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Results for “Injections, Intramuscular”

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PubMed1996

Subcutaneous or intramuscular injections of insulin in children. Are we injecting where we think we are?

OBJECTIVE: This study was designed to assess the insulin injection location in a group of children who had their injection according to their daily practice, thought to lead to subcutaneous injections. RESEARCH DESIGN AND METHODS: The location of the insulin deposit at the injection site was visualized using an ultrasound device. RESULTS: The exact insulin injection location could be localized, and 18 of 59 injections (30.5%) (one injection for each child) were in the intramuscular tissue. Of the children who had intramuscular injection, 15 of 18 were boys. The children who had an intramuscular injection had a significantly lower percentile of BMI (mean +/- SE: 47 +/- 8 vs. 72 +/- 4, P = 0.004), lower distance from skin surface to muscle fascia without a skinfold (5.6 +/- 0.6 vs. 11 +/- 0.7 mm, P < 0.0001), and a lower distance from skin surface to muscle fascia with a skinfold (8.1 +/- 0.9 vs. 15.9 +/- 0.8 mm, P < 0.0001) than children who had a subcutaneous insulin injection. CONCLUSIONS: We identified a group of children at risk for intramuscular insulin injections and that may deserve specific injection technique and advice.

Analysis of Variance↗

PubMedDate not supplied

Effect of positioning on discomfort from intramuscular injections in the dorsogluteal site.

An intramuscular injection into a relaxed muscle is believed to result in less discomfort than an injection into a contracted muscle. When the femur is internally rotated, the gluteus maximus muscle is relaxed. The hypothesis that a dorsogluteal injection with the femur internally rotated will cause less discomfort than when the femur is externally rotated was tested in 44 surgical patients who received two injections of preoperative medication. Each patient received an injection of a narcotic medication and one of diazepam. All possible combinations of the factors--position (internal and external rotation), order of injection (first or second injection), and medication (narcotic or diazepam)--were determined, and patients were randomly assigned to one of these conditions. Patients rated their perceived discomfort after each injection on a five-point scale. The hypothesis was supported by discomfort ratings from injections of both types of medications, although diazepam injections caused significantly more discomfort than injections of narcotics. Older patients tended to report less discomfort from diazepam injections than younger patients. Sex, order of injection, and nurse administering the injection did not significantly influence discomfort ratings.

Adult↗

PubMed2005

Intramuscular injection of hypertonic saline: in vitro and in vivo muscle tissue toxicity and spinal neurone c-fos expression.

Intramuscular injection of hypertonic saline (4-6% NaCl) is widely used to induce muscle pain in volunteers. The quality of the pain is comparable to clinical muscle pain with localised and referred pain. The objective was to evaluate the muscle toxicity of hypertonic saline by characterisation of 1) cytotoxicity in vitro, 2) local muscle toxicity in rabbits and 3) number of spinal dorsal horn neurones expressing c-fos after intramuscular injection in pigs as an indicator of nociception. Rat myocyte cultures and erythrocyte suspensions were treated with hypertonic NaCl solutions. The creatine kinase activity remaining in the myocytes and haemolysis were measured. Groups of six rabbits were given an intramuscular injection of 0.5 ml of 0.9, 3 or 6% NaCl. Three days later, creatine kinase activity was determined in injection site muscle tissue and normal contralateral muscle. The amount of injection site muscle tissue totally depleted of creatine kinase was calculated. Groups of two pigs were given an intramuscular injection of 3.0 ml of 6% NaCl. The spinal cord was sampled 1, 2 or 3 hr later and processed for stereological quantification of the number of dorsal horn neurones expressing c-fos. Saline was not toxic in vitro at 0.9-6%, but toxic to erythrocytes at 7% or higher and rat myocytes at 15% or higher. No muscle toxicity was seen in rabbits. The number of dorsal horn neurones expressing c-fos was not above basal level. In conclusion, 6% saline caused no in vitro or in vivo toxicity in sensitive models. Consequently, the pain caused by intramuscular injection of hypertonic saline is most likely not related to tissue damage. Consistently, intramuscular injection of 6% NaCl did not activate dorsal horn neurones in pigs to express c-fos beyond basal level.

Animals↗

PubMed1998

Intramuscular injection of hrRANTES causes mast cell recruitment and increased transcription of histidine decarboxylase in mice: lack of effects in genetically mast cell-deficient W/WV mice.

