Chapter#1
INTRODUCTION
Background
Intramuscular injection (IMI) is an important and commonly used nursing intervention. The
World Health Organization (WHO) defines intramuscular injection as a parenteral, prophylactic,
or curative drug delivery route to muscle tissue by choosing the appropriate needle size.
Interpreted as a simple intervention, it requires important assessments, skills and knowledge of
the right place and the safest course of action. World health organization estimates that of the 12
billion injections made each year worldwide, 50% receive unsafe injections. (FEKONJA U. ,
2020) .
There are three major muscle groups identified for intramuscular injection administration: the
deltoid muscles of the upper arm, the gluteus medius, which represents the dorsal and abdominal
(ventro-gluteal ) sites, and the quadriceps femoris. Straight and vastuslateralis. The choice of the
right place depends on factors such as the type and amount of the drug, age, and patient health.
Carelessness, inaccuracies, and misjudgment of the right application can cause serious
complications. (FEKONJA U. , 2020)
Most complications occur when intramuscular injection is administered to the delto-glutealsite.
This is because this area contains a rich interweaving of blood vessels and is located near the
sciatic nerve. There is also a thin layer of subcutaneous tissue. Much of the recent evidence-
based literature recommends the use of ventro-gluteal sites. This is because the ventro-gluteal
site has no relatively large blood vessels or nerves (sciatic nerve) and is sealed with bone. It is
also easy to identify and the subcutaneous tissue layer is much thinner than the delto-gluteal side.
At this point the gluteusmedius muscle is large and well developed. We found that patients who
received intramuscular injection at the ventro-gluteal site had less pain, discomfort, and bleeding
than those who received intramuscular injectionat the delto-gluteal site. Ventro-glutealsites allow
faster absorption of drugs and easier and better access to muscle tissue (FEKONJA U. , 2020) .
Nurses perform some skills in healthcare. In the clinical setting, caregiver performance needs to
be effective in patient recovery. Nurses practice intramuscular injection, which is highly
regarded as an evidence-based practice and application of skills. For intramuscular injections, the
injection site, needle insertion angle, and suction should be selected according to the relevant
guidelines. The purpose of a healthcare provider is to give injections to save lives and protect
health. Through observation, practices are properly monitored and well controlled. Inappropriate
practice of intramuscular injection causes side effects and harm to clients.( Rehman, 2020).
In the nursing profession, psychomotor skills are a very important activity and have considerable
consequences. intramuscular injection best practices not only improve the quality of care, but
also maintain standards of care in the clinical setting. Intramuscular injection is a nursing
practice and is very important in providing better care and relief to the patient and making the
patient easier. ( Rehman, 2020)
The safe practice of intramuscular injection requires the use of a safety pin. It reduces the pain of
injections and minimizes the risk of needle stick injury. Needle size is measured with a gauge
(needle diameter). About 12 billion injections are given each year around the world. For most
injections, the intravenous route is preferred over the intravenous and subcutaneous routes due to
the increased vascular distribution of muscle tissue and the corresponding increased
bioavailability of the drug during intramuscular administration.Like tranquilizers, antipsychotics,
hormonal agents, and vaccines are given via intramuscular routes. This is an advantageous way
to provide drug absorption.( Rehman, 2020).
We recommend using two needles for intramuscularinjections. One needle is used to prepare the
drug and the other is used for injections to avoid discomfort, pain and possible complications.
The intramuscular injection is inserted at a 90 ° angle to ensure that the needle reaches the
muscle. Ztracktechnology is preferred because it reduces both pain and the occurrence of drug
leaks to needle marks. It is also recommended to wait 10 seconds after injecting the drug, pull it
out at the same angle as the needle was inserted, and then lightly apply pressure with a cotton
swab instead of massaging the area.( Rani Sah, 2020).
Knowledge and skills associated with intramuscular injection are required to avoid complications
and minimize the risk to the patient. Nurses need to understand the relevant anatomy and
adjacent anatomy so that they can safely and confidently recognize the boundaries between
landmarks and sites. Unnecessary complications can result from poor skills, lack of
understanding, and lack of caregiver skills and trust. This study aims to analyze the general
aspects of knowledge about intramuscular injection and their consistency with current
recommendations..( Rani Sah, 2020).
First of all, you need to know the correct intramuscular injection technique. Good habits include
choosing the right site for an intramuscular injection. Second, inadequate intramuscular injection
habits can cause pain, irritation, contractures, necrosis, and muscle contractures. The best
injection site is ventrogluteal. ( Rehman, 2020).
It has been reported that clinicians often prefer the dorsal buttock injection site because the
choice of intramuscular injection site depends on many factors. It has been found that the
majority of nurses prefer the dorsal buttock injection site. In their study, Floyd and Meyer (2007)
stated that 99% of nurses use the dorsal gluteal muscles and 9% of nurses use the ventral cavity
for intramuscular injection.( Kara, 2015).
In a study by Walsh to Brophy (2011), 71% of nurses stated that they prefer the dorsal buttock
injection site for intramuscular injection. A study conducted in Turkey reported that the majority
of nurses prefer the dorsal buttock injection site during injection. ( Kara, 2015).
