THERAPEUTIC PROCEDURES - Medicine for Mountaineering and Other Wilderness Activities - page 533

needle contamination usually limit the quantity of bacteria introduced to a number that the
body's defenses can destroy.
The following steps should be followed in administering any therapeutic agent intra-
muscularly:
1. The skin over the injection site should be cleaned with soap and water, swabbed with
alcohol or preferably a povidone-iodine disinfectant such as Betadine®, and permitted
to dry.
2. The label on the drug container should be read closely to ensure the proper medication
in the correct dose is being administered.
3. A syringe of appropriate size should be fitted with a 25-gauge needle that is at least
one inch long.
4. Therubbertopofthevialthroughwhichtheneedleistobeinsertedshouldbeswabbed
with alcohol or a disinfectant.
5. The drug should be extracted by inverting the vial, inserting the needle through the
rubber top, injecting a volume of air equal to the volume of fluid to be removed, and
withdrawing the medication. While the needle is still in the vial, air bubbles or excess
medication should be expressed from the syringe.
6. The label on the container must be reexamined to ensure no mistakes have occurred.
Such errors are far easier to prevent than to correct.
7. An injection site should be selected at which the muscle is thick enough to prevent
striking theunderlying bone.Thedeltoid muscle oftheshoulder,gluteus muscle ofthe
buttock, or quadriceps muscle of the anterior thigh are the usual sites ( Fig. B-1 ) . The
deltoid is used most commonly because it is easily accessible; the gluteus is not as re-
liable for injections of vaccine, particularly rabies and hepatitis vaccines. The needle
should be inserted with a jab.
Figure B-1. Sites for the administration of intramuscular injections (A, shoulder; B, thigh; C, buttock)
8. Beforeinjectingthemedication,theplungerofthesyringemustbepulledbacktomake
certain the needle is not in a blood vessel. If blood is pulled back into the syringe, the
needle must be removed and inserted in a different location.