A study on parental perspectives towards childhood fever

Background: Parents play an important role in recognizing and treating paediatric fever as well as initiating home treatment. Their knowledge and attitude can greatly influence paediatric fever treatment and parental phobia may at times lead to overtreatment of fever. Objectives of this study was to assess the knowledge, attitudes and practices of parents towards childhood fever. Methods: This cross-sectional observational study was conducted in the Paediatric department at Saveetha Medical College, Chennai. Data collection from parents was done using a questionnaire to study the knowledge, attitude and practices of parents towards fever and its management in children. Data analysis was done using SPSS 16 software.Results: Total 100 parents participated in the study, most of participants were mothers (69%) and 51% were between 20-30 years. 67% parents believed that fever could cause harmful effects like convulsions and delirium whereas 61% parents believed that consumption of large doses of antipyretic is harmful. Majority of parents 87% were aware that vaccinations can cause fever. Around 82% of parents declared that they had sleepless nights whenever their child was febrile. Majority of the parents 95% stated that they confirmed the presence of fever in their child by tactile assessment. About half the parents preferred using injections for reducing fever than oral medications.Conclusions: The study revealed presence of high levels of anxiety in majority of parents highlighting the need for reassurance and counsel ling by health professionals. Since most of the parents relied on tactile assessment for fever, there is a need to educate them about proper use of a thermometer for accurate detection and better assessment of fever.

(Re)discutindo a técnica de administração de medicamentos pela via intramuscular: revisão sistemática / (Re)discussing the drug administration technique by the intramuscular route: a systematic review / (Re)discutir la técnica de administración de fármacos por vía intramuscular: revisión sistemática

Objetivo: Identificar la producción del conocimiento en enfermería junto la técnica de administración de medicamentos por vía intramuscular, describa las diferencias, congruencias, y la ocurrencia de las complicaciones de la técnica y analizar las recomendaciones formuladas en la literatura con las mejores prácticas y las actualizaciones clínicas en enfermería. Método: Revisión sistemática sin meta-análisis. Búsqueda realizada en las bases de datos LILACS, PUBMED, MEDLINE, DEDALUS, Portal de Evidencia en Salud y Bibliotecas SciELO y Cochrane, en el período de 1993-2012, por un total de 16 estudios. Resultados: Estúdios mostraron diferencias en las variaciones en la demarcación de la región ventral glútea, la realización de la antisepsia y la aplicación de presión antes de la administración intramuscular. Consonancia en la aspiración del contenido de la jeringa después de la inserción de la aguja en el músculo, de ricino secuencias del sitio de aplicación para inyección IM, entre otras. Conclusión: La incorporación de la mejor evidencia permite la ejecución segura de la técnica intramuscular, proporcionando comodidad y la excelencia en la atención al paciente

Objective: The study's purpose has been to identify the production of nursing knowledge related to the medication administration technique by the intramuscular route. It was also aimed to describe the differences, similarities, and occurrence of complications of the technique and to analyze the recommendations described in literature with best practice and clinical updates in the nursing research field. Methods: This is a systematic review without meta-analysis. The research was performed through the following electronic databases, LILACS, PUBMED, MEDLINE, DEDALUS, Health Evidence Portal and Libraries SciELO and Cochrane, during the period from 1993 to 2012, then totaling 16 studies. Results: The findings have shown the different variations in the limit of the ventrogluteal region, conducting antisepsis, and applying pressure before intramuscular administration. They also showed consonances in the aspiration of the contents of the syringe after insertion of needle into the muscle, caster application site during sequences IM injections, among others. Conclusion: The incorporation of best evidence allows safe execution of intramuscular technique, providing comfort and excellence towards the patient care

