Intramuscular Injection: Definition and Patient Education

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An intramuscular injection is a technique used to deliver a medication deep into the muscles. This allows the bloodstream to absorb the medication quickly.

You may have received an intramuscular injection at a doctor’s office the last time you got a vaccine, like the flu shot.

In some cases, a person may also self-administer an intramuscular injection. For example, certain drugs that treat multiple sclerosis or rheumatoid arthritis may require self-injection.

Intramuscular injections are a common practice in modern medicine. They’re used to deliver drugs and vaccines. Several drugs and almost all injectable vaccines are delivered this way.

Intramuscular injections are used when other types of delivery methods are not recommended. These include:

  • oral (swallowed into the stomach)
  • intravenous (injected into the vein)
  • subcutaneous (injected into the fatty tissue just under the layer of skin)

Intramuscular injections may be used instead of intravenous injections because some drugs are irritating to veins or because a suitable vein cannot be located.

They may be used instead of oral delivery because some drugs are destroyed by the digestive system when you swallow them.

Intramuscular injections are absorbed faster than subcutaneous injections. This is because muscle tissue has a greater blood supply than the tissue just under your skin. Muscle tissue can also hold a larger volume of medication than subcutaneous tissue.

Intramuscular injections are often given in the following areas:

Deltoid muscle of the arm

The deltoid muscle is the site most typically used for vaccines. However, this site is not common for self-injection because its small muscle mass limits the volume of medication that can be injected — typically no more than 1 milliliter.

It’s also difficult to use this site for self-injection. A caregiver, friend, or family member can assist with injections into this muscle.

To locate this site, feel for the bone (acromion process) that’s located at the top of your upper arm. The correct area to give the injection is two finger widths below the acromion process. At the bottom of the two fingers will be an upside-down triangle. Give the injection in the center of the triangle.

Vastus lateralis muscle of the thigh

The thigh may be used when the other sites are not available or if you need to administer the medication on your own.

Divide the upper thigh into three equal parts. Locate the middle of these three sections. The injection should go into the outer top portion of this section.

Ventrogluteal muscle of the hip

The ventrogluteal muscle is the safest site for adults and children older than 7 months. It’s deep and not close to any major blood vessels or nerves. This site is difficult for self-injection and may require the help of a friend, family member, or caregiver.

Place the heel of your hand on the hip of the person receiving the injection, with your fingers pointing toward their head. Position your fingers so your thumb points toward their groin and you feel the pelvis under your pinky finger. Spread your index and middle fingers in a slight V shape, and inject the needle into the middle of that V.

Dorsogluteal muscles of the buttocks

The dorsogluteal muscle of the buttocks was the site most commonly chosen by healthcare professionals for many years. However, due to the potential for injury to the sciatic nerve, the ventrogluteal muscle is most often used instead.

This site in the dorsogluteal muscle is difficult to use for self-injection and is not recommended.

You should not use an injection site that has evidence of infection or injury. If you’ll be giving the injection more than once, make sure to rotate injection sites to avoid injury or discomfort to the muscles.

Any person who administers intramuscular injections should receive training and education on proper injection technique.

The needle size and injection site will depend on many factors. These include the age and size of the person receiving the medication, and the volume and type of medication.

Your doctor or pharmacist will give you specific guidelines about which needle and syringe are appropriate to administer your medication.

The needle should be long enough to reach the muscle without penetrating the nerves and blood vessels underneath. Generally, needles should be 1 inch to 1.5 inches for an adult and will be smaller for a child. They’ll be 22-gauge to 25-gauge thick, noted as 22g on the packaging.

Follow these steps for a safe intramuscular injection:

1. Wash your hands

Wash your hands with soap and warm water to prevent potential infection. Be sure to thoroughly scrub between your fingers, on the backs of your hands, and under your fingernails.

The Centers for Disease Control and Prevention (CDC) recommends lathering for 20 seconds, which is the time it takes to sing the “Happy Birthday” song twice.

2. Gather all the needed supplies

Assemble the following supplies:

  • needle and syringe with medication
  • alcohol pads
  • gauze
  • puncture-resistant container to discard the used needles and syringe (typically a red, plastic sharps container)
  • bandages

3. Locate the injection site

To isolate the muscle and target where you’ll place the injection, spread the skin at the injection site between two fingers.

The person receiving the injection should get into a position that is comfortable, provides easy access to the location, and keeps the muscles relaxed.

4. Clean the injection site

Clean the site selected for injection with an alcohol swab and allow the skin to air dry.

