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Aims and objective(s) The objective of this systematic review was to determine the needle length required to reach the dorsogluteal muscle based on body mass index and sex. Our aim was to provide evidence-based recommendations to current intramuscular injection guidelines from the result(s) of this review. Background Studies worldwide are documenting reduced medication effectiveness due to improperly placed dorsogluteal intramuscular injections because of incorrect needle length, wrong site selection and/or obesity. Current intramuscular injection guidelines lack specific instructions according to weight or sex. While there are similar concerns with other injectable sites, this review focuses solely on adult dorsogluteal intramuscular injections. Design A systematic review of relevant literature of dorsogluteal intramuscular injections based on body mass index and sex. Methods This systematic review was reported using the PRISMA checklist 2020. The review protocol was registered with Center for Open Science (OSF). We analysed 1,412 articles from nine databases. We compared twelve studies that utilised computerised tomography or ultrasonography using The Johns Hopkins Evidence-Based Practice Model and Guidelines. Results A significant number of dorsogluteal intramuscular injections are administered into subcutaneous tissue rather than muscle because needles are too short for populations with body mass indexes over 25, especially women. Poor landmarking often results in improperly placed injections. Conclusions To prevent administering a dorsogluteal intramuscular injection into subcutaneous tissue, women with a BMI of 25 and over require needles longer than 38 mm (1.5 inches). Men have less subcutaneous tissue in the dorsogluteal area and only require longer needles if BMI is 35 and over. If skin-to-muscle depth is questionable in either sex, an ultrasound-guided intramuscular injection is warranted for accurate dorsogluteal placement. Landmarking and needle length are key to appropriately placed IM injections. Relevance to clinical practice Dorsogluteal injections are often injected into subcutaneous tissue rather than muscle because needles are not long enough to reach muscle, especially in women. Critical elements that determine placement of intramuscular injections into muscle versus subcutaneous tissue are sex, BMI, needle length and landmarking. Medications delivered into subcutaneous tissue may have reduced bioavailability.

Objective To assess anesthetic induction, recovery quality and cardiopulmonary variables after intramuscular (IM) injection of three drug combinations for immobilization of horses. Study design Randomized, blinded, three-way crossover prospective design. Animals A total of eight healthy adult horses weighing 470–575 kg. Methods Horses were administered three treatments IM separated by ≥1 week. Combinations were tiletamine–zolazepam (1.2 mg kg−1), ketamine (1 mg kg−1) and detomidine (0.04 mg kg−1) (treatment TKD); ketamine (3 mg kg−1) and detomidine (0.04 mg kg−1) (treatment KD); and tiletamine–zolazepam (2.4 mg kg−1) and detomidine (0.04 mg kg−1) (treatment TD). Parametric data were analyzed using mixed model linear regression. Nonparametric data were compared using Skillings–Mack test. A p value Results All horses in treatment TD became recumbent. In treatments KD and TKD, one horse remained standing. PaO2 15 minutes after recumbency was significantly lower in treatments TD (p Conclusions and clinical relevance In domestic horses, IM injections of tiletamine–zolazepam–detomidine resulted in more reliable recumbency with a longer duration when compared with ketamine–detomidine and tiletamine–zolazepam–ketamine–detomidine. Recoveries were comparable among protocols.

This study aimed to investigate the specific pharmacokinetic profile and effects of alfaxalone after intravenous (IV) and intramuscular (IM) administration to rabbits and evaluate the potential interaction with dexmedetomidine. The study design was a blinded, randomized crossover with a washout period of 2 weeks. Five New Zealand white rabbits were used. Each animal received single IV and IM injections of alfaxalone at a single dose of 5 mg/kg, and single IV and IM injections of alfaxalone (5 mg/kg) combined with dexmedetomidine (100 μg/kg) administered intramuscularly. Blood samples were collected at predetermined times and analysed by high-performance liquid chromatography. The plasma concentration-time curves were analysed by non-compartmental analysis. Sedation/anaesthesia scores were evaluated by a modified numerical rating scale. At pre-determined time points heart and respiratory rates were measured. Times to sternal recumbency and standing position during the recovery were recorded. Concentrations of alfaxalone alone were very similar (slighty smaller) to concentrations when alfaxalone was combined with dexmedetomidine, after both routes of administration. Dexmedetomidine enhanced and increase the duration of the sedative effects of alfaxalone. In conclusion, alfaxalone administered in rabbits provides rapid and smooth onset of sedation. After IV and IM injections of alfaxalone combined with dexmedetomidine, a longer MRT and a deeper and extended sedation have been obtained compared to alfaxalone alone. Consequently, alfaxalone alone or in combination with dexmedetomidine could be useful to achieve respectively moderate to deep sedation in rabbits.

We had developed an inexpensive intramuscular (IM) injection simulator and gathered feedback from Canadian hospital-based practicing nurses about the design features of the simulator. While the feedback critiqued the density of the simulator as being too stiff and suggested making the shape more realistic, it was also unanimously agreed that this IM injection simulator is more realistic than any other previous models they have used, therefore deeming it an acceptable training tool for nursing students in Canada. For this simulator to serve as a training tool in other countries, such as Singapore, we partnered with SingHealth, a hospital network in Singapore, to conduct identical product testing in a different ethnic context and compare the data to our previous work. This article is based on this study. We had 21 nurses from Singapore General Hospital test the IM injection simulator and fill out the same survey the Canadian nurses had done. With a 100% response rate, only 26% of the Singapore hospital-based nurses agreed that this IM injection simulator is a more ethnically appropriate representation of anatomy than previous simulators they have used. There were numerous other differences in feedback compared to the Canadian nurses, such as the fat layer being too thick. These differences in feedback highlight the importance of including ethnicity as a factor during the design of simulators. Therefore, despite the silicone IM injection simulator being a cost-effective solution to practice IM injections, the features of the simulator need to be improved to make it a valuable teaching tool for nursing students, especially those in Singapore.

Administering IM injection is one of the basic and important duties of a nurse often associated with pain and anxiety. Providing pain relief is considered a basic human right and it is the duties of the nurse to use most successful techniques to minimize pain. Different methods are used by the nurses to reduce pain during intramuscular injections such as applying pressure, taping the skin, giving injections to a relaxed muscle, applying cold, ShotBlocker, and Z-track techniques. Aim: the study aimed to evaluate the effectiveness of using ShotBlocker and Z – Track techniques on minimizing the needle pain and anxiety among adult receiving intramuscular injection. Methods: Quazi experimental research design was conducted at Medical & Surgical department at Mansoura University Hospital. A convenient sample of a sixty adult patients, aged (18-65 years old) .Subjects were selected by simple random sampling technique and assigned in to two groups ,30 for each(30 in shotblocker and 30 in Z- track technique). Results: It revealed that the pain score was reduced when IM injections were administered using ShotBlocker and Z-track techniques (second injection) rather than routine standard technique (first injection).The patients in the group II (Z-track) shows that a mean anxiety score was decrease after second injection. There was no statistical significant difference between two groups before and after two times of injections. While there was a statistical significant difference between first injection and second injection in group II, where p- value = 0.000. But no statistical significant difference between first injection and second injection in group I, where p- value = 0.330. Conclusion: It was noticed that the ShotBlocker and Z-track technique was effective in minimizing needle pain perception and Z-track technique is effective in minimizing level of anxiety but ShotBlocker was not effective in reducing anxiety.

