Intramuscular vaccine administrations including the adoption of"Zeta-track technique"&"without aspiration slow injection technique"(ZTT&WASiT):a prospective review

Objective:To review the current literature on the practice of intramuscular injections(IMIs),focusing on immunizations.Methods:The present study comprises 2 reviews,characterized by high-quality evidence,per taining to the deployment of the slow injection technique without aspiration(referred to in this paper as the without-aspiration slow injection technique[WASi T])and combined with the Zeta-track technique(ZTT).The literature review is oriented toward the analysis of 2 features associated with IMIs techniques:safety and pain,integrating new evidence on vaccinee positioning for each muscle site and general relaxation techniques in the multi-parametric analysis.Results:The rigorous and in-depth reviews in the current study reveal the usefulness of including,among the international guidelines for via intramuscular immunizations,the adoption of WASi T only for compliant vaccinees,and in combination with all validated techniques for IMIs,and the use of ZTT limitedly if specific well-developed muscles are indicated.All the technique's limitations are exposed.Conclusions:Future research directions are presented by including the author's study designs to provide indirect evidence for the validity of the rationale of the slow injection technique using scientific methods,and for the conduction of future randomized controlled trials(RCTs)focused on revisiting the adoption of ZTT in a dynamic and integrated immunizations protocol in anterolateral thigh(ALT),ventrogluteal(VG),and also in the deltoid muscle,in the specific cases analyzed.

Factors influencing time course of pain after depot oil intramuscular injection of testosterone undecanoate

Pain following depot intramuscular （IM） injection of oil vehicle-based drugs has been little studied. This study aimed to determine prospectively the prevalence,determinants,severity and functional consequences of pain during the week after IM injection of 1 000 mg testosterone undecanoate （TU） in a 4-mL castor oil vehicle. Androgendeficient men receiving regular T replacement therapy at an academic andrology clinic were recruited to report pain scores using a coloured visual linear analogue scale at seven times over the first day and daily for a week after a deep IM gluteal injection. The time course and covariables influencing pain scores were analysed by mixed model analysis of variance （ANOVA）. Following 168 injections in 125 men,pain was reported by 80% of men,peaking immediately after injection,reaching only moderate severity,lasting 1-2 days and returning to baseline by day 4.The pain required little analgesic use and produced minimal interference in daily activities. The time course of pain scores was reproducible in the 43 men who underwent two consecutive injections. Pain was more severe in men who had an earlier painful injection,but less severe in older and more obese men. There were negligible differences in post-injection pain experience between experienced nurses administering injections. Deep IM gluteal injection of depot TU in 4-mL castor oil is well tolerated and post-injection pain is influenced by earlier painful injection experience,as well as age and obesity.

The relationship between body mass index, thickness of subcutaneous fat, and the gluteus muscle as the intramuscular injection site

An intramuscular injection (IMI) is an injection given directly into the central area of a specific muscle. Certain medicines need to be administered by the gluteal route for these to be effective. The aim of this study was to determine the influence of body mass index (BMI), subcutaneous fat, and muscular thickness of the dorsogluteal IMI site among healthy Japanese women. There were 39 healthy female subjects who volunteered and met the criteria. Their ages ranged from 40s to 60s (50.82 ± 6.04). With the data collected using the B-mode ultrasound images of the dorsogluteal site, it was found that the distance from the epidermis to the under-fascia (DEUF) of the gluteus maximus was dissimilar between the subject’s right and left buttocks. It was found that the distance from the epidermis to the iliac bone (DEI) was significantly more on the right than on the left buttocks. In the case of an adult Japanese woman with a BMI of 21 or more, the DEUF of the gluteus medius was found to be about 30 mm, and the DEI was approximately 50 mm or more. Based on these findings, it is recommended that a needle length of 38 mm (1.5 inches) can be safely used to administer IMIs to the gluteus medius muscle to effectively and efficiently deliver medications through the IMI route.

