Department: Peak Technique
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.
Sample policy and procedure
The following sample policy and procedure incorporates current rationale for each step.
The end is just the beginning
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!
Learn more about it
Barron C, Cocoman A. Administering intramuscular injections to children: what does the evidence say? J Children's Young People's Nurs. 2008;2(3):138–144.
Carter-Templeton H, McCoy T. Are we on the same page?: a comparison of intramuscular injection explanations in nursing fundamental texts. Medsurg Nurs. 2008;17(4):237–240.
Centers for Disease Control and Prevention. In: Atkinson W, Haborsky J, McIntyre L, Wolfe S, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 10th ed. 2nd printing. Washington, DC: Public Health Foundation; 2008.
Craven RF, Hirnle CJ. Fundamentals of Nursing: Human Health and Function. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
Diggle L. Injection technique for immunization. Practice Nurse. 2007;33(1):34–37.
Hummel P, Puchalski M, Creech SD, Weiss MG. Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain. J Perinatol. 2008;28(1):55–60.
Ipp M, Taddio A, Sam J, Gladbach M, Parkin PC. Vaccine-related pain: randomised controlled trial of two injection techniques. Arch Dis Child. 2007;92(12):1105–1108.
Johnston CC, Filion F, Campbell-Yeo M, et al. Enhanced kangaroo mother care for heel lance in preterm neonates: a crossover trial. J Perinatol. 2009;29(1):51–56.
Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recomm Rep. 2006;55(RR-15):1–48.
Preston ST, Hegadoren K. Glass contamination in parenterally administered medication. J Adv Nurs. 2004;48(3):266–270.
Santoro N, Grandone A. Vaccine-related pain: picking up the child soon after the injection reduces the time of crying. Arch Dis Child. 2008;93(5):449–450.
Wood DA. Speedy shots equal less pain: Canadian study calls for rapid injections in young children. Nurs Spectrum. 2007;17(22):12.