WOS: 000482217800005 PubMed: 31257044 Introduction: Procedural pain in general, and intramuscular (IM) injection pain in particular, is one of the most distressing and painful health care experiences for children. Pharmacologic and nonpharmacologic methods are used as forms of pain control for children undergoing acute painful interventions in emergency departments. Methods: This study was a prospective, randomized controlled trial. The sample consisted of children aged 5 to 10 years old who required IM injections. Children were placed in 4 subgroups through randomization, using a computer program: the Buzzy (MMJ Labs. Atlanta, GA) group (n = 40), the ShotBlocker (Bionix Development Corporation, Toledo, OH) group (n = 40), the bubble-blowing group (n = 40), and the control group (n = 40). Immediately before and after the injection, the children, their parents, and an observer were asked to evaluate the child's level of fear. The Oucher scale was also employed by the observers, children, and parents immediately after the procedure to assess the level of pain in the children in each group. Results: No statistically significant difference was determined between the control and intervention groups in terms gender, age, previous pain experienced with injection, the parent who was with the child, the parent's age. A significant difference was found between the intervention and control groups in terms of levels of pain and fear during IM injection. Pain and fear were notably less in the group of children receiving the Buzzy intervention. Discussion: The Buzzy intervention should be used when children are undergoing IM injections to reduce their levels of pain and fear.

Intramuscular (IM) injections are preferred over subcutaneous injections for administering medicine such as epinephrine and vaccines as the muscle tissue contains an increased vascular supply that provides ideal absorption of the drug being administered. However, administering an IM injection requires clinical judgment when choosing the injection site, understanding the relevant anatomy and physiology as well as the principles and techniques for administering an IM injection. Therefore, it is essential to learn and perform IM injections using injection simulators to practice the skill before administering to a real patient. Current IM injection simulators either favor realism at the expense of standardization or are expensive but do not provide a realistic experience. Therefore, it is imperative to develop an inexpensive but realistic intramuscular injection simulator that can be used to train nursing students so that they can be prepared for when they enter the clinical setting. This technical report aims to provide an overview of the development of an inexpensive and realistic deltoid simulator geared to teach nursing students the skill of IM injections. After development, the IM simulators were tested and validated by practicing nurses. An 18-item survey was administered to the nurses, and results indicated positive feedback about the realism of the simulator, in comparison to previous models used, such as the Wallcur® PRACTI-Injecta Pads (Wallcur LLC, San Diego, CA). Feedback to improve the density of the simulator as well as the shape and size to make it a more realistic experience was provided.

This short report outlines the rationale, design and method of production for a thigh-mounted intramuscular (IM) pad in the thigh of a SimMan 3G manikin. The aim of this project was to create an IM injection site in the manikin’s thigh to allow simulation participants to practise administering IM injections in a safe, supported environment. After creating a prototype from a plastic bottle, a module was designed to use with the SimMan 3G. A mould of SimMan’s leg was created using plaster of Paris, and then a relief was added to this mould to create the shape required to hold the sponge. Once the mould was completed, glass reinforced plastic (GRP) was applied to create the final module. Using an electric rotary tool, a hole was cut in the SimMan’s thigh to enable the module to be fitted. The final product was waterproof, lightweight and strong. It sits discretely beneath the SimMan 3G’s leg skin enabling students to practise high-fidelity IM injections on the manikin’s leg without faculty intervention. This module is a cost-effective solution for allowing participants to practise IM injections on a manikin during healthcare simulation.

An ideal dexmedetomidine protocol has yet to be determined for standing sedation in horses. It was hypothesized that an IV bolus followed by CRI dexmedetomidine would have a quicker increase in plasma concentrations compared with repeated IM injections. In a crossover design, eight adult, female horses were randomly placed into two groups: the CRI group (IV bolus dexmedetomidine at 0.005 mg/kg followed by a CRI at 0.01 mg/kg/h for 15 min then 0.005 mg/kg/h for 60 min) and the IM group (dexmedetomidine at 0.01 mg/kg, followed by 0.005 mg/kg in 30-min intervals for 60 min). Clearance and elimination half-life were 134 ± 67.4 ml/kg/min and 44.3 ± 26.3 min, respectively, in the CRI group, and apparent clearance and half-life were 412 ± 306 ml/kg/min (Cl/F) and 38.9 ± 18.6 min, respectively, in the IM group. Analgesia was evaluated using mechanical pressure threshold. Intravenous dexmedetomidine produced faster onset of sedation and increased pressure threshold compared with IM administration. Individual horses had a large variability in dexmedetomidine plasma concentrations between CRI and IM administration. The odds of a decreased GI motility following IV administration was 12.34 times greater compared with IM administration.

There are several methods to treat vitamin B12 deficiency (VB12d): intramuscular (IM), oral, sublingual (SL), and intranasal vitamin B12 (VB12) preparations. Large studies comparing the efficacy of SL vs. IM supplements are lacking. The aim of the present study was to compare the efficacy of SL versus the standard IM administration of VB12 in restoring B12 levels. This was a retrospective analysis of data from the computerized pharmacy records of Maccabi Health Service (MHS). Data were recorded for all patients older than 18 years of age who were prescribed VB12 during January 2014–December 2017. The main outcome was the change in levels of serum vitamin B12 (sVB12) after treatment. Overall, there were 4281 patients treated with VB12 supplements. Of them, 830 (19.3%) patients were treated with VB12 IM injections and 3451 (80.7%) with SL tablets. The mean ± SD difference between sVB12 levels before and after administration of VB12 supplements was significantly higher in the SL group vs. IM injection group (252 ± 223 vs. 218 ± 184 ng/L, p

Prolactin controls mammary development as well as the lactogenic and galactopoietic processes in sows and increasing prolactin during gestation can augment milk yield. The dopamine receptor antagonist domperidone can increase circulating prolactin concentrations in pigs, but the ideal dose to achieve sustained hyperprolactinemia remains unknown. An experiment was performed to develop a protocol for using domperidone in studies of rapid and sustained hyperprolactinemia in late-pregnant gilts. On day 90 of gestation, gilts were divided into 4 groups: (1) intramuscular (IM) injections of canola oil (3 mL, controls [CTL], n = 9), (2) IM injections with 0.1 mg/kg BW of domperidone (low [LO], n = 8), (3) IM injections with 0.5 mg/kg BW of domperidone (medium [ME], n = 11), and (4) IM injections with 1.0 mg/kg BW of domperidone (high [HI], n = 11). Injections were given daily at 8:05 from days 90 to 109 of gestation. Treated gilts also received domperidone per os (0.5 mg/kg BW) at 8:00 and 20:00 on days 89, 90, and 91 of gestation. Three jugular blood samples were collected from all gilts at 6-h intervals on days 89, 90, and 91 of gestation, then twice daily on days 92, 93, and 94. Thereafter, samples were obtained at 8:00 every other day until day 114 of gestation. Blood was sampled serially from 9 CTL and 11 HI gilts on days 89 and 94 of gestation. On day 89 of gestation, prolactin concentrations for LO, ME, and HI gilts increased within 6 h of domperidone per os (P0.001). From days 89 until 93 of gestation, the area under the curve (AUC) for LO, ME, and HI gilts was greater than that for CTL gilts (P0.001), whereas from days 89 until 114, ME and HI gilts had greater AUC than CTL and LO gilts (P0.05). Results demonstrate that the combination of per os treatment with IM injections of 0.5 mg/kg of domperidone in an oil emulsion leads to the rapid and sustained release of prolactin over 24 d in late-pregnant gilts. Higher doses of domperidone failed to further increase circulating prolactin levels. These findings provide a useful strategy to induce sustained hyperprolactinemia in late-pregnant gilts.

