Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention. However, there are dangers such as vascular damage, muscle contracture, nerve injury due to IM injection, and injections site reactions such as redness and swelling, which may occur. Moreover, in administration of injectable medications, physicians and nurses are unable to confirm visually whether or not the tip of the injection needle has reached the muscle. Therefore, physicians and nurses need to select an appropriate injection needle penetration depth in conjunction with patient physique, injection site and anatomical understanding of nerves and blood vessels.

Accurate anatomical knowledge is necessary in order to administer IM injections. It is possible to gain an adequate understanding of injection site anatomical structures by using ultrasound diagnostic devices. In particular, ultrasonography offers real-time diagnostic data allowing for observation of injection site, subcutaneous tissues, fat layers, muscle membrane, muscles and bones. The aim of this article was to indicate a safe and effective IM injection technique based on evidenced data derived from ultrasonographic data. Data were obtained from 136 patients undergoing treatment with LAI and 83 healthy subjects by ultrasonography at four psychiatric hospitals and one psychiatric clinic in Japan.

The findings showed that when administering IM injections to the buttocks area, a suitable injection needle between 23G 25 mm to 21G or 22G 38 mm must be chosen depending on physique and drug characteristics. Needles determined as safe and effective through ultrasonographic evidence are needed such as in the case of a deltoid injection site, in which a 23G 25 mm injection needle is used in the absence of notable obesity. Not only the needle type is essential, but also the IM procedure itself. It is important to stretch the skin, inserting the needle at 90 degree angle to ensure depth of needle insertion to the muscle.

In conclusion, until new confirmed evidence becomes available, it is necessary to increase the understanding of injection site selection methods, needle insertion depth, needle angle, and established IM injection techniques. And the application of ultrasound devices in the development of next-generation techniques for IM injection is promising. Importantly, these techniques provide critical information from a risk management perspective.

Article by Tetsuya Tanioka, et al, from Japan.

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