5. Prepare the syringe with medication

  • Remove the cap. If the vial or pen is multidose, take a note about when the vial was first opened. The rubber stopper should be cleaned with an alcohol swab.
  • Draw water into the syringe. Draw back the plunger to fill the syringe with air up to the dose that you’ll be injecting. This is done because the vial is a vacuum and you need to add an equal amount of air to regulate the pressure. This also makes it easier to draw the medication into the syringe. If you forget this step, you can still get the medication out of the vial.
  • Insert water into the vial. Remove the cap from the needle and push the needle through the rubber stopper at the top of the vial. Inject all of the air into the vial. Be careful not to touch the needle to keep it clean.
  • Withdraw the medication. Turn the vial and syringe upside down so the needle points upward and pull back on the plunger to withdraw the correct amount of medication.
  • Remove air bubbles. Tap the syringe to push any bubbles to the top and gently depress the plunger to push the air bubbles out.

6. Self-inject with a syringe

Hold the needle like a dart and insert it into the muscle at a 90-degree angle. You should insert the needle in a quick but controlled manner. Don’t push the plunger in.

7. Inject the medication

Push the plunger slowly to inject the medication into the muscle.

8. Remove the needle

Withdraw the needle quickly and discard it into a puncture-resistant sharps container. Don’t put the cap back on the needle.

A sharps container is a red container that you can purchase at any pharmacy. It’s used to collect medical waste, such as needles and syringes. You should not put any of these materials into the regular garbage, as needles can be dangerous to anyone who handles the trash.

9. Apply pressure to the injection site

Use a piece of gauze to apply light pressure to the injection site. You can even massage the area to help the medication be absorbed into the muscle. It’s normal to see slight bleeding. Use a bandage if necessary.

To minimize possible discomfort before your injection:

  • Apply ice or an over-the-counter topical numbing cream to the injection site before cleaning it with the alcohol pad.
  • Allow the alcohol to dry completely before the injection. Otherwise, it might cause stinging.
  • Warm the vial of medication by rubbing it between your hands before drawing the medication into the syringe.
  • Have someone you trust give you the injection. Some people find it difficult to inject themselves.

It’s typical to experience some discomfort after an intramuscular injection. But certain symptoms may be a sign of a more serious complication. Call your doctor or healthcare professional right away if you experience:

You may have some anxiety about performing or receiving an injection, especially an intramuscular injection, due to the long needle. Read through the steps several times until you feel comfortable with the procedure and take your time.

You can ask your doctor or pharmacist to go through the procedure with you before hand. They’re more than willing to help you understand how to perform a safe, proper injection.

Changing definition of success in education system a way for S’pore to stay relevant: Chan Chun Sing – Mothership.SG

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Minister for Education Chan Chun Sing gave the opening speech of the Institute of Policy Studies’ (IPS) flagship Singapore Perspectives 2023 conference on Jan. 5.

Chan highlighted five key shifts needed to ensure that Singapore’s education system can remain relevant in an increasingly “connected, yet fragmented world”.

A changing society

Chan opened by talking about the challenging and constantly changing environment that Singapore and Singaporeans find themselves in.

Going forward, society will be shaped by various forces.

As Singapore faces a slowing birth rate, Chan pointed out the growing challenge to integrate non-local citizens born to sustain the country’s economic vibrance and social cohesion.

“For Singapore, managing diversity and being able to connect and collaborate are essentials, not options,” he said.

Singapore will also face increasing competitive pressures as it becomes more integrated with the rest of the world, and will need to “counter the tendencies to turn insular, nativist, and retreat into our own echo-chambers”.

Additionally, Chan acknowledged that there is a greater risk of “us seeing the world as we want it, rather than as it is”, which would threaten Singapore’s ability to connect and remain relevant with the world.

To meet these challenges, Chan said Singapore’s education system needs to “evolve at speed”.

He said Singapore’s education system needs to deliver curiosity, collaboration, and confidence at the individual level.

At the industry level, it needs to help companies connect better across geographies, geopolitics, and culture, and to remain competitive.

At the societal level, Singapore’s education system will also need to be cohesive enough to move “against the forces that threaten to fragment us”.

Five key shifts

In order to achieve this, Chan highlighted five “key shifts” to deliver these outcomes.

  • Moving beyond mass access to education to mass customization
  • Defining success beyond the first 15 years of education, but also in the next 50 years
  • More closely intertwining the Academia-Industry partnership into a relationship
  • Going beyond the efforts of the Ministry of Education (MOE) to the efforts of society as a whole
  • Investing in lifelong learning and innovation for the teaching fraternity

1. Mass access to quality education

Lauding Singapore’s strong basic system that allowed mass access to quality education, Chan noted three things that the education system needed to improve on in this area.

Firstly, stronger investments in early year education, especially for less privileged children of families with higher needs.

Chan cited evidence which showed that it was important not to let the learning and developmental gap to grow too wide in young children, as it would be difficult to rectify, and remediation required in the future would be extremely high.