Domestic goats, although present in large numbers worldwide, are still considered a minor species in Europe and the USA. Due to their minor status, new therapies directed to relieve pain is a neglected area of investigation. Unfortunately there is a lack of approved drugs for this species and many drugs are administered in an extra-label manner. Often no information on the safety profile for goats and for humans consuming their products is available. Meloxicam (MEL) is a potent anti-inflammatory drug characterized by a preferential COX-2 isoenzyme inhibition. The aim of this study was to determine the pharmacokinetics of MEL at the dose of 0.5 mg/kg in lactating goats after intravenous (IV) and intramuscular (IM) administration and to quantify its residues in milk. The analytical method was performed by the HPLC diode array detector. The IV and IM administrations of MEL in lactating goats showed suitable pharmacokinetic profiles for this animal species. The IM route showed a bioavailability of 105% and long half-life of elimination (10.82 h). The simulation of multiple daily IM injections provides a plasma concentration above the therapeutic concentrations determined for other species for the majority of 24 h. The high IM bioavailability, the long half-life of elimination and the mean plasma concentration at the steady state suggested that once a day administration might be sufficient. MEL residues were quantifiable in milk up to 48 h in IM group and 60 h in the IV group. This data seems to be in line with the milk depletion reported in cattle. Further studies are necessary to establish if the minimal effective concentration determined in other animal species can be applied to goats too.

Made available in DSpace on 2020-12-10T20:10:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-09-15 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Germinal vesicle oocytes obtained by ovum pick-up (OPU) on a random day are heterogeneous in terms of chromatin maturity, and those with an intermediate degree of chromatin compaction present higher developmental competence. We previously developed a synchronization protocol combining follicle aspiration and FSH treatment capable of increasing the percentage of oocytes with intermediate chromatin compaction (classified as GV2 oocytes; within progressive stages of chromatin compaction ranging from GV0 to GV3) at the time of OPU. In this study, we tested the capacity of a similar protocol to synchronize oocyte chromatin maturity before OPU, as well as to improve the efficacy of in vitro embryo production (IVP) in Holstein cows. In the first experiment, eight non-lactating Holstein cows were subjected to the D5/4FSH, during which all follicles larger than 2 mm were aspirated and a progesterone intravaginal device was inserted on a random day (day 0). Subsequently, four IM injections of FSH (Folltropin; 40/40/20/20 mg) were administered 12h apart on days 2 and 3, and removal of the progesterone device and OPU were performed on day 5. Of the oocytes recovered by OPU, 83.2% were at the GV2 stage. In a second experiment, eighteen non- lactating Holstein cows (Synchro group) were subjected to the D5/4FSH protocol followed by IVM/IVF, and embryo production was compared with that of other seventeen cows submitted to OPU on a random day followed by IVM/IVF (Control group). Blastocyst rate in relation to total oocytes recovered was higher in the Synchro group (37.9%) compared to the Control group (21%; P < 0.05). The percentage of good quality blastocysts morphologically selected for freezing and later transfer in relation to the total number of oocytes recovered tended to be higher in the Synchro group (27.68%) compared to the Control group (14.34%; P = 0.1). These data suggest that synchronization protocols increasing the percentage of GV2 oocytes in the population subjected to IVM/IVF can improve the efficacy of embryo in vitro production in cattle. (c) 2020 Elsevier Inc. All rights reserved. Sao Paulo State Univ, Inst Biosci, Dept Physiol, Ovarian Mol Physiol Lab, Botucatu, SP, Brazil Neogen Assisted Reprod Lab, Ribeirao Preto, Brazil Univ Milan, Dept Hlth Anim Sci & Food Safety, Reprod & Dev Biol Lab, Milan, Italy Reprod Med Ctr, Biogenesi, Monza, Italy Sao Paulo State Univ, Inst Biosci, Dept Physiol, Ovarian Mol Physiol Lab, Botucatu, SP, Brazil CAPES: 001 FAPESP: 2017/07588-4 FAPESP: 2016/21671-9

Objective: Medications are generally administered by either the enteric or parenteral route. With parenteral administration, intramuscular (IM) is the preferred approach because it increases the bioavailability of the drug, acts more quickly than the enteric route. The aim of this study was to determine the rate of true dorsogluteal intramuscular drug injection and to determine the causes for application failures in practice by ultrasonography (US). Methods: The study was conducted from May 1 to May 30, 2017 in Giresun University Education and Research Hospital, Giresun, Turkey. We examined 60 patients who were administered dorsogluteal IM injection with a 38.1mm length needle. After the injection, localization of medications (whether intramuscular or subcutaneous adipose tissue [SAT]) was evaluated by Ultrasound. Results: Female/male ratio of the patients was 27/33, with a mean age of 39.78±2.16 years. Obese/normal weight ratio was 20/40. The mean dorsogluteal area SAT thickness of obese and normal weight patients were 32.34±2.17 mm and 20.85±1.20 mm, respectively. In 23 of the patients, IM injected drug was observed in the SAT, while it was observed in the IM area in 37 patients. Medication was observed in IM area in 37 of 50 patients who dorsogluteal region SAT thickness was appropriate (SAT thickness lower than 33.1mm) for IM injection while it was seen in SAT area in 13 patients. Conclusions: SAT thickness values are important if IM drug injection is to be administered correctly. Unsuccessful IM injections may be seen even in patients with appropriate SAT thicknesses. doi: https://doi.org/10.12669/pjms.35.4.313 How to cite this:Ozen O, Gunaydin M, Tosun A, Coskun ZU, Aytekin K, Takir S. Assessment rate of true dorsogluteal intramuscular drug injection using ultrasonography. Pak J Med Sci. 2019;35(4):1132-1137. doi: https://doi.org/10.12669/pjms.35.4.313 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

OBJECTIVES: Intravenous (IV) and intramuscular (IM) antibiotics have comparable efficacy in treating neonates undergoing sepsis evaluations. There are no clinical data favoring the use of either route regarding newborn pain and parental preferences. We hypothesized that pain associated with IM injections would worsen breastfeeding effectiveness and decrease parental satisfaction, making IV catheters the preferred route. METHODS: This prospective cohort study took place in an academic institution with nurseries in 2 separate hospitals, 1 providing IV antibiotics, and the other, IM antibiotics. Newborns receiving 48 hours of antibiotics were compared by using objective pain and breastfeeding scores and parental surveys. RESULTS: In 185 newborns studied, pain scores on a 7-point scale were up to 3.4 points higher in the IM compared with the IV group (P < .001). Slopes of repeated pain scores were 0.42 ± 0.08 and −0.01 ± 0.11 in the IM and IV groups, respectively (P = .002). Breastfeeding scores were similar between groups. Parents in the IV group were less likely to perceive discomfort with antibiotic administration (odds ratio [OR] 0.22; 95% confidence interval [CI] 0.06–0.74) but more likely to perceive interference with breastfeeding (OR 26; 95% CI 6.4–108) and bonding (OR 101; 95% CI 17–590) and more likely to prefer changing to the alternate route (OR 6.9; 95% CI 2.3–20). CONCLUSIONS: IM antibiotics in newborns are associated with pain sensitization and greater pain than IV dosing. Despite accurately recognizing newborn pain with the IM route, parents preferred this to the IV route, which was perceived to interfere with breastfeeding and bonding.

The study was carried out in the superficial digital flexor tendon (SDFT) of the right forelimb of nine clinically apparently donkeys for evaluation the efficacy of Polysulfated Glycosaminoglycan (PSGAG) and Dexaphenylarthrite in treatment of artificial induced tendonitis. To achieve this goal, clinical, ultrasonography, biochemical and histopathological examinations were concluded. Tendonitis of the SDFT was induced by using bacterial collagenase enzyme from Clostridium histolyticum. Donkeys were classified into three groups. Group Ι (after induction of tendonitis they left as control group= 3 donkeys). Group ΙΙ, 3 days after induction of tendonitis, they received five IM injections of 5ml PSGAG (100 mg/ml) every four days. Group ΙΙΙ, 3 days after induction of tendonitis, they received Dexaphenylarthrite in a dose of 20 ml/day for the first two days followed by 10 ml/day for the other three days. From this study, it can be concluded that PSGAG had beneficial effects in treatment of artificial induced tendonitis in donkeys rather than Dexaphenylartrite based on clinical, ultrasonography, biochemical and histopathological findings.