RANTES (regulated upon activation, normal T cell expressed and presumably secreted) and other chemoattractant proteins are members of the intercrine or chemokine family of proinflammatory basic polypeptides. RANTES is a prototype of the C-C chemokine subfamily that acts as a selective chemoattractant for human monocytes and CD4-positive lymphocytes and increases the adherence of monocytes to endothelial cells. However, the role of RANTES in white cells is still unclear. We report here that hrRANTES at 20 ng/50 microl in mice causes mast cell recruitment 4 h after intramuscular injection, an effect inhibited by anti-RANTES, as evidenced by 0.1% Toluidine blue, a specific dye for coloring mast cells. Injections of PBS (50 microl) vehicle (negative control) did not produce any appreciable inflammatory response, whereas injection of lipopolysaccharide 20 ng/50 microl (positive control) generated a marked inflammatory state. When RANTES was injected intramuscularly in genetically mast cell-deficient W/Wv mice, the inflammatory effect was not present. The RANTES injection sites were then excised and studied under an optical and electron microscope. A Northern blot analysis was performed using a probe that was prepared to detect mRNA encoding the histidine decarboxylase (HDC) gene on excised muscle tissue. We found that hrRANTES provoked generation of HDC mRNA from muscle tissue after 4 h. These effects were inhibited by an anti-RANTES antibody and were absent in genetically mast cell-deficient mice. The increasing number of mast cells in the RANTES injection sites led to an augmentation of histamine content compared to controls (PBS). The injection of hrRANTES 20 ng/20 microl into the sole of a rat paw confirmed the inflammatory and the mast cell recruitment potential of this chemokine. In these studies, hrRANTES injections in muscle tissue provided direct in vivo evidence that RANTES has a significant effect on mast cell recruitment and HDC mRNA generation.

Animals↗

PubMed1977

Effects of intramuscular injections of selenium and vitamin E on selenium-vitamin E deficiency in young pigs.

Effects of intramuscular injections of selenium and vitamin E on lesions in pigs with selenium-vitamin E deficiency syndrome were determined in 2 factorial experiments, using a total 69 pigs. The pigs were fed a selenium-vitamin E deficient, 22.3% protein ration, supplemented with methionine, minerals, and vitamins. Weekly intramuscular injections of isotonic saline solution, vitamin E, selenium, or vitamin E and selenium were given to the respective treatment groups. Selenium-vitamin E deficiency lesions occurred only in pigs that were given saline injections. Weekly intramuscular injections of either selenium (as selenous acid buffered to pH (7.3) at the rate of 0.05 mg/kg of body weight or vitamin E at the rate of 20 IU/kg of body weight or the combination of selenium and vitamin E prevented cardiac and skeletal myodegeneration, hepatic necrosis, and death. Significant increases of serum aspartate aminotransferase activity values were noted in pigs with liver, heart, or skeletal muscle lesions, but these increases were not correlated with the extent of the lesions. Vascular lesions, epicardial and endocardial hemorrhages, and yellow discoloration of body fat were not features of this experimentally induced disease. These lesions may be related to factors other than the deficiency of selenium, vitamin E, or selenium and vitamin E in rations previously used in reported studies.

Animals↗

PubMed1985

Bioavailability of indomethacin after intramuscular injection and rectal administration of solution and suppositories.

The pharmacokinetics of indomethacin was studied after intravenous and intramuscular injection of 50 mg and administration of rectal solution and suppositories of 100 mg to 8 volunteers. Peak plasma concentrations of indomethacin occurred 20 min. after administration of the rectal solution (3.7 micrograms X ml-1), 40 min. after intramuscular injection (2.7 micrograms X ml-1), and 60 min. after suppositories (3.7 micrograms X ml-1). The bioavailability after the two rectal forms was found to be almost the same, about 80%. After intramuscular injection the bioavailability was calculated to be complete. These results suggest that indomethacin administered as a rectal solution or as intramuscular injection may be an alternative to intravenous administration when an early plasma peak of the drug is required.

Adult↗

PubMed1995

Intramuscular injections within 30 days of immunization with oral poliovirus vaccine--a risk factor for vaccine-associated paralytic poliomyelitis.

