05/03/2025, 20:57 💬 2 - Intramuscular Injection (IM) - OSCE Guide | IM Injection | Geeky Medics
Intramuscular Injection (IM) – OSCE Guide
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Gather equipment
Gather the appropriate equipment:
Non-sterile gloves
Apron
Equipment tray
Syringe (the smallest syringe that will accommodate the medication volume)
Injecting needle (21–23 gauge): a standard length is 25mm.
Drawing-up needle (also known as a blunt filter needle): filters out sub-visible
particles of glass, rubber and other residues when drawing up medications from
ampoules.
Alcohol wipe (70% isopropyl)
Gauze or cotton swab
Sharps container
The medication to be administered
The patient’s prescription
Introduction
Wash your hands and don PPE if appropriate.
Briefly explain what the procedure will involve using patient-friendly language: “Today I
need to administer some medication, this will involve an injection into your muscle. You
may briefly experience a sharp scratch as the needle is inserted. The procedure does
involve some risks which include bleeding, bruising, a persistent lump at the injection site
and a small chance of infection or serious allergic reaction.”
Check the patient’s understanding of the medication being administered and explain
the indication for the treatment.
Gain consent to proceed with the intramuscular injection.
Check for any contraindications to performing an intramuscular injection:
Bleeding disorders (e.g. haemophilia)
Anticoagulant use (e.g. warfarin, apixaban)
Check if the patient has any allergies.
Ask if the patient has a preferred injection site. If the patient is receiving regular
intramuscular injections, ensure that the injection sites are rotated.
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Adequately expose the planned injection site for the procedure (e.g. deltoid).
Position the patient so that they are sitting comfortably.
Ask the patient if they have any pain before continuing with the clinical procedure.
Performing the intramuscular injection
1. Wash your hands and don some gloves and an apron (if not already done).
2. Draw-up the appropriate medication into the syringe using a drawing-up needle.
3. Remove the drawing-up needle and immediately dispose of it into a sharps bin, then
attach the needle to be used for performing the injection.
4. Choose an appropriate site for the injection such as:
Deltoid
Ventrogluteal
Vastus lateralis
Do NOT use a site that is scarred, inflamed, irritated or bruised.
If multiple injections need to be administered, use different sites for each subsequent
injection. If frequent injections are administered, rotate injection sites.
5. Position the patient to provide optimal access to your chosen site.
6. Cleaning the site:
When administering a vaccination, the site does not need to be routinely cleaned
prior to injection unless the skin is visibly soiled (in which case you would need to
clean the site with soap and water). 1
There is some debate as to whether the skin should be cleaned with an alcohol
wipe prior to administration of intramuscular medication, with WHO stating that
cleaning is likely unnecessary. Many hospitals, however, still recommend routinely
cleaning with an alcohol wipe to reduce the risk of hospital-acquired infections, so
you should adhere to your local medical school and hospital guidelines.
7. Gently place traction on the skin with your non-dominant hand away from the injection
site, continuing the traction until the needle has been removed from the skin. This
application and subsequent removal of traction is known as the ‘Z-track technique’ and
helps to keep the administered medication within the muscle. When the traction applied to
the skin is released, the alignment of the subcutaneous and muscle layers shifts, locking
the medication into the muscle layer.
If the patient is elderly with reduced muscle mass or the patient is emaciated, do not
apply traction, instead, bunch the muscle up to ensure adequate bulk before injecting.
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8. Warn the patient of a sharp scratch.
9. Holding the syringe like a dart in your dominant hand, pierce the skin at a 75-90° angle.
Insert the needle quickly and firmly, with the bevel facing upwards, leaving approximately
one-third of the shaft exposed (however this varies between sites and patients).
10. Aspirate to ensure the needle is not placed within a blood vessel:
If blood appears, remove the syringe and prepare a new injection (explaining the
reason for this to the patient).
It is recommended that you aspirate before performing deep intramuscular
injections, such as those involving medications, as they are associated with a higher
risk intravascular administration.
If administering a vaccination via a shallow intramuscular injection, UK guidance
suggests there is no need to aspirate prior to injection of the vaccine. 3
11. If aspiration does not reveal evidence of intravascular needle placement, inject the
contents of the syringe whilst holding the barrel firmly. Inject the medication slowly at a
rate of approximately 1ml every 10 seconds.
12. Remove the needle and immediately dispose of it into a sharps container.
13. Release the traction you were applying to the skin, locking the medication into the
muscle layer (Z-track technique).
14. Apply gentle pressure over the injection site with a cotton swab or gauze and avoid
rubbing the site.
15. Replace the gauze with a plaster.
16. Dispose of your used clinical equipment into an appropriate clinical waste bin.
Palpate to identify the appropriate site for injection
Clean the site using an alcohol swab (this is not required for vaccines/medication
given via shallow IM injection)
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Aspirate the syringe to ensure the needle is not located within a vessel (not required
for shallow IM injections)
Inject the contents of the syringe slowly at a rate of 1ml per 10 seconds
Remove the needle
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Release the traction
To complete the procedure…
Discuss post-injection care:
Warn the patient that it is normal for the injection site to be sore for one or two days.
Advise that if they experience worsening pain after 48 hours they should seek
medical review.
Reiterate the potential complications of intramuscular injections including
haematoma formation, persistent nodules, local irritation and rarely anaphylaxis.
Dispose of PPE appropriately and wash your hands.
Document the details of the procedure and the medication administered.
Injection sites
Below is a brief overview of the common sites used for intramuscular injections.
Deltoid site
The deltoid muscle is relatively easy to locate and access, making it an ideal site for
intramuscular injections. The deltoid site is most commonly used for the administration of
small volume intramuscular injections such as vaccines.
Procedure
1. Position the patient sitting on a chair with their arm relaxed.
2. Expose the patient’s upper arm and shoulder.
3. Palpate the lower edge of the acromial process and administer the intramuscular
injection approximately 2.5cm below this.
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Deltoid intramuscular injection site 5
Ventrogluteal site
The ventrogluteal site provides access to the gluteus medius and minimus muscles whilst
avoiding nerves and blood vessels, making it an ideal candidate for most intramuscular
injections including those involving higher volumes of medication.
Procedure
1. The patient can be positioned prone, semi-prone or supine for this procedure, so
choose whichever is most comfortable for the patient.
2. Place the palm of your hand over the greater trochanter of the patient’s hip, with your
thumb pointing anteriorly.
3. Extend your index finger to touch the anterior superior iliac crest and point your middle
finger towards the iliac crest to form a V-shape.
4. Insert the needle between your index and middle fingers (i.e. within the V-shape).
Ventrogluteal intramuscular injection site 5
Vastus lateralis site
The vastus lateralis muscle is relatively easy to locate and access making it an ideal site
for intramuscular injections. The vastus lateralis site is most commonly used for
immunisations in infants up to the age of 7 months. Patient’s at risk of anaphylaxis are
also often taught to use this site for administering adrenaline intramuscular injections (i.e.
Epipen).
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Procedure
1. To locate the site, divide the front thigh into thirds vertically and horizontally to make six
squares and inject into the outer middle square. 4
Vastus lateralis intramuscular injection site 6
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