The World Health Organization and Centers for Disease Control and Prevention no longer recommend aspiration during intramuscular (IM) injections. The purpose of this study was to investigate the technique registered nurses (RNs) use during IM injections and incidence of blood aspiration. This descriptive study surveyed 164 RNs. Results noted that 74% of the sample continue to aspirate at least 90% of the time. Of the participants who continue to aspirate, only 3% aspirate for the recommended 5 to 10 s. Forty percent reported having aspirated blood at least once, whereas 6 RNs (4%) noted blood aspiration ≥13 times. Blood aspiration occurred most frequently in the dorsal gluteal (15%) and deltoid (12%). Based on the findings, it is recommended that RNs use a decision-making process to select the safest technique for IM injections. If a parental medication has different administration rates, dose, viscosity, or other concerns when given IM versus intravenously (IV), aspiration during IM administration should be implemented.

We assessed aversion to injections using an avoidance-learning paradigm. Holstein calves (n = 24) were randomly assigned to one of four routes of administration for 0.5 ml of saline: intramuscular (IM), intranasal (IN), subcutaneous (SC) and a null control. Calves were first trained to approach a milk reward of 1 L. Once the latency to approach the reward was consistent, calves received their assigned treatment when approaching the bottle. For the first 3 treatment sessions calves received a 1 L milk reward. This reward was then reduced to 500 mL, and then to 250 mL, and finally to 0 mL, each for 3 sessions. Compared to control calves, calves receiving the intramuscular injections showed a longer latency to approach the milk reward, but only when the milk reward was 0.25 L (P = 0.05) and 0 L (P 0.2). We conclude that IM injections are aversive and that SC and IN routes are a refinement to be considered when feasible.

Literature on complications after intramuscular (IM) injections in equids is fairly sparse and consists of a few studies, case series, personal opinions, and surveys. The necessity of injection-site preparation protocols and appropriate localization for IM injections are often discussed, especially when compensation claims arise. The variety of adverse reactions and their symptoms is well known to all practitioners, with some being less frequently observed than others. Especially, the contribution of tissue-irritating capacities of IM administered drugs to abscess formation or even clostridial myonecrosis is discussed. With this review, we aim to summarize the current knowledge, standards and opinions on injection-site preparation protocols, injection techniques, adequacy of injection sites, complications after IM injections, and possible causes of IM injection complications.

Case Immunomodulatory injections are becoming common long-term treatments for neuromuscular diseases such as multiple sclerosis (MS), although they carry a risk of local site infection. We describe a case of a 57-year-old man who developed necrotizing fasciitis of the anterior thigh secondary to intramuscular (IM) injections of interferon-beta-1A for MS, ultimately developing septic shock and requiring serial debridements for source control. Conclusions This is the first reported case of necrotizing fasciitis from chronic IM injections for MS and deserves particular attention because of the immunosuppressive nature of the injections. In patients with underlying predisposing factors for infection, such as decubitus ulcers, it may be prudent to reconsider the administration route. Patients in hypermetabolic states should be closely monitored for impaired response to infections.

Objective: To study a probable luteolytic effect of castor beans in ewes and find which part of the bean is effective. Methods: in experiment I the estrous cycle of 30 desert ewes was synchronized with 2 im injections of 125 μg PGF2 α, 9 days apart. Then the ewes were grouped into 3 groups: A, B and C (10 ewes each). Each ewe in group A was fed 2-4 gm of whole castor beans on day 9 of the estrous cycle (T1) and each ewe in group B was fed 6-8 gm (T2). Group C was left to cycle naturally to serve as a control. Experiment II investigated the effective portion of castor beans. The testae (outer shells) of 8 gm castor beans were removed and separated from the decorticated part. Then 10 cyclic ewes were divided into 2 groups. Group I (n=5) were fed the decorticated castor beans and group II (n=5) were fed the castor beans’ testae. Results: A significant (p

Introduction It was estimated that 3.2 million Indians with diabetes injected insulin in 2010, but little is known about the techniques used. Methods In 2015 we conducted an injection technique questionnaire (ITQ) survey throughout India involving 1011 patients. Indian values were compared with those from 41 other countries participating in the ITQ, known here as rest of world (ROW). Results Mean HbA1c was 8.6. BMI values in India were 1.5–3 units lower than in ROW depending on patient group, meaning the risk of intramuscular (IM) injections is high in India. The mean total daily dose (TDD) of insulin was lower in every category of Indian patient than in ROW, perhaps reflecting the lower BMI. Needle reuse, whether with pens or syringes, is much higher in India than ROW and so is the number of times the needle is used. The majority (56.8%) of Indian insulin users performed only 2 injections/day as opposed to ROW where 45% of patients performed at least 4 injections/day. Indian patients inject insulin in the thighs more often than patients in ROW, a site where IM injections are more risky. Many patients do not have proper access to sharps containers or have other risk factors that could lead to blood-borne pathogen spread. More than 60% of used sharps in India go into the rubbish, with nearly 12% not even having the minimum protection of a cap. Discussion The shortest needles are very common in India; however, the level of needle reuse is high. Multiple daily injections therapy is not as common in India as ROW. More focus needs to be given to dwell times under the skin, reconstitution of cloudy insulins, skinfolds, and safe sharps disposal.

Robert L Hill,1,* John G Wilmot,1,* Beth A Belluscio,1Kevin Cleary,2 David Lindisch,3Robin Tucker,4Emmanuel Wilson,2Rajesh B Shukla11Meridian Medical Technologies Inc., Columbia, MD, 2Children’s National Medical Center, 3Washington DC VA Medical Center, 4Georgetown University Medical Center, Washington, DC, USA *These authors have contributed equally to this work Abstract: Parenteral routes of drug administration are often selected to optimize actual dose of drug delivered, assure high bioavailability, bypass first-pass metabolism or harsh gastrointestinal environments, as well as maximize the speed of onset. Intramuscular (IM) delivery can be preferred to intravenous delivery when initiating intravenous access is difficult or impossible. Drugs can be injected intramuscularly using a syringe or an automated delivery device (autoinjector). Investigation into the IM delivery dynamics of these methods may guide further improvements in the performance of injection technologies. Two porcine model studies were conducted to compare differences in dispersion of injectate volume for different methods of IM drug administration. The first study compared the differences in the degree of dispersion and uptake of injectate following the use of a manual syringe and an autoinjector. The second study compared the spatial spread of the injected formulation, or dispersion volume, and uptake of injectate following the use of five different autoinjectors (EpiPen® [0.3 mL], EpiPen® Jr [0.3 mL], Twinject® [0.15 mL, 0.3 mL], and Anapen® 300 [0.3 mL]) with varying needle length, needle gauge, and force applied to the plunger. In the first study, the autoinjector provided higher peak volumes of injectate, indicating a greater degree of dispersion, compared with manual syringe delivery. In the second study, EpiPen autoinjectors resulted in larger dispersion volumes and higher initial dispersion ratios, which decreased rapidly over time, suggesting a greater rate of uptake of injectate than the other autoinjectors. The differences in dispersion and uptake of injectate are likely the result of different functional characteristics of the delivery systems. Both studies demonstrate that the functional characteristics of the method for delivering IM injections impact the dispersion and uptake of the material injected, which could significantly affect the pharmacokinetics and, ultimately, the effectiveness of the drug. Keywords: anaphylaxis, autoinjector device, injector pen, intramuscular drug administration, dispersion volume