In Vivo Kinetics and Biodistribution of a Hantaan Virus DNA Vaccine after Intramuscular Injection in Mice

To study the kinetics in vivo of a Hantaan virus DNA vaccine, we constructed a fusion DNA vaccine, pEGFP/S, by cloning the S segment of Hantavirus into the vector, pEGFP-C1, which encodes Green fluorescent protein EGFP. In this report, we provide evidence that pEGFP/S was distributed and persistently expressed for more than 60 days in several organs after inoculation. Our findings suggest that the persistent immune responses induced by a Hantaan virus DNA vaccine are likely due to the plasmid pEGFP/S deposited in vivo, which acts as a booster immunization.

Comparison of Gluteal Muscle Intramuscular Injection Sites of Japanese Healthy Subjects: Considerations for Optimal Insertion of Injection Needle Length

Long Acting Injectable (LAI) medications for patients with schizophrenia is commonly administered to relieve their symptoms. Through shared decision-making and clinical evidence-based, psychiatrists should systematically offer LAIs to all patients requiring long-term antipsychotic treatment as a first-line treatment. Gluteal intramuscular (IM) injection requires accurate insertion of needles into the specific muscle area, often the outer upper quadrant of the buttocks, in order to achieve the required blood concentration. The purposes of this study were to compare the “Distance from the Epidermis to the Under-Fascia (DEUF)” and “Distance from the Epidermis to the Iliac Bone (DEB)” of the buttocks IM injection sites at the dorsogluteal and ventrogluteal sites among healthy Japanese volunteer subjects, and to identify the optimal insertion injection needle length. The DEUF and DEB at the gluteal regions were measured by ultrasonography. Welch’s one-way analysis of variance was used to compare the DEUF and the DEB at the gluteal IM injection regions. There was no statistically significant difference observed between the right and left mean values of DEUF for Hochstetter and Clark’s point at the ventrogluteal sites, and the Four and Three-way split or Double Cross point at the dorsogluteal sites. However in the DEB, the Hochstetter’s point (P < 0.01) at ventrogluteal site on the right side, and Clark’s point (P < 0.05) were significantly shorter than the Double Cross point at dorsogluteal sites (F = 4.38). The left buttocks Hochstetter’s point was significantly shorter than the Double Cross point (F = 4.38, P < 0.01). These results, however, did not establish a statistically significant difference in the DEUF among injection sites. It was considered that the difference in the DEB depended on muscle volume and thickness in the gluteal injection sites.

Appropriate Needle Lengths Determined Using Ultrasonic Echograms for Intramuscular Injections in Japanese Infants

Adjuvanted vaccines are recommended for administration through an intramuscular route. The Centers for Disease Control and Prevention (CDC) has recommended the anterolateral thigh using a 22 - 25-G 25-mm (1 inch) needle for infants, injected at a 90° into the skin surface, and using a 16 mm (5/8 inch) for newborns. Appropriate needle lengths may differ depending on racial backgrounds. In the present study, the thickness of the epidermis and lengths from the skin surface to the muscle fascia and bone were measured using ultrasonic echograms in order to determine suitable needle lengths for Japanese infants aged 2, 3, 4, 5, 6, and 12 - 15 months old. The thickness of the epidermis was 1.44 - 1.54 mm (95% CI), and the lengths from the skin surface to the muscle fascia and bone were 11.52 - 12.28 mm (95% CI), and 25.66 - 26.93 mm (95% CI), respectively, at the anterolateral thigh. At the center of the deltoid muscle, skin thickness was similar to that at the thigh, furthermore the lengths from the skin surface to the muscle fascia and bone were 8.49 - 9.10 mm (95% CI), and 17.38 - 18.31 mm (95% CI), respectively. The lengths from the skin surface to the muscle fascia and bone were 1 - 2 mm shorter in 2-month-old infants than those in older generations. Therefore, the appropriate needle length for intramuscular injections in Japanese infants was 16 mm (5/8 inch) at any age and sites, and with 25 mm (1 inch) needles at a 90° angle being associated with the risk of over-penetration.

A narrative review of the success of intramuscular gluteal injections and its impact in psychiatry

There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding increase in the bioavailability of drugs when administered intramuscularly. This paper is a review of the variables that affect the success of intramuscular injections and the implications that these success rates have in psychiatry and general medicine. Studies have shown that the success rates of intended intramuscular injections vary between 32 and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition. These rates are found to be even lower for certain at-risk populations, such as obese patients and those on antipsychotic medications. The variables associated with an increased risk of injection failure include female sex, obesity, site of injection, and subcutaneous fat depth. New guidelines and methods are needed in order to address this challenge and ensure that patients receive optimum care. Looking forward, the best way to improve the delivery of intramuscular injections worldwide is to develop uniform algorithms or innovative medical devices to confirm or guarantee successful delivery at the bedside.

