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Guide to I.M. injections in newborns

Robinson, Martha Wortham BSN

doi: 10.1097/01.NME.0000386795.73141.3a
Department: Peak Technique

Registered Nurse • Maxim Healthcare Services • Bellevue, Wash.

Did you ever wonder why we give I.M. injections to newborns? I.M. injections are administered in newborns to deliver medications deeply into the muscle without causing injury to the tiny patient. Skeletal muscle can accommodate larger volumes of medication than subcutaneous tissue, and absorption is faster because muscle tissue is highly vascular. Muscle has fewer pain-sensing nerves than subcutaneous tissue and is less sensitive to irritating and viscous medications, so pain is lessened. The I.M. route is also used for medications requiring a prolonged period of action.

However, there are disadvantages to I.M. injections. They pose risk to bones, nerves, tissues, and blood vessels, such as contractures, palsy, peripheral nerve injury, neuropathy, hematomas, bleeding, persistent nodules, arterial punctures, permanent damage to the sciatic nerve resulting in paralysis, fibrosis, abscess, tissue necrosis, gangrene, and muscle contraction. There's also a danger of foreign bacteria being introduced into the body, which may lead to infection.

Because of the dangers associated with this clinical skill, it's important for nurses to update themselves regularly on the latest evidence-based practices. Many nurses learned to give injections in a time-honored ritual from other nurses and may not see a need to review current research on the topic. However, recommendations often change, even for such a basic skill as I.M. injections! For example, in 1996 there was a recommendation that nurses select the rectus femoris as the best place to give an I.M. injection to a newborn. A decade later, in 2007, it's clearly stated that the vastus lateralis is the preferred site for administering I.M. injections in this age group.

By familiarizing yourself with the most recent recommendations for the proper site, volume, angle, speed of injection, and comfort measures for administering I.M. injections in newborns, you'll contribute to a higher standard of care.

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Sample policy and procedure

The following sample policy and procedure incorporates current rationale for each step.

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The end is just the beginning

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You now have the answers to the most common questions you may have asked yourself about giving I.M. injections to newborns or those you may have been asked by other nurses. Remember, you can search research databases such as the Cumulative Index to Nursing and Allied Health Literature, which you should have access to at your facility. Contact your facility's librarian to discover how incredibly easy it is to find the answers to your questions!

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Learn more about it

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