Simple Summary Physical castration (PC) of piglets is a painful and stressful procedure and alternatives are being sought to improve animal well-being, such as immunological castration (IC). However, IC requires injections which may also cause pain and stress during handling. In this study, piglets and finishing pigs were placed in the following treatment groups: no handling or treatment (NO), sham-handling (SHAM), intramuscular injection (IM), subcutaneous injection (SQ), or PC on piglets only. Behavior was monitored for 1 h prior and 1 h post treatment in each age group. Social behavior and feeding behavior, and signs of pain were recorded. Physical castration caused measurable pain-like behaviors and general behavioral dysregulation at a much higher level than changes associated with handling associated with IM or SQ injections. Overall, injections did not cause a change in weaning pig behaviors. Finishing pigs given SQ injections showed a lower number of feeding behaviors post treatment but other changes were not observed in the other treatment groups. Abstract Physical castration (PC) is painful and stressful for nursing piglets. One alternative to PC is immunological castration (IC), but the pain and stress of handling associated with injections have not been assessed. The objectives of this study were to measure the pain and distress of subcutaneous (SQ) and intramuscular (IM) injections compared to PC in piglets, and to compare SQ or IM injections in finishing pigs. After farrowing, 3 to 5 d old male piglets were randomly assigned to (control) no handling treatment (NO), sham-handling (SHAM), IM, SQ, or PC. Finishing pigs were assigned to NO, SHAM, IM, or SQ. Behavior was monitored for 1 h prior and 1 h post treatment in each age group. Social, feeding behaviors, and signs of pain were recorded. Finishing pigs treated with SQ injections had higher feeding behaviors pre-treatment than they did post-treatment. Overall, physical castrations caused measurable pain-like behaviors and general behavioral dysregulation at a much higher level than the other treatment groups. SQ and IM injections did not cause either significant behavioral or physiological alterations in piglets. SQ injections caused a decrease in finishing pig feed behaviors post treatment (p = 0.02) and SHAM treated finishing pigs spent significantly more time lying than the other treatment groups. In general IM and SQ injections did not cause any other significant changes in behavior or physiology.

Objectives: To investigate the effects of air-lock technique (ALT) on pain of intramuscular (IM) injection delivered to the ventrogluteal and dorsogluteal site (DS). Methods: A randomized controlled trial design was used to assess the pain intensity associated with IM injections administered using 2 different methods and injection sites. Recruitment of patients was carried out between April and August 2013 at the Department of Brain Surgery, Cekirge State Hospital, Bursa, Turkey. The sample comprised 60 patients who developed no complications at the IM site, and had no illness that could affect their perception of pain. The patients were randomly divided into 2 groups of 30 patients. Patients in the first group received injections in the ventrogluteal site (VS), while the DS was used for injections in the second group. Patients in each group received 2 injections, one using ALT and one not using the technique. After each injection, the pain felt by patients during the injection was immediately assessed using a visual analog scale. Results: The mean pain score after injections to the DS by the ALT was 3.30 ± 2.70, while the mean pain score after injections to the VS using the same technique was 2.53 ± 2.52. Conclusion: Although the difference between groups was not significant, the results of the study supported the idea that injections delivered to the VS by ALT are less painful than those delivered to the DS. Saudi Med J 2016; Vol. 37 (3): 304-308 doi: 10.15537/smj.2016.3.13113 How to cite this article Yilmaz DK, Dikmen Y, Kokturk F, Dedeoglu Y. The effect of air-lock technique on pain at the site of intramuscular injection. Saudi Med J 2016; 37: 304-308.

OBJECTIVE We aimed to establish the ideal injection techniques using 5-mm needles to reliably inject insulin into the subcutaneous fat in both children and adults and to quantify the associated pain and leakage of the test medium. RESEARCH DESIGN AND METHODS A total of 259 subjects (122 children/adolescents and 137 adults) were injected with sterile air corresponding to 20 IU insulin (200 μl) with 32-G 5-mm needles at 90° or 45°, in the abdomen and thigh, and with or without a pinched skin fold. Injection depth was assessed via ultrasonography. Subjects rated pain on a visual analog scale. Test medium injections into the abdomen and thigh (0.2–0.6 ml) were also administered to assess injection leakage. RESULTS Among children, 5.5% of injections were intramuscular (IM) and 0.5% were intradermal, while in adults, the incidence was 1.3 and 0.6%, respectively. The frequency of IM injections was greater in boys and negligible among adult women. Subcutaneous fat thickness was the primary predictor of the likelihood of IM injections (P < 0.001). A third of all patients reported experiencing no pain during insulin injection, with children/adolescents experiencing considerably more discomfort than adults. Some leakage of medium was observed, but was unrelated to injection volume and was generally minimal. CONCLUSIONS 5-mm needles are reliably inserted into subcutaneous fat in both adults and children. These needles were associated with reduced pain and minimal leakage. We recommend an angled injection with a pinched skin fold for children, while in adults, the technique should be left to patient preference.

This paper reviews practice in the area of intramuscular (IM) injection administration, an everyday activity for many nurses in clinical practice. The authors address administration of neuroleptic depot drugs within the adult mental health environment and examine the evidence base for this practice. A historical overview of injection practices and use of the dorsogluteal site is given, followed by more contemporary evidence on the benefits of using the ventrogluteal, deltoid and thigh sites. The authors point out that despite being a very commonplace nursing activity, there is a dearth of research-based guidelines for nurses in this area. A quantity of published papers and nursing texts on injection sites and techniques were assessed to evaluate their quality and relevance and their overall benefit to improving clinical practice. Much of the literature available was in the form of opinion pieces without a sound research/evidence base. There appears, however, to be enough consensual evidence to form an evidence-based clinical guideline for the administration of IM injections. The review of the available evidence, albeit at times contradictory, is presented along with a discussion of the implications for nurses.

Tulathromycin is a new injectable macrolide antibiotic used for the treatment of pulmonary diseases of swine and cattle. In this study, 37 foals with sonographic evidence of lung abscesses were treated with tulathromycin (2.5mg/kg intramuscularly [IM] once weekly, group 1) and 33 foals (group 2) with a combination of azithromycin (10mg/kg per os [PO] once daily for the first seven days of therapy, thereafter every other day) and rifampin (10mg/kg PO twice daily). The bacterial aetiological agent was not determined. The foals were only mildly sick and the median number of pulmonary abscesses was 1.4 (group 1) and 1.6 (group 2). Thirty foals in each group were treated without modifying therapy protocols until all clinical signs of disease had subsided. Tulathromycin was administered for a mean of 53 days, and azithromycin/rifampin for 42 days. The following side effects were associated with tulathromycin (279 IM injections): self-limiting diarrhoea in 11 foals; elevated temperature in six foals, and swellings at the injection site in 12 foals. This study provides some evidence that tulathromycin is well tolerated and appears promising for the treatment of pulmonary abscesses in foals.

Summary Introduction In France, self-administration is less common for intramuscular (IM) than parenteral injections, because of the widespread availability of home visits by nurses, who can give these IM injections. An easy, personalized training program was set up to help French patients who wanted to be self-sufficient regarding their injections. Methods This noncomparative, open-label, multicenter study enrolled patients aged 18-75 years, diagnosed with relapsing-remitting multiple sclerosis (MS), with at least 2 relapses during the previous 3 years, no evidence of progression between relapses, and treated with IM interferon beta-1a. The main objective was to assess the proportion of patients able, according to their treating neurologist, to perform the IM injections on their own at the end of an 8-week training program led by nurses. Results The study included 440 patients (74% women, mean age = 38.7 ± 9.8 years) at 98 MS centers. At the end of the study, 87% were assessed as “able” to self-inject, and8 6.6% of this group could do so by the second injection. Patients' satisfaction regarding the training program was high (89.4 ± 13.4 mm at week 4. 89.5 ± 12.1 mm at week 8 on a visual analog scale rated from 0 to 100 mm), as was their satisfaction regarding the injection (82.7 ± 21.2 mm at week 4 and 84.2 ± 20.0 mm at week 8). The correlation between the nurses' and neurologists' evaluations of the patients' ability to self-inject was high, exceeding > 90%. Conclusion This large-scale study demonstrated the feasibility of IM self-injection of interferon beta-1a in patients who want to administer their own injections.