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention. The aim of this article was to indicate a safe and effective IM injection technique based on evidenced data derived from ultrasonographic data. Accurate anatomical knowledge is necessary in order to administer IM injections. It is possible to gain an adequate understanding of injection site anatomical structures by using ultrasound diagnostic devices. In particular, ultrasonography offers real-time diagnostic data allowing for observation of injection site, subcutaneous tissues, fat layers, muscle membrane, muscles and bones. To deliver the drug accurately into the muscle is essential, to achieve maximum drug efficacy and prevent injection site reactions. Therefore, when administering IM injections to the buttocks area, a suitable injection needle between 23G 25 mm to 21G or 22G 38 mm must be chosen depending on physique and drug characteristics. Needles determined as safe and effective through ultrasonographic evidence are needed such as in the case of a deltoid injection site, in which a 23G 25 mm injection needle is used in the absence of notable obesity. Not only the needle type is essential, but also the IM procedure itself. It is important to stretch the skin, inserting the needle at 90 degree angle to ensure depth of needle insertion to the muscle. Until new con-firmed evidence becomes available, it is necessary to increase the understanding of injection site selection methods, needle insertion depth, needle angle, and established IM injection techniques. The application of ultrasound devices in the development of next-generation techniques for IM injection is promising. Importantly, these techniques provide critical information from a risk management perspective.

Optimal needle insertion length for intramuscular injection of risperidone long-acting injectable (RLAI)

Risperidone long-acting injectable (RLAI) is approved for the treatment of schizophrenia in many countries. The suggested site is the gluteal muscle with a needle length of two inches (50 mm) in Japan, which is longer than the ordinarily used needle for intramuscular injections. The aim of this study was to determine the optimal needle insertion length for accurate delivery of RLAI procedure among subjects who have normal body mass index (BMI: 18 to 25) and high BMI (>25). Thirty-seven patients with schizophrenia were administered RLAI intramuscularly into the dorsogluteal muscle. The standard procedure required inserting 80% of the two inch needle. By using data collected by ultrasonography, the findings confirmed that the median needle insertion lengths for subjects with normal and high BMI were 39.0 and 45.5 mm, respectively. To deliver RLAI effectively and safely, the authors strongly recommend that a specialized needle be used that is “marked” at the 40 mm point from the tip of the needle to the base. In this way regardless of subcutaneous fat content, the RLAI can be safely delivered into the muscle without causing untoward or side effects.

Effect of intramuscular calcitonin injection combined with intra-articular ozone injection on the expression of the IL family and MMPs family of knee osteoarthritis

Objective: To study the effect of intramuscular calcitonin injection combined with intra-articular ozone injection on the expression of the IL family and MMPs family of knee osteoarthritis. Methods: A total of 128 patients with knee osteoarthritis who were treated in the hospital between January 2015 and January 2017 were collected and divided into control group and observation group by random number table, each with 64 cases. Control group received intra-articular ozone injection therapy, and observation group received intramascular calcitonin injection combined with intra-articular ozone injection therapy. The differences in serum levels of IL family members and MMPs family members were compared between the two groups before and after treatment. Results: Before treatment, the differences in serum levels of IL family members and MMPs family members were not statistically significant between the two groups. 1 week after treatment, serum levels of IL family members IL-1β, IL-15, IL-17 and IL-18 as well as MMPs family members MMP-1, MMP-2, MMP-3 and MMP-13 of both groups of patients were significantly lower than those before treatment, and serum IL-1β, IL-15, IL-17, IL-18, MMP-1, MMP-2, MMP-3 and MMP-13 levels of observation group were significantly lower than those of control group. Conclusion: Intramuscular calcitonin injection combined with intra-articular ozone injection therapy can effectively inhibit the expression of IL family and MMPs family in patients with knee osteoarthritis.

