Deltoid Intramuscular Injection and Obesity
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According the World Health Organizations and Centers for Disease Control and prevention in United States, approximately one –third of adults are considered obese. This has raised the no of intramuscular injections with approximate rate of 16 billion per year. Despite complex skills in administering, IM injections into deltoid muscle for administering the vaccine is best considered. IM injections is injection in which the needle pierces the muscle at least by 5mm, Zayback (2007).This has raised a great concern to the health sector whether the standard needle of 25-38 mm used, is able to deposit the medication to the muscle of obese individual. For the last six years, this has pushed researchers to address the issue of IM needle length in obesity. Further, the research based its findings reached conclusion 1.5 inches needle is the best as opposed to 1-inch needle. Further, it was discovered that there is no commonly accepted method if IM injection for a person with high BMI (Plotkin, 2008).
Implication on leadership and management
The procedure for administering the vaccine by use of IM injections in obese individuals has not been an easy go to the leadership and management of health care in United States. With increased number of patients, the cases of incapability of vaccine causing a reaction(reactogenicity),wrong vaccine injection techniques and incorrect needle length used for IM injection in obese individuals has been of major concern. According to World Health Organization, the concerns have been associated to patient’s discomforts and increased cases of risks. It is therefore imperative to the leadership of medical-surgical nurses find an appropriate solution to the above raised concerns.
Also according to WHO (2009), administration of IM injection has for long been a complex challenge .Perhaps it has been found that the nurses when giving IM injections, use techniques that are little more ritualistic procedure but based on tradition ,which is passed from one nurse to another, generation to another. It is in great concern it has been addressed to the management and the leadership .This is because the skills not only requires dexterity in manipulating needle and syringe, but also knowledge in deciding the appropriate needle, syringe type and appropriate location of the injection ( Coco man & Murray 2008).
Following this, timely reaction from management and leadership of health care in U.S is of great essence. This is because wrong IM injection technique and incorrect needle length can result to complications such, as are muscle fibrosis, abscess, gangrene, nerve injury and contracture. On the other side, unsafe injection technique may result in many of infections, such as HIV (6-8) and hepatitis B and C. According to Cocoman & Murray (2008), Detroid IM injection has resulted to permanent disability and in some cases to legal actions due to inappropriate injection techniques. In additional, this has problems to health care management in imparting proper knowledge to its nurses despite continued iatrogenic complications.
Implications of issues for nursing practice
Based from the questions, concerns, statistics and issues raised, there has been increased awareness to the nurses’ and other health care professionals carry out the appropriate techniques of intramuscular injections, appropriate vaccine and identification of appropriate needle length for injection in obese patients.
Following the effects of injecting vaccine into the subcutaneous tissue, complications such as granulomas and abscesses, injecting the vaccine into the deltoid muscle was more recommended .Further (Walters & Furyk, 2010) describes that although Obese patients still receive the injections into subcutaneous tissue there are more harm. This is because there is slower rate of absorption and medication efficiency can be compromised, resulting to vaccine failure.
In determining the correct needle length, for the past six years the research based on issues of intramuscular needle –length in obesity begun. A research by Zaybak and colleagues (2007) was conducted to measure SCT in ventrogluteal and dorsogluteal sites to determine the optimum injections. In determining the optimum injection for IM injections, Weight was the key factor to the research whereby the BMI for extremely obese was greater than 35, for obese 30-30.5 and for overweight the BIM ranged 25 -29.9 in adults. Following the research, 16mm long needle in adolescents less than 60kg is recommended. It is acceptable for those adults weighing 60-70 kg when using flattened technique or bunch. However, it was agreed 1.5 inches needle to use as standard in Detroid IM injection of vaccine in obese patients. To the question of common method of Detroid IM injection, it was discovered that there is no commonly accepted method of IM injection for a person with high BMI.
Strengthening of nursing practice
From above review, there are many discrepancies in the practice of IM administration. There is because there is no standard method of detroid IM injection and needle length as. This has further created gaps in nursing education as well as the nursing practice (Cook, 2006).There is therefore need to apply the above currently evidence –based research guideline to harmonize the practice and the nursing education in United states.
Cook, I.F., Williamson, M., & Pond, D. (2006).Definition of needle length required for intramuscular deltoid injection in elderlyadults: An ultrasonographic study.Voccine, 24(7), 937-940.
Cocoman, A., & Murray, J. (2008). Intramuscularinjections: A review of bestpractice for mental liealtii nurses.Journalof Psychiatric & Mental Health Nursing,/ 5(5), 424-434.
Zaybak.A., Günes,Y.,Tamsel, S., Khorshid, L, &Eser, I. (2007). Does obesity prevent theneedle from reaching muscle in intramuscular injections? journal ofAdvanced Nursing, 58(6), 552-556
Plotkin, S., Orenstein, W, & Offit, P (2008).Vaccines (5* ed.). Philadelphia: SaundersElsevier.