Fear of pain from injections may affect adherence to needed drug therapy. A single-blind, placebo-controlled crossover study was conducted to evaluate the efficacy of EMLA cream in reducing the fear and pain associated with intramuscular (IM) injection during administration of interferon beta-1a to patients with multiple sclerosis. Patients rated fear of injection on a visual analog scale before the injection and rated injection pain following the injection. With the application of EMLA cream, the mean pain-of-injection score was found to be significantly lower than the mean fear-of-injection score. The 18 patients who completed the study experienced a statistically significant decrease in both scores. This study suggests that the use of EMLA cream may reduce the pain and fear associated with IM injections.

High utilization of emergency services by patients at increased risk for agitation and aggression makes the determination of effective therapy a major concern of psychiatric care. Agitated and aggressive behavior needs to be treated rapidly and effectively to minimize the risk to both patients and staff. Traditionally, short-acting intramuscular (IM) formulations of conventional antipsychotic drugs have been preferred in the emergency setting due to their rapid onset of action and the ability to administer them to uncooperative patients. IM injections, however, may not always be the preferred option. Recently, orally administered second generation (atypical) antipsychotics have been shown to be at least as effective in managing acute agitation as conventional antipsychotic drugs, with a superior tolerability profile. The current review evaluates pharmacokinetic parameters, formulation options, and clinical efficacy data for the treatment of acute agitation or aggressive behavior with antipsychotic medications. A synthesis of data from individual clinical trials, meta-analyses, review articles, and expert consensus recommendations is used to develop a working clinical algorithm for the acute management of aggression and agitation.

O uso de bezerras pré-púberes como doadoras de ovócitos oferece um considerável potencial para acelerar o ganho genético através da diminuição do intervalo de gerações, além de incrementar o aproveitamento de fêmeas bovinas de alto valor genético. Os objetivos deste estudo foram analisar o efeito da idade e do tratamento estimulatório com gonadotrofinas sobre a resposta folicular, a taxa de recuperação, a produção e a avaliação morfológica de ovócitos colhidos em bezerras da raça nelore (B. t. indicus) a partir de 10 meses de idade. As bezerras foram distribuídas aleatoriamente em três grupos (n=4) e receberam tratamentos hormonais distintos, repetidos nos mesmos animais nos três períodos, aos 10, 11 e 12 meses de idade. No dia zero (D0), todas as bezerras receberam um implante intravaginal de progesterona e, em D1, 2 mg de benzoato de estradiol intramuscular (im). Em D6, deu-se início à diferenciação dos tratamentos (T): T1- 120 UI de FSH, divididos em quatro aplicações im a cada 12 horas; T2 - 120 UI de FSH, em uma única aplicação subcutânea (sc), mais 300 UI de eCG sc, T3 - sem tratamento estimulatório. No D8, o implante de progesterona foi retirado e a punção folicular transvaginal, guiada por ultra-som (PFTV), foi realizada no D9. Dos 402 ovócitos coletados, 53 foram desnudados e medidos, incluindo a zona pelúcida, encontrando-se um diâmetro médio de 153,38 (8,06) mm. Não houve diferença significativa entre os tratamentos e entre as idades para quantidade de folículos > 3 mm, de ovócitos recuperados e de ovócitos viáveis. A média de ovócitos recuperados e ovócitos viáveis para cada tratamento foi: T1- 11,08 (6,20) e 59,58% (25,80), T2- 12,75 (8,04) e 66,02% (36,71), T3 - 9,66 (8,15) e 51,51% (30,69), respectivamente. O valor médio da taxa de recuperação foi de 78,70%. O uso de FSH e FSH + eCG não aumentou significantemente a quantidade de folículos > 3 mm no momento da PFTV, assim como dos ovócitos recuperados e viáveis aos 10, 11 e 12 meses de idade. The use of pre-pubertal calves as oocyte donors offers a considerable potential to increase the genetic gain lowering the generations interval, as well as increase the usage of bovine females with high genetic value. The objectives of this study were to analyze the effect of age and of the stimulatory treatment with gonadotropins in the follicular response, the recovery rate, quantity and quality of oocytes of the prepubertal Nelore (B. t. indicus) calves. Twelve Nelore prepubertal females were stimulated with gonadotrophin hormone and were submitted to ultrasound guided transvaginal oocyte recovery (OPU) at 10, 11 and 12 months of age. Before OPU the females were randomly distributed into three treatment groups (n=4), which consist of different protocols of ovarian super stimulation. For all treatments the animals on day zero (D0) received one intravaginal progesterone implant (CIDR-G®) and on D1, 2 mg of estradiol benzoate im (Estrogin®). The stimulatory treatment began on D6 according to the following treatments: T1-120 IU of FSH (Foltropin®), divided in 4 im injections with 12 hours interval; T2-120 IU of FSH in one sc application plus 300 IU of eCG (Folligon®) on D6; T3 - without stimulatory treatment (control). At D8 the CIDR-G®was removed and OPU was performed on D9. Among the 402 oocytes retrieved, 53 were denuded and measured (including the pellucid zone) where a mean diameter of 153.38 ± 8.06 mm was obtained. No significant difference was detected among treatments and among ages for the quantity of follicles > 3 mm, quantity of oocytes recovery and quantity of oocytes morphologically viable. The mean of recovery oocytes and viable oocytes for each treatment was T1- 11.08 (6.20) and 59.58% (25.80), T2 - 12.75 (8.04) and 66.02% (36.71), T3 - 9.66 (8.15) and 51.51% (30.69), respectively. The mean value of recovery rate was 78.70%. The use of FSH or FSH + eCG does not increase significantly the amount of follicles > 3 mm at the OPU moment, as well as the total and viable oocytes by 10, 11 and 12 months of age.

Rationale. The relative reinforcing strength of cocaine can be characterized by the distribution of operant behavior during the availability of other reinforcing stimuli. Objective. To develop a procedure to rapidly evaluate the relative reinforcing strength of cocaine in monkeys. Methods. Monkeys were trained to respond on two levers under concurrent fixed-ratio 30 (FR30) schedules of reinforcement. Responding on one lever resulted in food delivery, responding on the alternative lever resulted in delivery of IV saline or cocaine (0.032 or 0.1 mg/kg per injection). Daily sessions consisted of three 30-min components separated by 10-min timeout periods. The availability of saline, 0.032, or 0.1 mg/kg per injection cocaine varied across components, and only in an ascending order. The relative reinforcing strength of 0.0032–0.32 mg/kg per injection cocaine was examined by substituting different unit doses for the training doses of cocaine. Effects of cocaine pretreatment on response distribution were determined by giving IM injections of 0.1–1.8 mg/kg cocaine 10 min prior to sessions of saline availability. Results. Increasing unit doses of cocaine monotonically increased the distribution of responding on the injection-lever and monotonically deceased response rates. Responding occurred predominantly on the food-lever during availability of saline or 0.0032 mg/kg per injection cocaine, whereas availability of 0.032–0.32 mg/kg per injection produced >90% of responding on the injection-lever. Availability of 0.01 mg/kg per injection cocaine resulted in approximately equal levels of responding on the food- and injection-levers. Presession IM cocaine injections dose-dependently increased responding on the injection-lever. Conclusions. Stable behavior can be maintained under concurrent FR schedules of food and cocaine presentation in monkeys, and the distribution of behavior on food- and injection-levers is dependent on the available dose of cocaine.