BACKGROUND: In Romania the rate of vaccine-associated paralytic poliomyelitis is for unexplained reasons 5 to 17 times higher than in other countries. Long ago it was noted that intramuscular injections administered during the incubation period of wild-type poliovirus infection increased the risk of paralytic disease (a phenomenon known as "provocation" poliomyelitis). We conducted a case-control study to explore the association between intramuscular injections and vaccine-associated poliomyelitis in Romania. METHODS: The patients were 31 young children in whom vaccine-associated paralytic poliomyelitis developed from 1988 through 1992. Eighteen were vaccine recipients, and 13 had acquired the disease by contact with vaccine recipients. Each of these children was matched with up to five controls according to health center, age, and in the case of vaccine recipients, history of receipt of the live attenuated oral poliovirus vaccine. Data were abstracted from medical records that documented the injections administered in the 30 days before the onset of paralysis. RESULTS: Of the 31 children with vaccine-associated disease, 27 (87 percent) had received one or more intramuscular injections within 30 days before the onset of paralysis, as compared with 77 of the 151 controls (51 percent) (matched odds ratio, 31.2; 95 percent confidence interval, 4.0 to 244.2). Nearly all the intramuscular injections were of antibiotics, and the association was strongest for the patients who received 10 or more injections (matched odds ratio for > or = 10 injections as compared with no injections, 182.1; 95 percent confidence interval, 15.2 to 2186.4). The risk of paralytic disease was strongly associated with injections given after the oral polio virus vaccine, but not with injections given before or at the same time as the vaccine (matched odds ratio, 56.7; 95 percent confidence interval, 8.9 to infinity). The attributable risk in the population for intramuscular injections given in the 30 days before the onset of paralysis was 86 percent (95 percent confidence interval, 66 to 95 percent); that is, we estimate that 86 percent of the cases of vaccine-associated paralytic poliomyelitis in this population might have been prevented by the elimination of intramuscular injections within 30 days after exposure to oral poliovirus vaccine. CONCLUSIONS: Provocation paralysis, previously described only for wild-type poliovirus infection, may rarely occur in a child who receives multiple intramuscular injections shortly after exposure to oral poliovirus vaccine, either as a vaccine recipient or through contact with a recent recipient. This phenomenon may explain the high rate of vaccine-associated paralytic poliomyelitis in Romania, where the use of intramuscular injections of antibiotics in infants with febrile illness is common.

Anti-Bacterial Agents↗

PubMed1987

Muscle necrosis in Syrian hamsters resulting from intramuscular injections of ketamine and xylazine.

To assess tissue damage resulting from intramuscular injection of mixtures of ketamine and xylazine, 48 hamsters were given 100, 150 or 200 mg/kg ketamine and 10 mg/kg xylazine in one hind leg and an equal volume of sterile physiologic saline in the other leg. Four hamsters from each group were killed 1, 3, 7 and 14 days after injection and the tissues at the injection sites were examined. There was grossly apparent muscle necrosis in most of the ketamine-xylazine injected legs. By light microscopy, 47 of 48 legs injected with ketamine-xylazine had moderate to extensive muscle necrosis with an acute to chronic inflammatory response, depending on the time elapsed since injection. Microscopic slides of the injection sites were coded, randomized and scored for severity of muscle lesions. Lesion scores for ketamine-xylazine injected legs were significantly higher than controls at all post-injection times. These findings indicate that intramuscular injection of ketamine with xylazine can cause extensive muscle necrosis in hamsters and should not be used for anesthesia in survival procedures.

Animals↗

PubMed2002

Effects of NMDA and non-NMDA ionotropic glutamate receptor antagonists on the development and maintenance of hyperalgesia induced by repeated intramuscular injection of acidic saline.