While celebrating the progress made in closing the gap over the past 15 years, he said there is still more to do, and shared that the government will examine news ways to provide support for these less privileged children.

Second, the government will use more adaptive learning technologies and pedagogies to “stretch the top, while freeing up resources to uplift the disadvantaged”.

New technologies such as artificial intelligence would allow Singapore to relook its pedagogies to enable even better mass customization of the education system.

Thirdly, Singapore will continue to diversify its success pathways for students, through programs like Full Subject Based Appeal, and customization of degree programs, among other things.

Chan said a more diverse education system would better serve Singapore, but would require a mindset shift away from constant comparison and benchmarking of students and institutions.

There is also a need to keep Singapore’s meritocracy broad and continuous, and not allow the “system to degenerate into credentialism”.

2. Beyond schooling years

Chan said that success cannot be defined by the 15 years spent in formal education, but would have to shift to be defined by the 50 years beyond that.

Disruptions and uncertainty meant that it would not be possible to frontload education, and the first 15 years of education would be to build learning foundations.

Instead, the new benchmarks for success will be “the spirit of inquiry, the desire to create new knowledge and value, the ability to discover, discern and distill”.

Chan said industry would have a part to play in achieving lifelong learning — industry cannot wait for the “perfect worker”, but must be an active partner in shaping students’ interests and skillsets before they even enter the workforce.

Industry will also need to work with academia to keep training workers after joining the workforce.

The government would also review funding and support for lifelong learning, to better guide those in the middle of their careers through challenges and opportunities, to defray costs, help smooth transitions in and out of jobs, and skills acquisition.

Chan said that more ideas would be put forward during the Forward Singapore deliberations.

3. Academia-industry relations

Chan said the third shift would be in the relationship between academia and industry in Singapore.

Singapore cannot outcompete other countries in scale, but can be a pioneer at intersections of disciplines, and thus create new value, he added.

This means being adequate at forming interdisciplinary teams across students, faculty, and alumni, and collaboration between institutions and faculties.

Chan spoke about the Research-Innovation-Enterprise cycle, saying Singapore had done well in research, but needed to improve in the latter two aspects.

Other than universities, Chan also highlighted the connection between industry and polytechnics/Institute of Technical Education.

He said that they would need to work together to help students and lifelong learners to better integrate work and study, and allow a better flow of research and practices between learners and industry.

4. Beyond the efforts of MOE to the whole of society

Chan said that the MOE never believed it alone could change society or develop future generations.

To broaden the definition of success, MOE needs to work closely with parents, community partners and industries, or its efforts would ultimately be “undone”, and Singapore’s speed of change would be measured in generations, not years.

To that end, he said that only by rallying together could Singapore build a culture that appreciates diverse learners.

Industry also has to close the remuneration gap, compensating according to skills and contributions, not credentials.

Success, he said, was “everyone doing justice to their blessings, rather than everyone chasing the same yardstick.”

5. Teaching the teachers

The final shift to improve the education system will be how Singapore equips and organizes the teaching faculty.

Teachers are not just academics, transmitters of information, or only engaging mainstream students with established pedagogies.

They need to be facilitators of discovery and learning, to support “higher needs” children and families, reaching and nurturing students with special education needs, by exploring and developing new pedagogies.

As new skillsets cannot be frontloaded, teachers would also need to upskill and reskill continuously.

Educators would need to understand the world beyond the education system, understand its changes, and bring back new perspectives to teaching.

Chan cited the Teacher Work Attachment Plus program as a way to facilitate that.

In a similar way, Singapore needs to ensure teaching ability and pedagogical practices of teaching faculties in institutes of higher or continuous learning.

Chan said that the Institute of Adult Learning would join the National Institute of Education and National Institute of Early Childhood Development; providing investment, research, and training to the teaching faculties at all levels.

For Institutes of Higher Learning, there is also a need to define success beyond research.

Chan said that there should be complementary pathways to success in teaching as well as leadership, in addition to research.

In closing, Chan highlighted the need for Singapore universities and education system to reach their fullest potential. He spoke about a conceptual “Education 4.0”.

Where the first three versions of education moved from catering to the privileged, then to industry, then to universal access, “Education 4.0” would need to equip Singaporeans to thrive in an uncertain, fragmented, diverse and competitive, yet more connected world.

The mentioned five key shifts are required for this, but Chan also noted the importance of the government remaining committed to “build the best system possible to enable future generations of Singaporeans to do even better than this generation”.

“What will also not change is our goal to distinguish ourselves as a nation that defines success not just by our achievements, but by our contributions,” he concluded.

Top image via Jacky Ho, for the Institute of Policy Studies, NUS