-
- Administration of medication
- Determination of drug dosage
- Few standardized doses ranges
- Body surface area
- Checking dosage
- Identification
- Two identifiers
- Preparing the parents
- Preparing the child
- Oral administration
- Preparation
- administration
- Intramuscular administration
- Apply EMLA (a eutectic mix of lidocaine and prilocaine) or LMX cream (lidocaine) topically over site if time permits.
- Prepare medication
- Selecting the syringe and needle
- If withdrawing medication from an ampule, use a needle equipped with a filter that removes glass particles; then use a new, nonfilter needle for injection.
- The maximum volume to be administered in a single site is 1 mL for older infants and small children.
- Have medication at room temperature before injection.
- Determining the site
- For infants and small or debilitated children, use the vastus lateralis or ventrogluteal muscles; the dorsogluteal muscle is insufficiently developed to be a safe site for infants and small children.
- Ventrogluteal: On side with upper leg flexed and placed in front of lower leg
- Vastus lateralis: Supine, lying on side, or sitting
- Obtain sufficient help in restraining child.
- Explain briefly what is to be done and, if appropriate, what child can do to help.
- Expose injection area for unobstructed view of landmarks.
- Select a site where skin is free of irritation and danger of infection; palpate for and avoid sensitive or hardened areas.
- With multiple injections, rotate sites.
- Place child in a lying or sitting position; child is not allowed to stand because landmarks are more difficult to assess, restraint is more difficult, and the child may faint and fall.
- Use a new, sharp needle (not one that has pierced rubber stopper on vial) with smallest diameter that permits free flow of the medication.
- Grasp muscle firmly between thumb and fingers to isolate and stabilize muscle for deposition of drug in its deepest part; in obese children, spread skin with thumb and index finger to displace subcutaneous tissue, and grasp muscle deeply on each side.
- Allow skin preparation to dry completely before penetrating skin
- For infants and small or debilitated children, use the vastus lateralis or ventrogluteal muscles; the dorsogluteal muscle is insufficiently developed to be a safe site for infants and small children.
- Administration
- Decrease perception of pain.
- Distract child with conversation.
- Give child something on which to concentrate (e.g., squeezing a hand or side rail, pinching own nose, humming, counting, yelling “Ouch!”).
- Spray vapo-coolant (e.g., ethyl chloride or fluoromethane) on site before injection, place a cold compress or wrapped ice cube on site about 1 minute before injection, or apply cold to contralateral site.
- Have child hold a small adhesive bandage and place it on puncture site after IM injection is given.
- Insert needle quickly using a dartlike motion at a 90-degree angle unless contraindicated.
- Avoid tracking any medication through superficial tissues:
- Replace needle after withdrawing medication.
- Use the Z-track or air-bubble technique as indicated.
- Avoid any depression of the plunger duringinsertion of the needle.
- Remove needle quickly; hold gauze firmly against skin near needle when removing it to avoid pulling on tissue.
- Apply firm pressure to site after injection; massage site to hasten absorption unless contraindicated, as with irritating drugs.
- Place a small adhesive bandage on puncture site; with young children, decorate it by drawing a smiling face or other symbol of acceptance.
- Hold and cuddle young child, and encourage parents to comfort child; praise older child.
- Allow expression of feelings.
- Discard syringe and uncapped, uncut needle in puncture-resistant container located near site of use.
- Record time of injection, drug, dose, and injection site.
- Decrease perception of pain.
- Determination of drug dosage
- Administration of medication
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