Possible complications with intramuscular injection

The article was professionally consulted with Master, Doctor Phan Ngoc Toan - Resuscitation - Emergency Doctor - Vinmec Danang International General Hospital.

The intramuscular injection technique uses a syringe to deliver medication deep into the muscle layer, allowing the drug to be absorbed into the bloodstream quickly. Intramuscular injection is one of the four basic injection routes, including intravenous, intramuscular, subcutaneous, and intradermal injections to deliver drugs into the body effectively and quickly.
The speed at which the drug penetrates the blood and is absorbed between the injection routes is different, specifically the intravenous route is the fastest, then the intramuscular injection, followed by the subcutaneous injection and finally the intradermal injection. Thus, it can be said that the use of intramuscular injection technique to deliver the drug into the patient's body will achieve faster effects.
Intramuscular injection is indicated in cases where the drug solutions are isotonic (isotonic solution is a solution with a concentration of solute equal to the intracellular environment, that is, the concentration of diffusible substances). passivities into and out of the cell are equal, so the cell does not shrink or burst), including:
Hydrophilic solutions. The drug cannot be administered intravenously. The drug solution dissolves slowly, causing pain. Most drugs that are injected under the skin can be injected intramuscularly, with the exception of caffeine. Drugs that are easily irritating or slow to work when administered subcutaneously. Intramuscular injection is contraindicated with drugs capable of causing muscle tissue necrosis such as Calcium chloride, Ouabain,...
According to the injection site, intramuscular injection is divided into two main groups:
Superficial intramuscular injection: Intramuscular injection at the following sites: Arm: Delta muscle. Arm triceps muscle. Legs: quadriceps thigh muscle. Deep intramuscular injection: injection in the gluteal region.

After intramuscular injection, patients may experience some unpleasant symptoms, but most are normal. But if you experience the following serious signs, seek medical attention:
Tingling or numbness. Prolonged bleeding. Feel severe pain at the injection site. Fatigue, high fever, headache. The injection site is swollen, red, or hot. The injection site shows signs of discharge. Occurrence of signs of an allergic reaction such as difficulty breathing, swelling of the face,... Complications that may occur when injecting intramuscularly include:
Broken needle, bent needle:
Broken needle: the accident occurred because of the patient. flap. The precaution is to keep the patient well, not to let the patient struggle during the injection. Curved needle: caused by technical errors of nurses when injecting. The way to prevent that is not to inject the needle edge, so that if the needle breaks, the needle can still be removed.
Injury to the great sciatic nerve:
It is caused by the technician's failure to determine the correct buttock injection site, the wrong injection site, or the oblique needle puncture angle. Prevention: it is necessary to accurately determine the injection site of the buttocks, perform the injection at the correct angle of 90 degrees. Embolism:
Caused by injection of oil or emulsion drugs into the blood vessels. Prevention: after inserting the needle, before injecting the drug, must test the syringe to see if there is blood. If there is blood, the needle must be removed and injected at another site. If there is no blood coming out, the medicine will be injected.

Infectious abscess, aseptic abscess:
The cause of an infected abscess is the failure to ensure the principle of aseptic injection. The cause of aseptic abscess is insoluble drugs such as Quinine, Hydrocortisone and oil-soluble drugs that will cause local abscesses. How to detect: at the injection site will be swollen, hot, red, painful. Treatment: depending on the extent of the damage, you can apply heat or prick the abscess when necessary. How to prevent: need to ensure the principle of sterility when injecting. Causes plaque:
Cause: is caused by the injection of substances that cause tissue necrosis - drugs that are contraindicated for intramuscular injection such as Calcium chloride. Findings: at the injection site, it felt hot, red, painful, initially hard, then soft like an abscess. Treatment: if detected early, block with Novocaine. You can apply heat at first. If there is necrosis, a thin bandage is needed to prevent further infection, if the necrosis is large, an incision may be needed. Prevention: it is necessary to carefully check the drug before injection to see if it is in the group of contraindications for intramuscular injection. Anaphylaxis:
Caused by the patient's body's response to the drug. Penalties appear through the patient's symptoms such as: The patient has unusual feelings such as: panic, restlessness, anxiety, fear, ... The patient has a rash, urticaria, erythema, edema Quincke (observed eyes, lips, face are swollen). Check that the pulse is fast, small, difficult to detect, blood pressure is low or not measured. Patient has abdominal pain and urinary incontinence. Patients may experience dizziness, headache, lightheadedness, struggle, convulsions, struggles, coma,... Treatment: it should be handled urgently according to the anaphylactic shock protocol of the Ministry of Health. How to prevent: need to check carefully before injecting, ask the patient about allergy history. With drugs that cause allergies such as Penicillin, anticonvulsants, Sulfamide drugs, insulin preparations (especially insulin derived from animals), anesthetics (such as Novocain, ..),... must be tested before injection. The intramuscular injection technique is one of the basic injection techniques, often used in the treatment of various diseases and also in vaccination. This is a technique that requires training. During the implementation process, it is necessary to ensure sterility, inspection, and correct technical operations, otherwise it is very easy to have an accident.