Neuroprotective effects of ultrasound-guided nerve growth factor injections after sciatic nerve injury

Nerve growth factor（NGF） plays an important role in promoting neuroregeneration after peripheral nerve injury. However, its effects are limited by its short half-life; it is therefore important to identify an effective mode of administration. High-frequency ultrasound（HFU） is increasingly used in the clinic for high-resolution visualization of tissues, and has been proposed as a method for identifying and evaluating peripheral nerve damage after injury. In addition, HFU is widely used for guiding needle placement when administering drugs to a specific site. We hypothesized that HFU guiding would optimize the neuroprotective effects of NGF on sciatic nerve injury in the rabbit. We performed behavioral, ultrasound, electrophysiological, histological, and immunohistochemical evaluation of HFU-guided NGF injections administered immediately after injury, or 14 days later, and compared this mode of administration with intramuscular NGF injections. Across all assessments, HFU-guided NGF injections gave consistently better outcomes than intramuscular NGF injections administered immediately or 14 days after injury, with immediate treatment also yielding better structural and functional results than when the treatment was delayed by 14 days. Our findings indicate that NGF should be administered as early as possible after peripheral nerve injury, and highlight the striking neuroprotective effects of HFU-guided NGF injections on peripheral nerve injury compared with intramuscular administration.

Comparison of in-vial exhaust method versus conventional exhaust method in the injection of COVID-19 vaccine

Objective:The objective of the study was to compare the application effects of in-vial exhaust method and conventional exhaust method in the process of coronavirus disease 2019 vaccine injection.Materials and Methods:Using convenient sampling method,102 vaccines were selected as experiment group during the process of vaccine injection,and the in-vial exhaust method was used.One hundred and five vaccines were selected as the control group and the conventional exhaust method was adopted.The incidence of vaccine solution spillage and exhausting time in the two groups during exhaust were observed.Results:The incidence of solution spillage in the experiment group was lower than that in the control group(0 vs.6.67%,P<0.05).The exhausting time of the experiment group was shorter than that of the control group([15.12±4.43]s vs.[22.74±6.53]s,P<0.05).Conclusion:Implementing the in-vial exhaust method in the vaccine injection can effectively reduce the incidence of solution spillage,reduce nucleic acid contamination,and ensure that the vaccine is injected at the prescribed dose.Moreover,the operation is simple and easy,which improves the nurse’s vaccination efficiency,and has a higher promotion and application value.

不同孕激素给药方式对激素替代方案准备内膜冻胚移植后妊娠及分娩结局的影响

目的探讨激素替代方案准备子宫内膜的冷冻胚胎移植(FET)周期中不同孕激素给药方式对妊娠及分娩结局的影响。方法选取接受第1周期冷冻单囊胚移植并使用激素替代方案准备内膜患者3357例,根据孕激素给药方式分为肌内注射黄体酮组(IMP组)749例、口服地屈孕酮联合阴道微粒化黄体酮胶囊组(DYD-VPC组)2249例及口服地屈孕酮联合阴道黄体酮凝胶组(DYD-VPG组)359例。比较三组基本临床特征、孕产期并发症及妊娠分娩结局的差异。结果三组年龄、BMI、不孕年限、未生育、患有原发性不孕症、窦卵泡数、获卵数、FET前子宫内膜厚度、PCOS患者比例、剖宫产史、移植胚胎发育时间等基线资料比较均无统计学差异(P均>0.05)。三组活产率、生化妊娠率、生化妊娠流产率、临床妊娠丢失率等均无统计学差异(P均>0.05);IMP组剖宫产率高于DYD-VPC组和DYD-VPG组(83.42%vs 76.88%vs 73.41%,P<0.05)。三组妊娠期和新生儿并发症如早产、巨大儿、低出生体质量儿、大于胎龄儿、小于胎龄儿、妊娠期高血压疾病和妊娠期糖尿病发生率均无统计学差异(P均>0.05)。多因素Logistic回归分析校正混杂因素后显示,肌内注射黄体酮与剖宫产风险增加相关。结论在激素替代方案准备子宫内膜的冻胚移植周期中,口服地屈孕酮联合阴道用黄体酮的临床妊娠率和活产率与肌内注射黄体酮相同,但剖宫产率降低。