A study by Cocaman and Murray (2008) states that medical professionals should have more up-
to-date information about injection sites.Recent studies recommend using a peritoneal injection
site instead of the dorsal buttock injection site because it is far from the sciatic nerve and large
blood vessels, is easy to see, and becomes thinner for intramuscular injection due to
subcutaneous tissue, etc. ( Kara, 2015)
Although the ventral cavity area has been identified as the safest area in intramuscular injection
practice, caregivers working in different countries appear to frequently use the dorsal buttock
area. For this reason, this combined study should be prepared to identify the advantages of using
the dorsal buttock for intramuscular injection applications, the reliable injection site, and the
shortcomings and reasons for physicians using the dorsal buttock.. ( Kara, 2015)
There are some wrong habits that nurses make when they are doing intramuscular injections
without following the guidelines. Unsafe injection practice reduces the effectiveness of the drug
and increases the risk of injury to the patient. However, it is important to evaluate the
intramuscular injection protocol prior to administration.( Kara, 2015)
Though considered a simple technique, it can cause serious complications if the process of
intramuscular injection is not done carefully. ( Rehman, 2020)
If you do not follow evidence-based guidelines and safe practices, intramuscular injection can
cause a variety of serious complications. Complications include pain, tissue necrosis, abscesses,
cellulite, nerve damage, hematomas, granulomas, myofibrosis and contractures, infections, blood
vessel or bone damage, and permanent or temporary paralysis of the lower extremities.
(FEKONJA U. , 2020)
Intramuscular injections are an important part of drug delivery in nursing procedures and are
used in almost half of the country. As a result, there are some false practices performed by
caregivers during intramuscular injections that do not follow guidelines. Unsafe injection
practice reduces the effectiveness of the drug and increases the risk of injury to the patient.
However, it is important to evaluate the intramuscular injection protocol prior to administration.
( Rehman, 2020).
Although the use of ventro-glutealmuscles is recommended, nurses rarely use ventro-gluteal
muscles and instead rely on traditional approaches to intramuscular injectionmanagement and
preferdelto-gluteallocations. Some knowledge and use is very important. Evidence-base
recommendations for intramuscular injection management of nurses to develop effective
training. (FEKONJA U. , 2020).
Objectives:
To assess knowledge and practical skills of intramuscular injection administration.
Research Question:
What is level of knowledge of staff nurses regarding intramuscular injection.
What type of practices nurses have regarding intramuscular injection.
Hypothesis:
Null hypothesis
Lack of knowledge can not lead to poor practice of intramuscular injection.
Alternative hypothesis
Lack of knowledge can lead to poor practice of intramuscular injection.
Definition:
Conceptual:
Knowledge: The is a familiarity, awareness, or understanding of someone or something, such as
facts,information, descriptions, or skills, which is acquired through experience or education by
perceiving, discovering, or learning.
Practice: The actual application or use of an idea, belief, or method, as opposed to theories relating to it.
Operational:
Knowledge:
How to assess the level of knowledge of nurse ?
Practice:
How to assess the practice of nurses?
Significance:
This will help the the nurses to increase the level of knowledge of nurses about the accurate
selection of muscles for intramuscular injection. It will also improve the practices of nurses by
increasing their level of knowledge.
Justification:
Out of 267 distributed questionnaires, 212 were returned, and 200 included in the analysis
(74.9% realisation). The detailed demographic characteristics are presented in Table 1. The total
average score relating level of knowledge was 5.0±3.020 (points ranging of 0–16). Statistical
significance was found between working service and educational level (p<0.05). Participants
working in emergency service and participants who had post-graduate degrees had higher
average scores (Table 1). 99.5% of participants reported they administer up to nine IMI per day.
From Table 2, it can be seen that the majority of participants (41.5%, n=83) said DG site is
recommended site in the latest literature. While the third (36.5%, n=73) of the participants were
aware that the VG site is currently evidencebased recommendation, the most frequently used site
for IMI remains DG (88.5%, n=177), VG site is commonly used only by 7.5% of participants
(n=15). Some individuals reported that they most frequently use deltoid muscle (2.0%, n=4) or
the vastus lateralis and rectus femoris muscles (1.0%, n=2). 15.5% (n=31) participants reported
they do not know what the recommended site is in the latest literature (Table 2).
When asked whether participants received any courses about administering IMI into the VG site,
52 (26.0%) answered affirmatively. Others, 148 (74.0%) were not trained or educated on current
evidence-based guidelines either in secondary excluded due to missing data, resulting in a total
sample of 200. In Slovenia, the nursing education system consists of a minimum four year
secondary education (for nursing assistants), three years of the first cycle Bologna higher
education (for nurses with a diploma degree), two years of the second cycle Bologna higher
education (for nurses with a master’s degree) and three years of third cycle Bologna higher
education (for nurses with a PhD).22 Nursing assistants are trained in providing basic nursing
care and also have competencies for medication administration (per os, intramuscular and
subcutaneous therapy).23 Nurses are independent experts who are responsible for nursing care
and independently and autonomously perform nursing procedures and interventions in the
nursing process.22,23 The current study included 65 nursing assistants (32.5%) and 135 nurses
(67.5%).
Referances:
1. Fekonja, U., Fekonja, Z., &Vrbnjak, D. (2021). The assessment of knowledge and
practical skills of intramuscular injection administration among nursing staff: a cross-
sectional study. AJAN-The Australian Journal of Advanced Nursing, 38(3).
2. Sah, S. R., &Maskey, S. (2020). Knowledge of intramuscular injection among the nurses
of a teaching hospital. Journal of Chitwan Medical College, 10(1), 40-43
3. Rehman S., Afzal F., Hussain M., Afzal M., Galani A.(2020). Assessment of Nurses
Practices Regarding Intramuscular Injection among Adult Pakistani. Merit Research
Journal of Medicine and Medical Sciences