Objetivo: Identificar a produção do conhecimento da enfermagem atrelado à técnica de administração de medicamentos pela via intramuscular; descrever as divergências, congruências e ocorrência de complicações acerca da técnica; e analisar as recomendações descritas na literatura com as melhores práticas e atualizações clínicas na enfermagem. Método: Revisão sistemática sem meta-análise. Realizada busca nas bases de dados LILACS, PUBMED, MEDLINE, DEDALUS, Portal de Evidência em Saúde e Bibliotecas SciELO e Cochrane, no período de 1993 a 2012, totalizando 16 estudos. Resultados: Os estudos evidenciaram divergências na variações de demarcação da região ventroglútea; realização de antissepsia; e aplicação de pressão antes da administração intramuscular. Consonâncias na aspiração do conteúdo da seringa após inserção da agulha na massa muscular, rodízio do local de aplicação durante sequências de injeções IM, dentre outros. Conclusão: A incorporação das melhores evidências permite a execução segura da técnica intramuscular, gerando conforto ao paciente e excelência na assistência

Iatrogenic Injury to the Sciatic Nerve due to Intramuscular Injection: A Case Report / 대한신경손상학회지

Iatrogenic injuries due to intramuscular (IM) injection, although less frequently reported than before, are still common. The sciatic nerve is the most commonly injured nerve because of an IM injection owing to its large size and the buttock being a common injection site. Iatrogenic injury to the sciatic nerve resulting from a misplaced gluteal IM injection is a persistent problem worldwide affecting patients in economically rich and poor countries alike. The consequences of sciatic nerve injection injury (SNII) are potentially devastating and may result in serious neurological and medico-legal problems. A 68-year-old male presented with intractable neuropathic pain from SNII that occurred during gluteal IM injection of an analgesic for post-appendectomy pain. This chronic SNII pain did not improve despite his gradual recovery from weakness in the left foot. Partial improvement was seen following an external neurolysis, performed three months post-appendectomy. SNII is a preventable complication of gluteal IM injection. While the complete avoidance of gluteal IM injection is desirable, should need arise, the use of an appropriate administrative technique is recommended.

Upper limb nerve injuries caused by intramuscular injection or routine venipuncture

The reported cases of upper limb nerve injury followed by needle procedure such as intramuscular injection or routine venipuncture are rare. However, it should not be overlooked, because neurological injury may cause not only minor transient pain but also severe sensory disturbance, hand deformity and motor dysfunction with poor recovery. Recognizing competent level of anatomy and adept skill of needle placement are crucial in order to prevent this complication. If a patient notices any experience of abnormal pain or paresthesia during the needle procedures, an administrator should be alert to the possibility of nerve injury and should withdraw the needle immediately. Careful monitoring of the injection site for hours is required for early detection of nerve injury.

Effects of Neck and Back Touch on Ultrasonic Vocalization and the Rat Grimace Scale in Rats Receiving Intramuscular Injections

PURPOSE: To determine the effects of neck and back touch on Ultrasonic Vocalization (UV) and the Rat Grimace Scale (RGS) in rats touched by the human hand as an intervention for reducing pain and anxiety associated with intramuscular injections. METHODS: This study was a randomized, controlled, pre-test/post-test design study. Twenty male Sprague-Dawley rats were assigned to either the experimental or control groups (n=10 rats/group). The experimental group was touched in a manner similar to massaging the rat's neck and back twice a day for one week. The two groups received two intramuscular injections. The 22kHz and 50kHz UV and the RGS scores were measured before and after each intramuscular injection. RESULTS: The 22kHz UV and RGS score were significantly higher in the control group than in the experimental group when the first intramuscular injection was administered; whereas, no difference between the experimental and the control groups were observed when the second intramuscular injection was administered. There was no statistical difference in the 50kHz UV between the two groups when the first and second injections were administered. CONCLUSION: This study found that touching was an effective intervention method to reduce negative emotions and pain in rats receiving their first intramuscular injection.