Background and objective: Intramuscular (IM) injections are administered to patients in all health care settings. Even though this procedure is invasive and the evidence supporting the process of administration is extensive, techniques and procedures vary throughout the literature and in practice. The purpose of this descriptive correlational study was to 1) investigate the literature on current evidence-based IM injection procedures pertaining to gender, patient weight, injection site, needle length, and technique, 2) compare surveyed healthcare personnel self-reported IM injection practices, and 3) query respondents on informational resources they access, continuing education they receive, and their years of healthcare experience and higher education.Methods: The Intramuscular Injection Questionnaire (IIQ) was sent via email to various professional healthcare facilities and their respective social media sites. Two hundred and six (206) healthcare personnel of various healthcare backgrounds and educational levels accessed the IIQ via a link to Qualtrics software. SPSS Version 24 was used for data analysis.Results: Most respondents were registered nurses with 4-15+ years of experience. Seventy-eight percent of respondents considered their IM injection knowledge at above average or expert levels. Gender was not considered an important factor when selecting an injection needle among 75% of participants. Of all respondents, 61% use z-track technique, 59% use the ventrogluteal site and 34% always bunch or stretch the skin during injection. IM injection education was not provided in 75% of healthcare facilities.Conclusions: IM injection practices vary among respondents and in the literature; some reported practices are contrary to current evidence-based practice. While the evidence provides some sound recommendations, some procedures are not well-documented or supported including in nursing texts. Nurses and other healthcare personnel must critically analyze the site, depth, needle, volume, medication, vaccine, and whether to bunch or stretch, according to evidence-based practice. Healthcare facilities should provide IM injection education routinely to ensure safe practices. Future studies (Level 1 and 2) are needed to further demonstrate the best evidence leading to safe and effective IM injections.

Objective To determine the effects of intramuscular (IM) administration of medetomidine and xylazine on intraocular pressure (IOP) and pupil size in normal dogs. Study design Prospective, randomized, experimental, crossover trial. Animals Five healthy, purpose-bred Beagle dogs. Methods Each dog was administered 11 IM injections of, respectively: physiological saline; medetomidine at doses of 5, 10, 20, 40 and 80 μg kg −1 , and xylazine at doses of 0.5, 1.0, 2.0, 4.0 and 8.0 mg kg −1 . Injections were administered at least 1 week apart. IOP and pupil size were measured at baseline (before treatment) and at 0.25, 0.50, 0.75, 1, 2, 3, 4, 5, 6, 7, 8 and 24 hours post-injection. Results A significant decrease in IOP was observed at 6 hours after 80 μg kg −1 medetomidine compared with values at 0.25 and 0.50 hours, although there were no significant changes in IOP from baseline. In dogs treated with 8.0 mg kg −1 xylazine, significant reductions in IOP were observed at 4 and 5 hours compared with that at 0.25 hours after administration. In dogs treated with 5, 10, 20 and 40 μg kg −1 medetomidine and 0.5, 1.0 and 2.0 mg kg −1 xylazine, there were no significant changes in IOP. Pupil size did not change significantly after any of the medetomidine or xylazine treatments compared with the baseline value. Conclusions and clinical relevance Low or moderate doses of medetomidine or xylazine did not induce significant changes in IOP or pupil size. In contrast, high doses of medetomidine or xylazine induced significant changes up to 8 hours after treatment, but values remained within the normal canine physiological range. The results of this study suggest a lack of significant change in IOP and pupil size in healthy dogs administered low or moderate doses of xylazine or medetomidine.

As knowledge to support nurses’ everyday practice increases, it is appropriate to reappraise routine procedures. This article revises nurses’ knowledge of the guiding principles for safe intradermal (ID), subcutaneous (SC), and intramuscular (IM) injections. It outlines the procedures used to select appropriate anatomical sites, and considers the idiosyncrasies of medications and patients’ special needs that may influence the choice of injection site. Issues related to the preparation of the patient and skin, and use of equipment, are discussed. Ways to reduce patient discomfort during the procedure are also suggested. The nurse is encouraged to review critically his or her injection technique in the light of evidence-based principles, to provide the patient with safe and effective care. After reading this article you should be able to: � Identify the safe anatomical sites for ID, SC and IM injections.

Drawing up and administering intramuscular injections: a review of the literature Intramuscular (IM) injections have been an integral part of drug administration in nursing practice for almost half a century. However, there are some conflicting practices which warrant investigation to determine their effectiveness in this aspect of patient care. To this end, this paper presents the results of a literature review which was carried out in order to establish current understanding of present day knowledge, procedures and guidelines for the administration of IM injections. Areas addressed within this review include injection sites used, injuries associated with IM injections, issues surrounding needle selection and volume administered through IM injections, injection techniques and nursing skills associated with IM injections. Synthesis of the research reviewed allows the development of research-based guidelines for this skill. These guidelines offer a framework for nurses who wish to provide practice in line with current research into the process of drawing up and administration of intramuscular injections.

Sixteen adult Black Bengal goats were synchronized in 2 groups with Alfaprostol (Gabbrostim® VETEM, Italy) or Luprostiol (Prosolvin®, Intervet, Netherlands) @ 2 mg and 7.5 mg, equivalent to 1 ml / donor respectively during the period from January 2002 to June 2003. The IM injections were given at 11 days interval. The percent of animals responded following 1st injection of Alfaprostol and Luprostiol was 75% and 87.5%, respectively. However, all animals responded following of 2nd injection of Alfaprostol, while that of Luprostiol were 87.5%. The mean time of onset of oestrus and duration of oestrus in Alfaprostol group were 36.2 ± 7.91 h and 57.37 ± 6.56 h and 20 ± 4.4 h and 28.5 ± 0.63 h following 1st and 2nd injections, respectively. The similar parameters were 37.5 ± 8.2 h and 49.5 ± 0.46 h and 21 ± 4.6 h and 27.3 ± 0.77 h in Luprostiol group. In both groups there was no significant difference (p > 0.05) between the treatment groups on either the time of onset of oestrus or the duration of oestrus.Key words: Alfaprostol; luprostiol; oestrus; sunchronization; Black Bengal goatsdoi: 10.3329/bjvm.v2i2.2557Bangl. J. Vet. Med. (2004). 2 (2): 143-145

As knowledge to support nurses’ everyday practice increases, it is appropriate to reappraise routine procedures. This article revises nurses’ knowledge of the guiding principles for safe intradermal (ID), subcutaneous (SC), and intramuscular (IM) injections. It outlines the procedures used to select appropriate anatomical sites, and considers the idiosyncrasies of medications and patients’ special needs that may influence the choice of injection site. Issues related to the preparation of the patient and skin, and use of equipment, are discussed. Ways to reduce patient discomfort during the procedure are also suggested. The nurse is encouraged to review critically his or her injection technique in the light of evidence-based principles, to provide the patient with safe and effective care. After reading this article you should be able to: � Identify the safe anatomical sites for ID, SC and IM injections.

Indwelling subcutaneous cannula for the administration of intermittent morphine boluses postoperatively have been been in several centers as an alternative to intramuscular (IM) injections. We introduced this technique to our hospital, assessed it for complications in 220 children, and conducted a survey to see if nursing staff preferred it to IM injections. The injections through the subcutaneous cannulae caused minimal distress to the children. There were no major complications, 95% of the nursing staff preferred this technique, and 74% would give morphine more readily to a child with a subcutaneous cannula in situ.

A new botulinum toxin type A free of complexing proteins (NT 201) was compared with BOTOX in patients with cervical dystonia by means of a double-blind noninferiority trial. Four hundred sixty-three patients received IM injections of 70 to 300 U of NT 201 or BOTOX and were followed up over 16 weeks. The study clearly shows that NT 201 is at least as effective and safe as BOTOX.

