Modifying I.M. Injections

Before you give an I.M. injection to an elderly patient, consider the physical changes that accompany aging and choose your equipment, site, and technique accordingly.

Choosing a needle

Remember that an elderly patient usually has less subcutaneous tissue and less muscle mass than a younger patient—especially in the buttocks and deltoids. As a result, you may need to use a shorter needle than you would for a younger adult.

Selecting a site

An elderly patient typically has more fat around the hips, abdomen, and thigh areas. This makes the vastus lateralis muscle and ventrogluteal area (gluteus medius and minimus, but not gluteus maximus muscles) the primary injection sites. If the patient can stand, instruct him to point the toes inward (foot inversion) to decrease pain felt with I.M. gluteus injections.

You should be able to palpate the muscle in these areas easily. However, if the patient is extremely thin, gently pinch the muscle to elevate it and to avoid putting the needle completely through it (which will alter the absorption and distribution of the drug).

Caution: Never give an I.M. injection in an immobile limb because of poor drug absorption and the risk that a sterile abscess will form at the injection site.

 

Checking technique

To avoid inserting the needle in a blood vessel, pull back on the plunger and look for blood before injecting the drug. Because of age-related vascular changes, elderly patients are also at greater risk for hematomas. To check bleeding after an I.M. injection, you may need to apply direct pressure over the puncture site for a longer time than usual.

Gently massage the injection site to aid drug absorption and distribution. However, avoid site massage with certain drugs given by the Z-track injection technique, such as iron dextran and hydroxyzine hydrochloride.