Preparo de medicamentos administrados via intramuscular na pediatria: atuação da equipe de enfermagem / Preparation of intramuscular drugs in pediatrics: nursing team / Preparación de medicamentos de administración intramuscular en pediatría: actuación del equipo de enfermería

Objetivou-se avaliar a atuação da equipe de Enfermagem na organização do ambiente, no preparo e na diluição de medicamentos administrados por via intramuscular na pediatria. Estudo observacional, quantitativo, desenvolvido mediante 327 observações do preparo de medicamento intramuscular, no período de dezembro de 2014 a maio de 2015, em um hospital pediátrico, Fortaleza-Ceará. Para observações utilizou-se um checklist composto pelas etapas: organização do ambiente com quatro ações; preparo e diluição de medicamentos com 12 ações. Na organização do ambiente, alcançou-se desempenho satisfatório na ação organizar a bancada, com 231 (70,6%). A etapa de preparo e diluição do medicamento obteve desempenho satisfatório em seis ações: separar bolas de algodão com álcool e seca, com 252 (77%); escolher seringa compatível com o volume a ser administrado, com 264 (80,7%); selecionar adequadamente a agulha para aspiração, com 233 (71,2%), e a agulha para administração, com 320 (97,8%); trocar agulha depois do preparo, com 266 (81,3%); e reconstituir medicação em água destilada, com 327 (100%). Com isso, identificaram-se fragilidades como observar a data de validade do medicamento e identificar a medicação preparada que interferem na segurança da administração de medicamentos na pediatria (AU).

The objective of this study was to analyze work by a nursing team regarding the environmental organization, preparation and dilution of drugs administered intramuscularly in a pediatric setting. This was an observational and quantitative study developed through 327 observations of the preparation of intramuscular medication from December 2014 to May 2015 in a pediatric hospital in Fortaleza, in the state of Ceará. Observations employed a two-stage checklist: organization of the environment with four actions; preparation and dilution of medications with 12 actions. For organization of the environment, performance regarding the action of organizing the bench with a count of 231 (70.6%) was satisfactory. The stage of medication preparation and dilution achieved satisfactory performance in six actions: separation of cotton balls soaked with alcohol from dry ones with 252 (77%); selection of syringe compatible with the volume to be administered with 264 (80.7%); proper selection of the needle for aspiration with 233 (71.2%); needle for administration with 320 (97.8%); change of needle after preparation with 266 (81.3%); reconstitution of medication in distilled water with 327 (100%). This allowed for the identification of weaknesses, such as observing the sell-by date of medications and identifying the medications prepared, actions that interfere with the safe administration of medications in pediatrics (AU).

Se objetivó evaluar la actuación del equipo de Enfermería en la organización del ámbito, la preparación y dilución de medicamentos de administración intramuscular en pediatría. Estudio observacional, desarrollado sobre 327 observaciones de preparación de medicamentos intramusculares, entre diciembre de 2014 y mayo de 2015 en un hospital pediátrico de Fortaleza-Ceará. Se utilizó en las observaciones un check-list integrado por las etapas: organización del ámbito, con cuatro acciones; preparación y dilución de medicamentos, con 12 acciones. En la organización del ámbito se alcanzó desempeño satisfactorio en acción de organización de mesada, con 231 (70,6%). La etapa de preparación y dilución del medicamento obtuvo desempeño satisfactorio en seis acciones: separar trozos de algodón con alcohol y secos, con 252 (77%); elegir jeringa compatible con volumen a administrar, con 264 (80,7%); selección adecuada de aguja para aspiración, con 320 (97,8%); cambiar aguja luego de preparación, con 266 (81,3%); y reconstitución de medicación con agua destilada, con 327 (100%). Así, fueron identificadas debilidades, como observar fecha de vencimiento del medicamento e identificar la medida preparada, que interfieren con la seguridad de administración de medicamentos en pediatría (AU).

Intramuscular injection of human umbilical cord mesenchymal stem cells and its effect on the cardiac function and myocardial ultrastructure in rats with Adriamycin-induced dilated cardiomyopathy rats / 中华实用儿科临床杂志

