ALERT

 Do not use an injection site in an area with bruising, induration, muscular

atrophy, reduced blood flow, or signs of infection.
 Intramuscular (IM) injections have been associated with adverse effects of
and pain; use this route of medication injection as a last resort. Consider
contacting the practitioner for an alternative, preferred route of medication
administration.
 Take steps to eliminate interruptions and distractions during medication
preparation.
 If the patient expresses concern regarding accuracy of a medication, do
not give the medication. Explore the patient’s concern, notify the
practitioner, and verify the order.

1. When you administer an intramuscular injection or give any agent, remember to

prepare medications for only one patient at a time.
2. Use aseptic technique. Avoid distractions and interruptions.
3. Check the medication label twice against the order in the medication
administration record (MAR). Be sure to check the medication expiration date
when you retrieve the medication.
4. Gather the necessary equipment and supplies.
5. Take the medication to the patient at the correct time following the six rights of
medication safety, according to your agency’s policy. Give time-critical
medications, such as “stat” and “now” doses, at the exact time specified in the
order.
6. Provide for the patient’s privacy.
7. Perform hand hygiene.
8. Introduce yourself to the patient and family, if present.
9. Identify the patient using two identifiers according to agency policy. Compare this
information to the MAR or medical record. Ask the patient if he or she has any
allergies.
10. Access the electronic MAR again. At the patient's bedside, again compare the
MAR or computer printout with the names of the medications on the medication
labels and with the patient's name. This is your third check.
11. Explain the procedure to the patient and ensure that he or she agrees to
treatment. Discuss the purpose of each medication with the patient, including its
action and possible adverse effects. Allow the patient to ask questions. Tell the
patient that the injection may cause a slight stinging or burning sensation.
12. Select an appropriate injection site. The vastus lateralis and deltoid muscles are
possible sites for an intramuscular injection. The ventrogluteal site is preferred.
Note the integrity and size of the patient's muscle. Palpate for tenderness or
hardness, and avoid such areas. If the patient receives frequent injections, rotate
the site selection.
13. Inspect the area for bruising, inflammation, or edema. If the skin is bruised or
shows signs of infection, use a different site.
14. Help the patient into a comfortable position, according to the site being used.
Expose only that portion of the body.
15. Apply clean gloves. Use anatomical landmarks to find the site again. The
dorsogluteal site is not recommended because of proximity to the sciatic nerve.
16. For a ventrogluteal injection:
a. Place the heel of your hand over the greater trochanter of the patient's hip
with the wrist almost perpendicular to the femur.
b. Point the thumb toward the patient's groin.
c. Point the index finger to the anterior superior iliac spine.
d. Extend the middle finger back along the iliac crest toward the buttocks.
e. The index finger, middle finger, and iliac crest form a V shaped triangle.
The injection site is the center of the triangle.
f. Once you locate the site, it may help to mark it with an unopened alcohol
wipe.
17. Cleanse the site with an antiseptic swab. Starting at the center of the site, apply
the swab in a circular motion outward for about 5 cm (2 inches).
a. Optional: Apply EMLA (eutectic mixture of local anesthetics) cream to the
injection site about 1 hour before the intramuscular injection, or if you use
a vapocoolant spray, such as ethyl chloride, spray it on the site just before
giving the injection.
18. Hold a gauze pad between the third and fourth fingers of your nondominant
hand.
19. Remove the needle cap or protective sheath by pulling it straight off.
20. Hold the syringe between the thumb and forefinger of your dominant hand, as
though you were holding a dart.
21. Remind your patient to try and relax.
22. Administer the injection:
a. Position the ulnar side of your nondominant hand just below the injection
site, and pull the patient's skin laterally 2.5 to 3.5 cm (about 1 to 1½
inches). Hold this position until you have inserted the needle.
b. If the patient has little muscle mass, grasp the body of the muscle
between your thumb and forefinger.
c. With your dominant hand, inject the needle quickly into the muscle at a 90-
degree angle using a steady and smooth motion.
d. After the needle has pierced the muscle, continue to pull the skin taught
with your nondominant hand. Stabilize the syringe by grasping the lower
end of the barrel with the fingers of your nondominant hand as they are
resting on the patient.
e. Aspiration is not necessary, but if it is performed and blood appears in the
syringe, remove the needle and discard the medication. Obtain a new
syringe and try again.
f. Inject the medication.
g. Wait 10 seconds, and then quickly, smoothly, and steadily withdraw the
needle. Engage the needle safety sheath. Release the skin, and apply a
dry cotton ball or gauze pad with light pressure for several seconds over
the site.
 23. Apply gentle pressure. Do not massage the site. Apply a bandage to the injection
site if needed.
24. Discard the needle and its attached syringe in a puncture-proof, leak-proof
container.
25. Help the patient into a comfortable position. Dispose of used gauze. Remove
your gloves, and perform hand hygiene.
26. Document the injection immediately in the MAR. Include the medication name,
the dosage given, and the site in which it was injected.
27. As part of your follow-up care, stay with the patient for several minutes,
observing for any allergic reaction.
28. Place toiletries and personal items within reach.
29. Place the call light within easy reach, and make sure the patient knows how to
use it to summon assistance.
30. To ensure the patient's safety, raise the appropriate number of side rails and
lower the bed to the lowest position.
31. Leave the patient's room tidy.
32. Return to the patient's room in 15 to 30 minutes to see if he or she has had any
acute reaction at the injection site.

What are the steps to administering an

intramuscular injection?
There are several priority actions to take before, during, and after administering drugs
intramuscularly.

Select each tab to learn more.

 Before
o Help the patient into a comfortable position that is appropriate for the site
being used.
o Select the injection site by identifying the correct anatomic landmarks.
o Wash your hands and be sure to wear clean gloves.
o Cleanse the injection site.
 During
o Insert needle firmly into muscle at a 90-degree angle.
o Aspirate syringe to ensure needle is not in a vein.
 Not recommended for vaccines or immunizations
 May be indicated for drug such as penicillin
o If the needle is in a vein, blood will appear in the syringe.
 Remove the needle and discard the drug.
 Get a new dose, sterile needle, and syringe.
 Prepare to inject in another site.
 o Once needle is not in a blood vessel, inject drug at a rate of 1 mL per 10
seconds.
o Remove needle.
The Z-track method may also be used for drugs that:
o Irritate subcutaneous tissue
o May permanently stain tissues (Fig. 2.14)
Steps include:
o Draw 0.1 to 0.2 mL of air into syringe after drug.
 Air follows drug into muscle and prevents oozing through needle.
o Wash hands and don clean gloves.
o Select and cleanse site.
o Pull tissue laterally and hold.
o Insert needle into the muscle and inject drug.
o Release tissue while removing needle (allows skin to slide over injection,
sealing drug in the muscle).

Fig. 2.14 Z-track intramuscular injection. (A) Displace the tissue downward, away
from the injection site. (B) Inject while holding the tissue away. (C) Allow the
displaced tissue to move back into place.

 After
o Apply pressure after removing the needle to prevent bleeding.
o Document the drug administration, including the injection site.
 o Check the patient for adverse effects, side effects, and expected effects of
the drug, and document findings.

Alert
With the Z-tract IM injection, draw up 0.1 to 0.2 mL of air after drawing up the drug.
Injection of air keeps the drug in the muscle, and the drug does not ooze through the
path of the needle.