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.
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