基于光学定位的三维超声引导肌肉注射仪设计研究

目的解决光学定位技术在引入肌肉痉挛治疗的注射手术应用中,光学定位设备与现有医用超声仪器之间的不适配问题,旨在进一步提升理论定位精度稳定性,简化必需操作并降低实际应用难度。方法在现有超声仪及相关设备功能基础上,结合光学定位设备工作条件需求进行需求分析,重新构建产品元件功能流模型并映射为网络节点,并基于复杂网络节点重要度评价方法,确定目标产品设计重心点并分层设计,最后采用仿真验证测试设计合理性。结果实验结果符合预期假设,目标节点所对应功能元件与其它节点的相关性程度与目标元件所需兼容连接的复杂度呈正相关。基于实验得出能够适配光学定位仪与超声设备的设计方案,有效解决二维超声导航引导肌肉注射所面临的不直观、不可视等问题。结论基于复杂网络节点的重要度评价方法更适用于复杂功能产品的设计研究,评价结果重要度差异更为显著。

表达PCV2 ORF2的重组T7噬菌体在猪体内的存留分析

为了检测经颈部肌肉注射入猪体的、表达猪圆环病毒2型(PCV2)衣壳蛋白(ORF2)的重组T7噬菌体(T7-ORF2)在体内的存留情况,本试验将PCV2抗原和抗体均为阴性的20日龄仔猪随机分为试验组和对照组,每组5只;试验组猪只以1.5mL/只剂量颈部肌肉注射增殖收获的T7-ORF2,对照组猪只以相同途径注射等体积的洗脱液;于注射前1 d、注射后10 h、1~7 d测量体温,观察猪只的临床症状和死亡情况;分别于注射后1 h、3 h、5 h、10 h、1 d、3 d、5 d和7 d采集猪只的血液和粪便样品,注射后10 h、1 d、3 d、5 d和7 d采集肝脏、脾脏和腹股沟淋巴结样品;将收集的各样品处理上清与宿主菌(大肠埃希菌BLT5403株)混合培养,通过细菌裂解分析T7-ORF2的感染性;以细菌裂解液提取的基因组DNA为模板进行PCR,检测ORF2基因;通过免疫组织化学检测T7-ORF2在肝脏、脾脏和腹股沟淋巴结中的分布和存留时间。结果显示,试验组猪只在试验期体温、采食、饮水和精神状态正常,无不良症状和死亡发生;注射后5 d能从血清和粪便中检测到感染性的T7-ORF2;注射后3 d能从肝脏、脾脏和腹股沟淋巴结中检测到感染性的T7-ORF2;从细菌裂解液中可扩增检测到PCV2 ORF2基因片段;免疫组织化学切片观察结果显示,T7-ORF2在机体中逐渐被清除,在脾脏中存留至少5 d,在肝脏和腹股沟淋巴结中存留至少7 d。结果表明,T7-ORF2可进入猪只的血液循环、肝脏、脾脏和腹股沟淋巴结中,并随粪便排出体外。本试验为利用T7-ORF2深入开发PCV2新型疫苗提供数据支撑。

不同治疗方法对复发性流产患者血清同型半胱氨酸水平的影响及临床意义

目的探讨肌肉注射维生素B12及口服复合维生素治疗血清同型半胱氨酸(HCY)升高的复发性流产(RSA)患者的疗效。方法选取HCY升高的RSA患者137例作为研究对象,分为注射组(肌肉注射维生素B12)和口服组(口服爱乐维复合维生素片),收集2组患者的年龄、自然流产次数、抗核抗体谱(ANA)、血清D-二聚体水平等一般资料,比较2组患者治疗前后HCY水平、治疗后HCY正常的百分率、HCY降至正常的时间、低分子肝素使用率、妊娠率、保胎成功率、抱婴率及妊娠合并症。结果与口服组比较,治疗后注射组患者HCY水平明显降低(P=0.002),HCY正常的百分率明显升高(P=0.042),HCY降至正常的时间明显缩短(P<0.001),妊娠率及抱婴率均明显升高(P<0.05),妊娠合并症的发生率明显降低(P=0.003)。结论与口服复合维生素治疗比较,肌肉注射维生素B12治疗HCY升高的RSA患者,能在较短时间内有效降低血清HCY水平,更能够改善患者的临床结局及减少妊娠合并症。