Objective To explore the effects of intramuscular injection human umbilical cord mesenchymal stem cells(hUCMSC)intramuscular injection on the cardiac function and myocardial ultrastructure in rats with Adria-mycin -induced dilated cardiomyopathy (DCM)rats.Methods One hundred and sixty rats were randomly divided in-to a normal group (20 cases)and DCMgroups (1 40 cases),rats in DCMgroups receiving Adriamycin (2 mg/kg)in-traperitoneally once a week for 8 weeks to establish DCM models.The DCM rats were randomly divided into a model control group (served as model group),the supernatant of hUCMSC group (served as supernatant group),the low -dose hUCMSC group(served as low -dose group),the medial -dose hUCMSC group(served as medial -dose group), and the high -dose hUCMSC group(served as high -dose group).Echocardiography was performed to evaluate the car-diac function,plasma brain natriuretic peptide (BNP)level and serum cardiac troponin I (cTnI)level were detected by enzyme -linked immunosorbent assay kit;light microscope and transmission electron microscopy (TEM)were used to observe the ultrastructure of myocardium.Results Rats in the DCM group showed low spirit,declining food intake, progressive emaciation,slow growth,hair loss and ascites.After the intramuscular injection of hUCMSC,the above symp-toms of rats in the low -dose and the medial -dose hUCMSC groups were improved significantly.Before the administra-tion of hUCMSC,the left ventricular ejection fraction (LVEF)[(64.53 ±2.61 )%]and the left ventricular fractional shortening (LVFS)[(30.80 ±2.1 1 )%]were significantly decreased in the DCMgroup compared to those of the con-trol group[(79.67 ±3.02 )%,(43.08 ±3.1 5 )%,all P <0.01 ].After the administration of hUCMSC,LVEF [(75.5 ±7.4)%,(74.0 ±6.1 )%]and LVFS[(40.8 ±3.8)%,(40.2 ±5.0)%]were significantly increased in the low -dose and the medial -dose group compared with those of the model group [(65.8 ±4.5)%,(30.2 ± 2.9)%,all P <0.01 ].The concentration of plasma BNP level [(438.3 ±82.2)ng/L,(341 .7 ±68.9)ng/L]and serum cTnI level [(375.9 ±1 1 0.9)ng/L,(355.9 ±55.6)ng/L]were significantly decreased compared with those of the model group [(449.9 ±91 .8)ng/L,(425.9 ±42.6)ng/L,all P <0.05].The findings of HE staining showed that cardiomyocytes were orderly arranged,edema decreased and cell nucleus homogeneously stained in the low -dose and the medial -dose group.The outcomes of TEM revealed that the ultrastructure of cardiomyocytes was improved in the low -dose and the medial -dose group compared with that of model group,and the cardiomyocyte sarcolemma re-mained intact,and the swelling of mitochondria ameliorated and the cristae of mitochondria remained clear.Conclusions Intramuscular injection of hUCMSC could significantly increase LVEF and LVFS in the Adriamycin -induced DCM rats,and decrease the plasma BNP levels and the serum cTnI levels,attenuate the myocardial pathological damage and improve myocardial ultrastructure.

Anaphylactic shock caused by intramuscular injection of midazolam during the perioperative period: a case report / 대한마취과학회지

Although anaphylactic shock during the perioperative period is rare, it can be lethal due to severe cardiovascular and respiratory collapse. Midazolam is generally used as premedication for relieving anxiety about the operation, and the danger of anaphylactic shock after intramuscular injection is not widely recognized. We report the first case of anaphylactic shock occurring during the perioperative period after intramuscular injection of midazolam. Since anaphylactic shock after intramuscular injection can be of slow onset, the operation should be delayed if an anaphylactic reaction is suspected, even if the symptoms are limited. In addition, anesthesiologists should be prepared for the occurrence of anaphylaxis at any time in the perioperative period.

Survey of Botulinum Toxin Injections in Anticoagulated Patients: Korean Physiatrists' Preference in Controlling Anticoagulation Profile Prior to Intramuscular Injection