The objective of the present study was to evaluate the hormonal responses of buffaloes to GnRH injections given at different moments of the estrous cycle. The estrous cycles of 15 buffaloes were synchronized with 2 im injections of prostaglandin F2α given 11 days apart. The buffalos were randomly assigned to 1 of 3 groups. Buffaloes in the control group received no treatment, whereas GnRH6 buffaloes received a GnRH injection between days 5 and 7 and GnRH16 buffaloes received a GnRH injection between days 15 and 17 of the estrous cycle (estrus = day 0). Up to day 6, the plasma progesterone levels in the three groups were low (1 ± 0.16 ng/ml) but gradually increased until day 12 (4.62 ± 0.41 ng/ml). The amount of plasma progesterone concentrations decreased from day 15 of the estrous cycle in all groups of buffaloes. No significant differences were observed in the plasma level of progesterone and estradiol concentrations of the three groups during the estrous cycle. The peak levels of plasma estradiol were observed on day 20 and the differences were not significant (11.34 ± 1.77, 11.74 ± 1.91 and 12.72 ± 2.49 pg/ml in the control, GnRH6 and GnRH16 groups, respectively (P> 0.05). In conclusion, GnRH given at the beginning or at the end of the estrous cycle did not alter the profile of progesterone and estradiol concentration in buffaloes.

This study aimed to improve the success rate of gluteal intramuscular (IM) injection.The outcomes of 328 intended gluteal IM injections in 115 patients receiving depot octreotide were evaluated using computed tomography performed in routine clinical practice. Patient-, nursing-, and technique-dependent factors were correlated with successful delivery of medication. Techniques associated with successful injection were taught to center nurses.At baseline, 52% of injections were successfully delivered (66% men, 36% women; P = 0.001). Factors associated with successful delivery included nurses' frequency of injections (P = 0.008), landmarks use to select injection site (P0.001), quick needle insertion (P0.001), and use of nonsyringe hand to compress injection site (P0.001). Patient-related factors included male sex (P0.001), lower body mass index (P0.001), and lower skin-to-muscle depth at injection site (P0.001). Techniques associated with successful injections were then taught to center nurses. After instruction, the success rate increased from 52% to 75% (P = 0.001). Importantly, improvements were observed in both men (66%-75%; P = 0.43) and women (38%-75%; P0.001). Successful injection was associated with better control of flushing among those with carcinoid syndrome (P = 0.005).Intended gluteal IM injections often are given into the subcutaneous space. Education in techniques associated with successful injections improves IM delivery rates.

Infestation of sheep by L. cuprina larvae produces extensive skin wounds, severe dermatitis, hyperammonaemia and stress with adrenal necrosis and haemmorhage. In infested sheep, intramuscular (im) injections of Dl-Alpha tocopherol induced wool shedding and Desferrioxamine im prevented declines in white blood cells (WBC). In further trials, daily im injections of sodium ascorbate with Dl-alpha tocopherol, desferrioxamine and oral butylated-hydroxyanisole prevented adrenal damage and induced adrenocortical hypertrophy of the zona fasciculata. The treatment boosted the levels of mature and juvenile neutrophils, and blood glucose. Increases in toxic ammonia levels were correlated with increased toxic and band neutrophils, and globulin levels in treated sheep and toxic neutrophils in non-treated sheep. Decreases in serum zinc were correlated with declining lymphocytes and globulin levels. The results suggested that antioxidants protect and enhance adrenal activation in hyperammonaemic toxaemia. The changes in WBC, globulins and glucose were consistent with protected adrenocortical activation.

Antimicrobial agents are usually administered to cattle intramuscularly (im). After im injections, tissue damage at the injection sites may occur. This may be caused by the vehicle, the active ingredient, or both. Other factors affecting tissue reaction are pH, osmotic status, injection volume, concentration of the antimicrobial agent, and the injection technique used. Repeated injections and large injection volumes promote tissue damage (Kern 1987).

The aim of this study was to determine the influence of follicular profiles over 4 days prior to superovulation on superovulatory responses. Eighty-eight Holstein cows were synchronized by two prostaglandin F(2)α injections given 11 days apart and conventionally superovulated between days 8 and 12 of the estrous cycle with 400 mg Folltropin-V given in decreasing doses over 4 days. Luteolysis was induced by 2 im injections of cloprostenol (2 ml) with the sixth and seventh injections of Folltropin-V. The ovaries of all cows were examined by ultrasonography with a real-time linear scanning ultrasound diagnostic system (Ls-300-A: Tokyo Keiki Co., Tokyo, Japan; 7.5 MHz Transducer) on days -3, -2, -1, 0 (initiation day of the superovulatory treatment=day 0). Data were analyzed by the GLM procedure of the SAS. Animals with a greater diameter of the largest follicle (F1; 13.4 vs 9.8 and 10.1 mm; p0.007) and with a greater difference in the diameter of the first and second largest follicles (7.6 vs 4.5 and 3.8 mm; p0.001) had the greater superovulatory response and produced the greater number of quality I embryos. In conclusion, the diameter of the F1 and the F1-F2 follicles were higher over a 4-day period prior to superovulation in animals yielding a high than a medium and a low number of quality I and I+II embryos.

Alefacept is a remittive treatment for generalized psoriasis but is rarely used due to its erratic efficacy.To determine if psoriasis plaques will respond to intralesional alefacept and if this predicts a systemic response to intramuscular (IM) alefacept.We describe a 25-week, single-center, open-label study. Patients received weekly intralesional alefacept of increasing concentrations into target plaques for 3 weeks followed by IM injections for 12 weeks and concluded with an observation period of 9 weeks. The psoriasis area and severity index (PASI) was used to assess the efficacy of IM alefacept.Interim results are reported for the first seven patients enrolled. Two patients responded intralesionally to the most dilute 1:100 concentration of alefacept to sterile water and achieved a 59% and 100% improvement in PASI. Five patients did not respond intralesionally to the most dilute form of alefacept and none achieved PASI 75. Two of these five patients did not respond to any concentration and achieved a 26% and 38% improvement in PASI. Limitations to this study include a small sample size and being non-placebo-controlled.Alefacept is effective intralesionally and may predict a systemic response - challenging the concept that biologics must work systemically.

The effects of cocaine on auditory and visual threshold functions and reaction times were studied in baboons. Single IM injections of cocaine HCl (0.001–1.0 mg/kg) were administered once or twice weekly and were followed immediately by psychophysical tests designed to assess cocaine's effects on sensory thresholds and reaction times. Consistent reductions in reaction times were observed in the cocaine dose range of 0.032–0.32 mg/kg. Reaction times were decreased by 5–8% at the more effective cocaine doses. Concurrently measured auditory and visual threshold sensitivities showed no systematic changes at any of the cocaine doses studied.

The World Health Organization (WHO) reported that the administration of injections is one of the most common healthcare procedures, and unsafe injections are associated with morbidity and mortality, especially in developing countries. Post-injection sciatic neuropathy (PISN) has been identified as a serious complication of gluteal intramuscular (IM) injections. The long-term care of PISN poses an economic burden on carers and increases physiotherapists’ burden of care. This study reviewed two hundred and ten cases of PISN among eight hundred paediatric cases seen from January 2004 to December 2008 in the Physiotherapy Clinic of Oni Memorial Children’s Hospital in Ibadan, Nigeria. Each patient was evaluated for the limb affected, the health care centre where the injection was given and the health care personnel who gave the injection. One hundred and twenty three (58.6%) of the patients were male while eighty seven (41.4%) were female. A majority of the injections were administered at private hospitals – 143 (68.1%). The others were at general hospitals 22 (11.2%), by ‘nurses’ at dispensing shops 17 (8.1%) , at primary healthcare centres 12 (5.7%) , and two (1%) were given at home by the children’s grandmothers. Since PISN is a preventable condition, there is a need to minimize gluteal IM injections especially when other routes such as the vastus lateralis muscle can be used. A majority of the children with PISN (84.7%) were below the age of five and this makes it imperative for caution to be exercised when gluteal IM injections are given to this age group. Update and refresher courses should be regularly organized for the health professionals concerned, to minimize the occurrence of PISN. KEY WORDS: post-injection, sciatic neuropathy, paediatric, intramuscular

B12 deficiency occurs from dietary insufficiency or impaired absorption. The traditional treatment method is B12 IM injections. Oral B12 therapy is not considered dependable. Eligen® technology use...