Two unilateral injections of pH 4.0 saline into the gastrocnemius muscle result in a bilateral decrease in mechanical withdrawal threshold after the second injection. This decrease is significant by 4h and lasts through 1 week. The purpose of this study was to characterize the involvement of both N-methyl-D-aspartate (NMDA) and non-NMDA glutamate receptors in the spinal cord dorsal horn in the development and maintenance of mechanical hyperalgesia from repeated intramuscular injections of acidic saline. 2-amino-5-phosphonovaleric acid (AP5) (2-20 nmol, 10 microl, pH 7) or 1,2,3,4-tetrahydro-6-nitro-2,3-dioxo[f]quinoxaline-7-sulfonamide (NBQX) (1-10 nmol, 10 microl, pH 8-9) was administered intrathecally to the lumbar spinal cord to block NMDA and non-NMDA ionotropic glutamate receptors in the dorsal horn, respectively. Drugs were administered at one of three different time points: (1) prior to the first intramuscular injection of pH 4.0 saline on Day 0, (2) prior to the second intramuscular injection of pH 4.0 saline on Day 5, and (3) 1 week after the second injection. Mechanical withdrawal thresholds were measured with von Frey filaments before, 4h, and 24h after injection 1 and before, 4h, 24h, and 1 week after injection 2. AP5 had no effect on mechanical withdrawal thresholds when administered prior to the first intramuscular injection of pH 4.0 saline. When AP5 was administered before the second intramuscular injection, the bilateral decrease in mechanical withdrawal thresholds was delayed for up to 24h. Intrathecal administration of AP5 1 week after the second intramuscular injection of pH 4.0 saline produced a bilateral increase in mechanical withdrawal thresholds. Blockade of non-NMDA glutamate receptors in the spinal cord dorsal horn prior to either the first or second intramuscular injection of pH 4.0 saline had no effect on the development of mechanical hyperalgesia. However, spinal injection of NBQX 1 week after the second intramuscular injection of pH 4.0 saline resulted in an increase in mechanical withdrawal thresholds when compared to vehicle controls. These data suggest that both NMDA and non-NMDA glutamate receptors are involved in the maintenance of chronic, muscle-induced hyperalgesia.

2-Amino-5-phosphonovalerate↗

PubMedDate not supplied

Rat ultrasound model for measuring pain resulting from intramuscularly injected antimicrobials.

Rats emit ultrasonic vocalizations in situations involving anxiety or stress, defense, and submission. This study demonstrates the use of ultrasonic vocalizations as a quantitative measure of pain associated with intramuscular (i.m.) injections. Intramuscularly administered cephalosporins used in a comparative evaluation of pain in humans were chosen to validate this rat model. Three groups of four rats each received an intramuscular injection of either drug first, and then placebo, or placebo and then drug. The three drugs used in this study were cefonicid, cefoxitin, and cefamandole; saline was used as the placebo. Ultrasonic vocalizations were measured from 20 kHz to 100 kHz. The number of vocalizations ranged from 50 milliseconds to 500 milliseconds and most of the vocalizations occurred between 60 kHz and 80 kHz. Rats injected with cefoxitin, cefamandole, cefonicid, and saline vocalized an average of 36 +/- 11, 33 +/- 9, 28 +/- 7, and 11 +/- 6 times respectively. The response to all three antimicrobials differed significantly when compared with placebo (p < 0.01), however, there was no significant difference between the number of vocalizations for each antimicrobial injection. Further research may allow the correlation of the total duration of each vocalization, with the individual frequencies such as the 22 kHz and the 55 kHz components and with the amount of pain associated with the injection. This correlation could then be used to further identify differences in the amount of pain associated with each antimicrobial injection without increasing the sample size.

Animals↗

PubMed2000

Drawing up and administering intramuscular injections: a review of the literature.

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.

Clinical Competence↗

PubMed1982

Intramuscular injections in children.

The most common serious complications of intramuscular injections in children are muscle contractures and nerve injury. Muscle contracture occurs most commonly after injections in the anterior and lateral thigh, and sciatic nerve injury is the most frequently reported serious complication of the gluteal area. The technique of administering intramuscular injections involves attention to the appropriate site of needle insertion, needle size, and angle of injection. Suggested techniques with illustrations are included. The appropriate site of injection depends upon the age and size of the child. Multiple injection sites may be preferable in some cases. Compliance with meticulous technique may reduce the incidence of complications; however, complications can occur in spite of every appropriate precaution.

Arm↗

PubMedDate not supplied

The myth of the 90 degrees-angle intramuscular injection.

This article shows that the textbook 90 degrees-angle requirement for intramuscular injections is unrealistic. Trigonometry demonstrates that an injection given at 72 degrees reaches 95% of the depth of an injection given at 90 degrees. This relation between needle angle and needle depth, previous research into the kinematics of hand motion during an intramuscular injection, and other practical considerations support the proposal for a new, relaxed standard: Intramuscular injections administered at a comfortable angle between 72 degrees and 90 degrees.

Biomechanical Phenomena↗

PubMed1977

Intramuscular injections and bioavailability.

