air bubble

[IRNMAD]

got a air bubble today and could not get it to go away. should I hold the vial upside down and then draw out the test?

[Live4thePump]

yeah, draw back passed the amount you want and tap the syringe a little to get the air to go to the top and push out all the extra till you get the amount you're going to inject. good luck

[ALLGONOQUIT!]

I pull back the plunger, while empty, to the amount I wanna withdraw from the vial then inject that much air in the vial. Make sure the tip is in the liquid with the bottle upside down and pull it out. Try to do it all without letting the plunger down until you have the desired amount cause it will give you a bunch of small bubbles if you do. For one larger bubble just point it needle up and flick it with your finger until it goes. It won't kill you though if you do get a little one. I get them probably once every coupla weeks and I've never had an absess or any problems at all.

[phreezer]

if it's a small bubble you have no worries... It actually takes up 10 cc's of air delivered intravenus in order to kill you... a couple of bubbles injected IM will do nothing...

no worries

[SV-1]

I intentionally inject about .2cc of air every time.




Originally posted by 956Vette:


Introduction

Intramuscular (IM) injections, as the name implies, administer drugs directly into the muscle beneath the subcutaneous tissue. This route allows quicker absorption than subcutaneous injections.

In the UK the Z-track method is widely used, advocated by Beyea and Nicoll (1996) as it controls leakage into the surrounding tissues and is generally more comfortable for the patient.

However, a comparative study of depot intramuscular injection techniques has revealed that the air-bubble method widely used in Canada and USA is significantly more effective at controlling seepage than the Z-track (Quartermaine, 1995).


A further study compiled at the Bracton Centre, Specialist Mental Health Service, could provide no advantages to choosing either the air-bubble method or the Z-track method over each other.

Complications of IM injections

Complications can occur at the site of the injection following IM drug administration, such as seepage of the injection solution and/or bleeding from the injection site onto the skin, pain, irritation and even skin lesions. Such complications are widely recognised and have been investigated (Hay 1995, Murphy 1991). One cause of complications noted in these investigations is some degree of fault in the IM injection administration technique itself.

Injection sites

Taylor et al (1993) recommend the rotation of sites if a series of injections is to be administered, in order to reduce the risk of local reaction.

IM injections should be given into the upper outer quadrant of either the thigh or buttock, into the gluteal muscles.

Correctly identify the site

Place patient on their side with their top leg flexed to relax the muscle.
Mark out an imaginary cross thus dividing the area into four quarters.
By injecting into the upper outer quadrant of the buttock, the sciatic nerve will be missed.
Z-track technique

Place the ulnar side of your non-dominant hand on the chosen injection site and stretch the skin taut.
Hold the needle at 90 degrees to the skin.
Plunge the needle in quickly, penetrating the muscle and leaving about a third of the needle exposed.
Pull back on the plunger to observe for blood aspiration. If blood is aspirated the procedure should be discontinued.
If no blood is aspirated, slowly and continuously inject the drug.
After a couple of seconds withdraw the needle at the same angle at which it went in.
Release the skin. This has the effect of breaking the needle track as the skin and subcutaneous layers move back over the muscle. The drug is therefore locked within the muscle. (Belanger, 1985)
Air bubble technique

The procedure for the air bubble technique differs from the Z-track in only one way. When drawing up the medication, a small bubble of air is also drawn up. This is injected into the muscle with the drug, thus forming an air lock in the muscle depot preventing the medication from seeping out along the needle track into other subcutaneous tissue or onto the skin. (Pritchard and Mallett 1992, Taylor et al 1993)

Keen, (1986) suggests that the Z-track technique produces more pain at the injection site and this is further supported by MacGabhann (1996).

Does experience improve IM technique?

MacGabhann goes on to suggest that "The period of training for staff during the study highlighted disparate knowledge and practice of injection techniques. There was no working policy or procedure on administering injections to which staff could refer". This implies a potential discrepancy between ongoing training and improving techniques.

Katsma and Smith (1997) suggest that the potential for pain experience in IM injections is due to the kinematics of injections, ie. the movement of the needle through muscle and tissue. He goes on to say "Minimizing of this effect is accomplished by controlling the needle trajectory during penetration along a linear path from point of contact to end point."

The study invloved 35 RGNs and 21 3rd year student nurses. Student nurse characteristics differed from experienced nurses primarily in syringe angular positioning. They tended to be closer to the "textbook" style (which they had been recently taught) with angle at contact closer to vertical. However, kinematic characteristics describing the non-linear characteristics during needle penetration were not significantly different from those of experienced nurses.


While it is fair to assume that the more experience a nurse has the more likely she will be to optimize a technique for IM administration, this study suggests the wide variability of the nurse kinematic characteristics argues against this optimization occurrence.

Conclusion

There are arguments for and against both the Z-track method and the air bubble method of IM injection techniques and currently in the UK the most commonly used is different variants of the Z-track method (MacGabhann, 1996). This said, nurses should not become complacent in their abilities to administer injections. As the study by Katsma and Smith showed, some experienced nurses have a much poorer technique than those less experienced than them. To understand the rationale, supported by effective research, behind good injection technique can only serve as a benefit to the profession as a whole, our patients and the nurses of the future.



References

Belanger MC (1985) Long acting neuroleptics: technique for intramuscular injection. Canadian Nurse. 81, 8, 41-44.

Beyea, S., Nicoll, L.M. (1996) Back to basics. Administering Intramuscular Injections the right way. American Journal of Nursing 96:1, 34-35

Hay J (1995) Complications at site of injection of depot neuroleptics. British Medical Journal. 311, 421.

Katsma, D., Smith, G. Intramuscular injection mechanics: Does experience improve technique?Nursing Research, 46, 288-292, 1997.


Mac Gabhann L (1996) A comparison of two depot injection techniques. Nursing Standard. 12, 37, 39-41

Murphy JI (1991) Reducing the pain of intramuscular (IM) injections. Clinical Care. July/August, 35.

Quartermaine S (1995) A comparative study of depot injection techniques. Nursing Times. 91, 30, 36-39.

Pritchard AP, Mallett J (1992) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Third edition. London, Blackwell Scientific.


Taylor C, Lillis C, Le Mone P (1993) Fundamentals of Nursing: The Art and Science of Nursing Care. Second edition. Philadelphia PA, JB Lippincott.

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phreezer and SV: thanks for the heads up, ive been really nervous about the air bubble thing but you've both put my worries to rest!