OBJECTIVE STRUCTURED ASSESSMENTS OF TECHNICAL SKILL (OSAT)
INTRAMUSCULAR INJECTION
(DELTOID MUSCLE)
S.L. CHECK POINTS Y/N
1.
Check materials in the tray
Drug to be administered in a labeled vial or ampoule
Medication syringe with sterile 22-25 gauge long & medium thickness
needle
Nonsterile gloves
Alcohol swab
Sterile gauze
Adhesive tape
2.
Communication with the patient
Introduce his/herself
Ask name of the patient
Describe the procedure to patient in vernacular
Ask patient about allergies or reactions to specific agents or medications
in the past
Allay patient’s apprehension
3.
Safety concerns
Check patient details
Check prescription & ensure that the drug name, strength and dosage
form match with that on prescription
Check the drug label for date of expiry
4.
Privacy consideration of the patient
Draw bedside curtains
5.
Draws up drug to be injected from AMPOULE into syringe:
o Wash hands properly with soap and water
o Take out syringe and needle from disposable pack taking care not to touch
naked end of the syringe
o Put the needle on the syringe
o Remove the liquid from the neck of the ampoule by flicking or tapping it
o File around the neck of the ampoule
o Carefully break off the top of the ampoule (for a plastic ampoule twist the
top). Protect your fingers with gauze (if ampoule is made of glass)
o Remove protective cover of the needle (after removing protective cover, do
not touch anything with unprotected needle)
o Aspirate the fluid from the ampoule
o Remove any air from the syringe
o Cover the needle again with the protective cover
Draws up drug to be injected from VIAL into syringe:
o Wash hands properly with soap and water
o Take out syringe and needle from disposable pack taking care not to touch
naked end of the syringe. Use a syringe with a volume of twice the required
amount of drug or solution.
o Put the needle on the syringe
o Remove protective covering from vial cap. Disinfect the top of the vial with a
cotton swab soaked in disinfectant.
o Remove protective cover of the needle (after removing protective cover, do
not touch anything with unprotected needle)
o Suck up as much air as the amount of solution needed to aspirate
o Insert needle into vial through rubber cap and turn upside down
o Pump air into vial
o Aspirate the required amount of solution and 0.1 mL extra. Make sure the
tip of the needle is below the fluid surface.
o Pull the needle out of the vial
o Remove any air from the syringe
o Cover the needle again with the protective cover
Draws up drug to be injected after dissolving dry powder in vial into syringe:
Wash hands properly with soap and water
Take out syringe and needle from disposable pack taking care not to
touch naked end of the syringe.
Put the needle on the syringe
Aspirant solvent into syringe from the ampoule
Remove protective covering from cap of vial. Disinfect the rubber cap
(top) of the vial containing the dry medicine
Insert the needle into the vial, hold the whole upright
Suck up as much air as the amount of solvent already in the syringe
Inject only the fluid into the vial (NOT THE AIR)
Shake well and turn the vial upside-down
Inject the AIR into the vial
Aspirate the total amount of solution (NO AIR)
Remove any air from the syringe
Cover the needle again with the protective cover
6. Identification of area for needle insertion
The patient may be positioned sitting/ standing/ supine
Uncover lateral upper arm (Deltoid muscle). Avoid atrophied or emaciated
muscle. At the site of injection, there should be no necrosis or abrasions.
Locate the site about two-three finger breadths below the acromion
process on the lateral midline of the arm
7. Preparation of site of the injection
Wash hands properly with soap and water
& wear gloves
Reassure the patient and explain the procedure.
Gently tap the site to stimulate nerve endings and minimize pain
Clean the site using alcohol swab in firm circular motion
Allow the site to dry
8. Process of Intramuscular injection
Tell the patient to relax the muscle.
Take the syringe in your dominant hand, remove the needle cover with
the free fingers of the other hand
With the thumb and index finger of the non-dominant hand, gently stretch
the skin
Insert the needle swiftly at an angle of 90 degrees
Using the non-dominant hand to steady the syringe, pull back slightly on
the plunger to aspirate for blood (If blood appears, withdraw needle, replace it
with a new one and inject at another site). If no blood appears, inject the
medication slowly and steadily using the dominant hand.
After complete administration, gently but quickly remove the needle at the
same 90-degree angle
Apply gentle pressure to the site with the used alcohol swab using any one
gloved hand. No need to massage (unless a large volume has been
injected). In case any blood oozes, pat with a dry sterile gauge piece
Once the injection has been given take care not to prick yourself or
somebody else. Carefully place the cap back on the needle and discard the
syringe in dustbin for sharp waste
Remove & discard the gloves, perform hand hygiene
Communicate to the patient about completion of the procedure
Evaluate the patient for any side-effects
Time to perform procedure in ___________ seconds.
Number of attempts (needle sticks) required to perform _____________
Exceeds expectations Meets expectations Below expectations (NEEDS
(PROFICIENT) (COMPETENT) FURTHER WORK)
COMMENTS
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