Summary of Key Points for OSCEs
Sites that can be used are the:
- Deltoid muscle
- Lateral thigh muscle (vastus lateralis)
- Gluteus muscle and the upper outer quadrant of the buttock, in order to avoid the sciatic nerve
Figure 60.1 Suitable sites for intramuscular injection: the deltoids and the upper outer quadrant of the buttock (as this position avoids the path of the sciatic nerve)
Table of Drugs That Can Be Administered Via the Intramuscular Route
| Conditions | Indication for injection | Example of drug |
| Pain | Analgesia | Morphine, tramadol, pethidine, diclofenac, ketoprofen |
| Nausea and vomiting | Antiemetic | Ondansetron, cyclizine, metoclopramide |
| Psychosis | Antipsychotic | Haloperidol, olanzapine |
| Infection | Antibiotic | Co-amoxiclav |
| Cardiac arrest | Adrenaline (epinephrine), atropine | |
| Anaphylaxis | Rapid drug administration if intravenous access difficult | Adrenaline, chlorpheniramine |
Hints and Tips for the Exam
- Always aspirate before injecting. The importance of this cannot be overemphasised as inadvertent intravascular injection may be fatal.
- In the event of aspirating blood, abandon the procedure, apply pressure and try again at a different site with a fresh set of equipment.
- Never resheath a needle. As you change your needle, immediately dispose of it in the sharps bin, ensuring the examiner sees you do this.
- Always have a sharps bin with you to minimise any risk of injury.
- It is very likely that you will receive a manikin or a slab of modified sponge on which to perform the procedure. There may, however, be an actor-patient present from whom you may be asked to obtain consent. If not, it is wise to tell the examiner that these are the steps you would take prior to performing your injection.
- If you do get an actor-patient, being polite and courteous and using a suitable introduction will get you some marks before you even start the procedure.
- Ensure the examiner sees that you would wash your hands before and after the procedure.
Questions You Could Be Asked
Q. What are the indications for intramuscular injection?
A. The intramuscular route may be the only tolerated, available or possible way of administering a particular medication. See the text above for examples.
Q. List some contraindications to intramuscular injection.
A. These may include patient refusal, allergy to the medication you are going to inject, thrombocytopenia, coagulopathy or the patient taking anticoagulant medication.
Q. What complications may arise from an intramuscular injection?
A. These can be classified broadly into local and general complications. Local complications include pain at the injection site, localised swelling, haematoma formation from local bleeding, damage to surrounding structures, for example adjacent nerves, introduction of air and bruising. General complications include introduction of infection, intravascular injection, anaphylaxis or reaction to the drug injected, and injection of the wrong dose or volume of the drug.
Q. What if your patient has anatomy that is difficult to discern, for example if they are obese?
A. If the patient is obese, longer needles can be used. If you feel you are unhappy performing a procedure on a patient, ask for senior help before attempting it. Intramuscular injections are relatively safe to perform, even if the anatomy is difficult.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
