses muscles gradually. Large mammals hunted in this way die slowly from a small injection of the poison.
Diamphotoxin | Introduction
The deltoid is supplied by the thoracoacromial artery (acromial and deltoid branches), the circumflex humeral arteries, and the profunda brachii artery (deltoid branch). (Standring, 2005).
Deltoid muscle | Blood supply
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
Immunization with Cervarix consists of 3 doses of 0.5-mL each, by intramuscular injection according to the following schedule: 0, 1, and 6 months. The preferred site of administration is the deltoid region of the upper arm. Cervarix is available in 0.5-mL single-dose vials and prefilled TIP-LOK syringes.
Cervarix | Administration
The exact procedures and techniques of the intravitreal injection varies among different guidelines, and may depend on the practices of the person performing the injection. Below is an example of the steps for the injection: The patient usually leans back on the chair (in supine position), in which the headrest is stable and the patient is comfortable. Sterile drape is sometimes used to cover the face of the patient and only show the eye for the injection. The specialist first applies anesthetics to the eye and eyelid to numb the area, so that the patient will not feel the pain during the procedure.
Intravitreal injection | Steps
Blood seepage and collection of blood may occur if heparin is given via an intramuscular route; to avoid this, heparin must be given intravenously or subcutaneously.
Hematoma | Introduction
"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
Depot injections provide long duration therapy through one of two main mechanisms – slowing absorption into the bloodstream, or slowing metabolism into the active compound. They are usually administered in the muscle, into the skin, or under the skin. The injected medication slowly releases or is slowly metabolized to the active compound consistently and predictably. Depot injections may be good choices to use in patients who forget to, or intentionally do not, take their medication. Some doctors and patients consider the use of a depot injection to be coercion and are opposed to using them for that reason. Depot injections may be desirable for their convenience as well – only requiring administration with one injection every few weeks or months as opposed to oral medications which may require administration multiple times per day.
Depot injection | Purpose
Tildren is administered intravenously. It is labeled for 0.1 mg/kg dosing, once daily for 10 days by slow intravenous injection, which for a 500 kg horse works out to be 1 vial per day. However, one study giving all 10 doses at once (1 mg/kg IV as a single CRI) was found to have the same pharmacological effects, and is used clinically. It may be given systemically or locally, by regional limb perfusion. Although RLP is thought to have certain benefits, including decreased cost and reduced risk of adverse effects, some diseases must be treated systemically, such as osteoarthritis of the vertebral column.
Tiludronic acid | Method of administration
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
They are not utilized significantly during strict transverse extension (shoulder internally rotated) such as in rowing movements, which use the posterior fibers.
Deltoid muscle | Function
Cephaloridine is easily absorbed after intramuscular injection and poorly absorbed from the gastrointestinal tract.
Cephaloridine | Absorption
Testosterone undecanoate and testosterone buciclate can be injected intramuscularly as infrequently as four times per year.
Pharmacokinetics of testosterone | Intramuscular injection
This includes common injections such as subcutaneous, intramuscular, and intravenous injections, as well as less common injections such as intraperitoneal, intraosseous, intracardiac, intraarticular, and intracavernous injections. Injections are among the most common health care procedures, with at least 16 billion administered in developing and transitional countries each year. Of these, 95% are used in curative care or as treatment for a condition, 3% are to provide immunizations, and the rest are used for other purposes, including blood transfusions. The term "injection" is sometimes used synonymously with inoculation, but injection does not only refer to the act of inoculation. Injections generally administer a medication as a bolus (or one-time) dose, but can also be used for continuous drug administration.
Injection (medicine) | Introduction
When intravenous injection is not possible, euthanasia drugs such as pentobarbital can be injected directly into a heart chamber or body cavity. While intraperitoneal injection is fully acceptable (although it may take up to 15 minutes to take effect in dogs and cats), an intracardiac (IC) injection may only be performed on an unconscious or deeply sedated animal. Performing IC injections on a fully conscious animal in places with humane laws for animal handling is often a criminal offense.
Animal euthanasia | Intracardiac or intraperitoneal injection
Intramuscular injection does give a faster and higher pharmacokinetic profile when compared to subcutaneous injection.
Epinephrine (medication) | Anaphylaxis
Methylprednisolone (brand name Medrol) is provided in prepackaged forms for oral use. Methylprednisolone acetate (Depo-Medrol) is a fat-soluble ester of methylprednisolone and is formulated as an aqueous suspension to be administered by intramuscular, intra-articular, soft tissue, or intralesional injection only. It has the potential to cause subcutaneous atrophy in the area administered. Methylprednisolone acetate is not indicated for intravenous use. The only formulation that should be given intravenously is methylprednisolone succinate (Solu-medrol), a water-soluble ester of methylprednisolone.
Methylprednisolone | Available forms
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
Upon intramuscular injection in oil, which results in the formation of a long-lasting depot in the muscle, nandrolone decanoate is stored unchanged and is slowly absorbed into the body. Once in the circulation, it is converted into nandrolone, which is the active form of the drug. There is a sharp spike in nandrolone levels 24 to 48 hours after an intramuscular injection of nandrolone decanoate, followed by a steady decline to baseline levels within approximately two or three weeks. The bioavailability of nandrolone decanoate is 53 to 73% with intramuscular injection and varies with the site of injection, with the highest bioavailability seen when injected into the gluteal muscle.
Nandrolone decanoate | Pharmacokinetics
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
In contrast to oral administration, the bioavailability of estradiol valerate is complete (i.e., 100%) via intramuscular injection. Due to the far greater bioavailability of intramuscular estradiol valerate relative to oral, the former is substantially stronger (in terms of potency) than the latter. As an example, a single 4 mg intramuscular injection is said to be approximately equivalent to 2 mg/day of the medication administered orally over the course of 3 weeks. Estradiol valerate, when given intramuscularly in oil, has a relatively long duration due to the formation of an intramuscular depot from which the medication is slowly released and absorbed.
Estradiol valerate | Intramuscular injection
Pentolinium can be given orally (20mg three times a day), injected intramuscularly, or administered intravenously.
Pentolinium | Route of administration and dose
The traditional procedure of ID injection (Mantoux Procedure) involves injecting at angle of administration of 5 to 15 degrees angle, almost against the skin. With bevel (opening) side up, the needle is inserted about with the entire bevel inside and injected while watching for a small wheal or blister to appear. When the needle is removed, it is immediately placed in the sharps container. The patient is instructed to avoid touching the injection site, to not apply a bandaid, and to return within 48 hours to have their TB test read. All soiled supplies are disposed of in a biohazard container, and the procedure is documented, making note of patient identifiers, injection site, NDC or LOT number, and expiration date on the vial.
Intradermal injection | Mantoux Procedure