OBJECTIVE: To evaluate Korean physiatrists' practice of performing intramuscular botulinum toxin injection in anticoagulated patients and to assess their preference in controlling the bleeding risk before injection. METHODS: As part of an international collaboration survey study, a questionnaire survey was administered to 100 Korean physiatrists. Physiatrists were asked about their level of experience with botulinum toxin injection, the safe international normalized ratio range in anticoagulated patients undergoing injection, their tendency for injecting into deep muscles, and their experience of bleeding complications. RESULTS: International normalized ratio <2.0 was perceived as an ideal range for performing Botulinum toxin injection by 41% of the respondents. Thirty-six respondents replied that the international normalized ratio should be lowered to sub-therapeutic levels before injection, and 18% of the respondents reported that anticoagulants should be intentionally withheld and discontinued prior to injection. In addition, 20%-30% of the respondents answered that they were uncertain whether they should perform the injection regardless of the international normalized ratio values. About 69% of the respondents replied that they did have any standardized protocols for performing botulinum toxin injection in patients using anticoagulants. Only 1 physiatrist replied that he had encountered a case of compartment syndrome. CONCLUSION: In accordance with the lack of consensus in performing intramuscular botulinum toxin injection in anticoagulated patients, our survey shows a wide range of practices among many Korean physiatrists; they tend to avoid botulinum toxin injection in anticoagulated patients and are uncertain about how to approach these patients. The results of this study emphasize the need for formulating a proper international consensus on botulinum toxin injection management in anticoagulated patients.

Botulinum Toxin A Injection into the Subscapularis Muscle to Treat Intractable Hemiplegic Shoulder Pain

OBJECTIVE: To evaluate the beneficial effect of botulinum toxin A (Botox) injection into the subscapularis muscle on intractable hemiplegic shoulder pain. METHODS: Six stroke patients with intractable hemiplegic shoulder pain were included. Botulinum toxin A was injected into the subscapularis muscle. Intractable hemiplegic shoulder pain was evaluated using an 11-point numerical rating scale. Pain-free range of motion was assessed for shoulder abduction and external rotation. The spasticity of the shoulder internal rotator was measured using the modified Ashworth scale. Assessments were carried out at baseline and at 1, 2, 4, and, if possible, 8 weeks. RESULTS: Intractable hemiplegic shoulder pain was improved (p=0.004) after botulinum toxin injection into the subscapularis muscle. Restricted shoulder abduction (p=0.003), external rotation (p=0.005), and spasticity of the shoulder internal rotator (p=0.005) were also improved. Improved hemiplegic shoulder pain was correlated with improved shoulder abduction (r=–1.0, p<0.001), external rotation (r=–1.0, p<0.001), and spasticity of the internal rotator (r=1.0, p<0.001). CONCLUSION: Botulinum toxin A injection into the subscapularis muscle appears to be valuable in the management of intractable hemiplegic shoulder pain.

Pseudo-Anterior Interosseous Nerve Syndrome by Multiple Intramuscular Injection

Blind intramuscular injection might cause severe neurovascular injury if it would be performed with insufficient knowledge of anatomy around the injection area. We report a case of pseudo-anterior interosseous syndrome caused by multiple intramuscular steroid injections around the antecubital area. The patient had weakness of the 1st to 3rd digits flexion with typical OK sign. Muscle atrophy was noted on the proximal medial forearm, and sensation was intact. The electrophysiologic studies showed anterior interosseous nerve compromise, accompanying with injury of the other muscles innervated by the median nerve proximal to anterior interosseous nerve. Magnetic resonance imaging of the left proximal forearm revealed abnormally increased signal intensity of the pronator teres, flexor carpi radialis, proximal portion of flexor digitorum superficialis, and flexor digitorum profundus innervated by the median nerve on the T2-weighted images. This case shows the importance of knowledge about anatomic structures in considering intramuscular injection.

Diagnóstico situacional do preparo eadministração de imunobiológicos / Situational diagnosis of preparation and administration of immunobiologics / Diagnóstico situacional de preparación y administración de inmunobiológicos

Esta pesquisa objetivou especificar como se caracteriza o preparo e a administração de imunobiológicos por viaintramuscular e descrever as condições ambientais nas quais são realizados esses procedimentos. Trata-se de uma pesquisa descritiva que utilizou observações não participativas registradas em um diário de campo, seguindo um roteiro específico. Foi realizada com sete profissionais de enfermagem, em Vassouras-RJ, em 2009. Os resultados mostram que os profissionais não estão realizando a higienização das mãos e os que a realizam o fazem de forma inadequada; foi evidenciada a não reconstituição cuidadosa dos imunobiológicos e a administração foi realizada da forma mais satisfatória. A maioria das Unidades são casas adaptadas e as salas apresentam um fluxo prejudicado por serem pequenas e utilizadas para execução de outros procedimentos. É fundamental que os enfermeiros mantenham supervisão detalhada do processo de imunização e que realizem ações de educação permanente visando à qualidade no cuidado.