改良Z-Track肌内注射法在体外受精-胚胎移植病人黄体酮注射中的应用

[目的]探讨改良Z-Track肌内注射法在体外受精-胚胎移植(IVF-ET)病人黄体酮注射中的应用效果。[方法]采用前瞻性随机对照研究方法,将纳入研究的122例IVF-ET病人按照随机数字表法分为观察组和对照组各61例。对照组采用常规肌内注射法,观察组根据病人不同体质指数,采用改良Z-Track肌内注射法。比较两组给药7 d内注射部位不良反应发生情况。[结果]观察组局部硬结发生率显著低于对照组,组间比较差异有统计学意义(χ 2=6.917, P <0.05);观察组疼痛程度显著低于对照组,组间比较差异有统计学意义( Z =6.622, P <0.05)。[结论]根据病人不同体质指数,采用改良Z-Track肌内注射法进行黄体酮臀部肌内注射,可有效减少局部不良反应,确保用药安全。

双柏散外敷治疗肌注黄体酮所致臀部硬结的效果

目的:探究肌注黄体酮所致臀部硬结采用双柏散外敷治疗的效果。方法:于2023年3—8月在江西省妇幼保健院肌注黄体酮所致的臀部硬结患者共80例,按照抽签法分为对照组(n=40)和观察组(n=40),其中对照组采用马铃薯外敷,观察组采用双柏散外敷。评估两组临床效果、疼痛程度、疼痛消失时间、硬结面积及生活质量。结果:治疗后,观察组生活质量评分均高于对照组,差异均有统计学意义(P<0.05)。观察组的总有效率高于对照组,差异有统计学意义(P<0.05)。治疗10 d、1个月后,观察组的疼痛程度评分均低于对照组,差异均有统计学意义(P<0.05);治疗10 d、1个月后,观察组的硬结面积均小于对照组,差异均有统计学意义(P<0.05)。结论:双柏散外敷治疗因肌注黄体酮所引起的臀部硬结的效果比常用的马铃薯的效果更好,改善患者的疼痛程度,减少患者的硬结面积,提升患者的生活质量。

棕榈酸帕利哌酮注射液三角肌肌内注射治疗精神分裂症的临床效果

目的:探讨精神分裂症患者接受棕榈酸帕利哌酮注射液三角肌肌内注射治疗的临床效果。方法:选取2020年3月—2022年1月临沧市精神病专科医院收治的120例精神分裂症患者作为研究对象,以投掷硬币法随机分为参照组与研究组,各60例。参照组给予利培酮口服治疗,研究组给予棕榈酸帕利哌酮注射液三角肌肌内注射治疗。比较两组临床症状、治疗效果、不良反应发生情况。结果:治疗前,两组临床症状评分比较,差异无统计学意(P>0.05);治疗3、6、12个月后,两组临床症状评分逐渐降低,且研究组低于参照组,差异有统计学意义(P<0.05)。研究组治疗总有效率高于参照组,差异有统计学意义(P=0.004)。研究组不良反应总发生率低于参照组,差异有统计学意义(P=0.011)。结论:精神分裂症患者采用棕榈酸帕利哌酮注射液三角肌肌内注射治疗的效果显著,可减少并发症,改善临床症状。

早期护理干预对肌内注射后局部硬结的预防效果观察

探究肌内注射患者接受早期护理干预对预防局部硬结的效果。纳入100例在2022年9月—2023年10月接受肌内注射治疗的患者为研究对象,应用随机抽签方法将其分为对照组和观察组,对照组50例(常规护理干预)、观察组50例(早期护理干预),对两组患者的护理干预效果开展对照分析。结果显示,观察组局部硬结情况优于对照组(P<0.05);干预后,观察组患者各项生活质量评分均高于对照组(P<0.05);观察组患者疼痛症状统计结果相比对照组显著更优(P<0.05);观察组患者总满意度高于对照组(P<0.05);观察组患者各项应用价值评分均高于对照组(P<0.05)。研究发现,通过开展早期护理干预,能够让患者肌内注射后的硬结问题得到良好改善,该方法有助于缓解患者疼痛症状,并提升其生活质量和满意度,应用价值显著,适合推广普及。