Bioavailability of drugs following intramuscular injection is reviewed, with particular emphasis on diazepam, chlordiazepoxide, phenytoin, digoxin and lidocaine. Clinical experience with these drugs has shown that i.m. absorption may be slow, erratic or incomplete. Factors which play a role in the bioavailability of i.m. medications include the water solubility of the drug, dispersion of the injected solution and blood flow at the muscle site. For many drugs, intravenous injection is the parenteral route of choice, and oral administration may be more efficacious than i.m. injection.

Absorption↗

PubMed1984

[Malignant lymphoma initially of the buttocks: possible role of repeated intramuscular injections].

The authors report the case of a patient who received intramuscular injections of bismuth and penicilline for three consecutive years. Twenty-five years later, a lymphoma of the right buttock developed. The tumor was treated with radiotherapy and remained localized for two years. It then diffused to lungs, maxilla and skin. The occurrence of a lymphoma in muscles is thought to be exceptionnal. It has been suggested that lymphomas may develop at the site of silicone injections or of protracted infections. Fibrosarcomas have been reported after intramuscular injections of iron. The observations may suggest that the muscular lymphoma observed in our patient may have been related to the injections of bismuth performed twenty-five years earlier.

Aged↗

PubMedDate not supplied

[Risks of serial intramuscular injections].

A recently reviewed case underlined the danger of serial intramuscular injections. More recent results about muscular response to injection treatment and its morphological, anatomical, and pathophysiological effects on muscular tissue are described. Our studies about the optimum length of the needle for intramuscular injections and the thickness measurements of tissue and fat layers in the area of the most important injection points (upper outer quadrant of Hochstetter point) were supplement by animal experiments to prove that the use of short needles might lead to subcutaneous misinjections causing acute drug-induced dermal embolism. On the other hand these animal experiments demonstrated that even correctly placed serial injections might cause severe necrosis of the deep muscular structures accompanied by a major increase in serum creatinin phosphokinase activity. With intragluteal serial injections one must think of repair-induced muscular fibrosis which led to an intragluteal implantation cyst in the case reviewed by us.

Creatine Kinase↗

PubMed1999

Effects of intramuscular injection of botulinum toxin and doxorubicin on the survival of abducens motoneurons.

PURPOSE: To investigate in vivo the survival of abducens motoneurons (AMNs) at different periods of time after a single intramuscular injection of the neurotoxin botulinum toxin A (BTxA) or doxorubicin (DXR). METHODS: In Sprague-Dawley rats, the AMNs were labeled with fluorogold (FG), which was applied intramuscularly in the lateral rectus muscle. The numbers of labeled neurons were determined in adult control animals; in young animals that had received intramuscular injections of 0.125, 0.250, 1, or 2 U BTxA; and in adult rats that had received 100 microg, 200 microg, or 300 microg DXR, at various survival times. RESULTS: In control animals, the numbers of FG-labeled motoneurons were similar to the numbers found by other investigators with the use of other retrogradely transported tracers; motoneuron numbers diminished with time after FG application. The numbers of FG-labeled neurons in the animals that had been injected with BTxA were similar to those found in control animals. However, there were fewer FG-labeled neurons in the animals injected with DXR. CONCLUSIONS: Fluorogold injected into the lateral rectus muscle can be used to label the AMNs. However, this tracer does not persist within the cytoplasm of the labeled neurons for more than 37 days. The intramuscular injection of 0.125, 0.250, 1, or 2 U BTxA does not induce significant motoneuron death in young rats 30, 60, or 90 days after the injection. Doxorubicin injected intramuscularly causes variable amounts of motoneuron death that is related both to the survival period and to the amount of DXR injected.

Abducens Nerve↗

PubMed1977

[Intramuscular injections and activity of serum creatine phosphokinase. Histopathological study in animal experiments].

In healthy Labrador dogs a single intramuscular injection of benzoctamin, diazepam and pethidin leads to a distinct increase in serum-creatine-phosphokinase (SCK) activity, whilst a single intramuscular injection of physiologic saline has no effect whatsoever. Intravenous injection of an identical dose of the above-mentioned drugs leaves SCK activity unchanged. Muscle specimens of the injection site, excised 5 days after intramuscular injection of the same drugs, display muscle cell necrosis, macrophage proliferation and reparative changes. The impressive histological alterations point to the striated muscle cell as a probable source of the increase in SCK activity (MM fraction).

Animals↗