This study aimed to describe specifically the preparation, and administration by intramuscular injection, of immunobiologics, and to describe the environmental conditions where these procedures are performed. This was a descriptive study of seven nursing workers in Vassouras, Rio de Janeiro State, in 2009, using non-participatory observations recorded in a diary, and following a specific script. The results show hand hygiene is either not practiced or only poorly so, immunobiologics were reconstituted without due care, and that administration was performed more satisfactorily. Most facilities are adapted houses where flows are irregular, because rooms are small and are used for other procedures. Itis essential that nurses monitor the immunization process in detail, and undertake continuing education to assure quality of care.

Esta investigación objetivó especificar como se caracteriza la preparación y la administración de inmunobiológicos por via intramuscular y describir las condiciones ambientales en que son ejecutados esos procedimientos. Se trata de una pesquisa descriptiva que usó observaciones no participantes registradas en un diario de campo, conforme una ruta específica. Fue hecha con siete profesionales de enfermería, en Vassouras-RJ-Brasil, en 2009. Los resultados muestran que los profesionales no hacen la higienización de las manos y los que la hacen lo hacen de forma inadecuada; fue evidenciada la no reconstitución cuidadosa de los inmunobiológicos y la administración fue llevada a cabo en la forma más satisfactoria. La mayoría de las Unidades son casas adaptadas y las salas tienen un flujo conturbado porque son pequeñas y utilizadas para otros procedimientos. Es fundamental que los enfermeros mantengan supervisión detallada del proceso de inmunización y que realizen acciones de educación permanente mirando a la calidad en el cuidado.

Eventos adversos pós-vacina dupla adulto em trabalhadores da construção civil / Eventos adversos post vacuna doble adulto en trabajadores de la construcción civil / Adverse events post adult diphtheria-tetanus vaccination on civil construction workers

Estudo longitudinal prospectivo sobre avaliação da ocorrência de reações no sítio de aplicação da vacina dupla adulto contra difteria e tétano (dT) realizado no município de Três Lagoas, MS, no período de setembro a outubro de 2008. Participaram 1291 trabalhadores de uma empresa de construção civil, com idade de 18 a 68 anos, cujas vacinas foram administradas sem antissepsia prévia do local de aplicação. As reações adversas foram avaliadas 48 horas após o procedimento. Diante das avaliações, não se constataram eventos adversos locais pós-vacinação sendo que em apenas dois casos houve relato de linfadenopatia na região axilar. O estudo apresentou evidências que corroboram as recomendações do Ministério da Saúde relativas a essa prática vacinal.

This longitudinal prospective study aimed at assessing the occurrence of reactions to adult diphtheria-tetanus vaccine (dT) in the application site, carried out in Três Lagoas,MS, Brazil between September and October, 2008 Participants totaled 1,291 workers from a civil construction enterprise aged between 18 and 68, who were vaccinated without previous skin antisepsis of the application site. Adverse reactions were evaluated 48 hours after the procedure. The assessment did not show adverse events on the site after vaccination, and only two cases were reported for lymphadenopathy in the axillary region. The study presented evidence that support the recommendations of the Ministry of Health related to this vaccination practice.

Estudio longitudinal prospectivo que objetivó evaluar la ocurrencia de reacciones en el sitio de aplicación de la vacuna doble adulto (dT), realizado en la ciudad de Três Lagoas, MS, Brasil, entre setiembre y octubre de 2008. Participaron 1291 trabajadores de una empresa de construcción civil, con edad entre 18 y 68 años, cuyas vacunas fueron aplicadas sin antisepsia previa del sitio de aplicación. Las reacciones adversas fueron evaluadas 48 horas después del procedimiento. Ante las evaluaciones, no se constataron eventos adversos locales post-vacunación, siendo que solo en dos casos hubo relato de linfadenopatía en la región axilar. El estudio presentó evidencias que corroboran las recomendaciones del Ministerio de la Salud relativas a esa práctica de vacunación.