ADMINISTERING IM INJECTION

DEFINITION

A form of parenteral administration of medication, where a drug is injected

into a deep muscle tissues.

Purpose : to obtain a quick effect of medicine,than obtain by oral /

subcutaneous administration, assure that the total dosage will be
administered & the same will be absorbed for the systemic action of the drug.
The medicine not suitable for IV administration.

Sites of IM injection.

Deltoid : Locate the lower edge of the acromion process and form a rectangle.
Or by keeping the three fingers of our hand on the upper part of deltoid
muscle ( Index finger on the acromion process) and widely separate the forth
finger . the space between the third &forth finger will be site of injection. The
deltoid area is used to inject very small quantities of non irritating drug.

Dorsogluteal site : It is located in the inner, outer angle of the upper outer
quadrent of the buttocks, approximately 5-8 cm below the iliac crest.The
patient may lie in a prone / side lying position with upper leg flexed at the
hip& knee. To locate the site palpate the posterior superior iliac spine and the
greater trochanter of the femur. An imaginary line is drawn between the two
land marks. The injection site is above & lateral to the line. The siatic nerve
runs parrell & below the line. This site is used for adults & Children over 3
years with well-developed gluteal muscle.

Vastus lateralis:This muscle is thick & well developed &is preferred for giving
injection to adults ,infant & children. The muscle is located on the anterior,
Lateral aspect of thigh & extends in adults from 4-5 fingers below the greater
trochanter of the femur to 4-5 fingers above the Knee. Middle part of the
muscle is the best site for the injection. It can be given in supine position with
knee flexed or in a sitting position to relax the muscle.
 Ventroglutial site: This muscle involves the glutial medius& minimus. Locate
the muscle by placing hand over the greater trochanter of the patient hip. The
right hand is used for the left hip And wiseversa.Place the intex finger over the
anterior superior iliac spine& extend the middle finger along the iliac crest
towords the buttocks. Index finger , middle finger & the iliac creast form a V
shaped triangle and the injection site is its center.

Indication: to obtain a quick effect of medicine, than obtain by oral /

subcutaneous administration, assure that the total dosage will be administered &
the same will be absorbed for the systemic action of the drug. The medicine not
suitable for IV administration.

Contra Indications : Infection of site of Injection,burns, cellulitis,Nerve injury,

Sterile abscesses,

ARTICLES
A tray containing:
Medication card,Medicine,Syringes and needles of appropriate size,Alcohol
swab,Clean gloves,Kidney tray
PROCEDURE
NURSING ACTION RATIONALE
Check physicians order and identify pt. Prevents errors in medication
administration.
Explain procedure to patient the purpose Reduces anxiety and encourages
of medication, the site of cooperation.
injection ,expected effect and how he has
to cooperate
Wash hands Reduces spread of microorganism
Prepare medication from ampoule/vial. Reduces spread of microorganism
Wash hands and don gloves.

Position patient: Assist patient to a Proper positioning ensures muscle

supine , lateral or prone position relaxation of pt.
depending on site chosen.if ventrogluteal,
have patient in supine position with knees
flexed or lateral position with upper leg
flexed or prone with toe in position
Select , locate and clean site:
a. Select a site free of skin lesions,
tenderness, swelling, hardness, localized
inflammation and one that has not been
frequently used.
b. Determine whether size of muscle is
adequate for amount of medication to be
injected.
c. Locate exact site for injection.
d. Don gloves.
e. Clean with alcohol swab in circular
motion moving from centre to periphery.
f.Transfer and hold swab between 3rd and
4th finger of non-dominant hand. Allow site
to dry
Select , locate and clean site:
a. Select a site free of skin lesions ,
tenderness, swelling, hardness, localized
inflammation and one that has not been
frequently used.
b. Determine whether size of muscle is An average adults deltoid muscle can
adequate for amount of medication to be absorb 0.5-1ml. Gluteal muscle can absorb
injected. 1-4ml
c. Locate exact site for injection.
d. Don gloves.
e. Clean with alcohol swab in circular
motion moving from centre to periphery.
f. Transfer and hold swab between 3rd and Cotton swab is kept in readiness for
4th finger of non dominant hand. Allow site removal of needle
to dry
Remove needle cover without Reduces risk of accidental needle prick.
contaminating the needle by pulling
straight off.
Confirm that medication and dosage are To avoid medication error
correct.
Ensure that medication is not dripping on Medication on outside of needle can cause
needle prior to injection. If it is dripping pain and irritation of subcutaneous tissue
change needle. when it passes into the muscle.
Inject the medication:
a. Grasp and pinch the area surrounding Provides easy and less painful entry into
the injection site or spread skin at site as muscle.
appropriate.
b.Hold the syringe between the thumb and
forefinger in a pen holding manner and
pierce skin at site at a 90 degree angle and
insert the needle.
c.Aspirate by holding the barrel steady Aspiration helps in checking if needle is in
with non dominant hand and pulling back blood vessel
the plunger with non dominant hand.

d.Withdraw needle if blood appears in the

syringe, discard and prepare new injection.

e.Inject the medication slowly and steadily Injecting medication slowly helps the
if blood does not appear in the syringe on dispersal of medication into muscle tissue
aspiration. thus decreasing pts discomfort.
Holding syringe steadily minimizes
discomfort
Z track technique:
a.Pull skin to one side downward or This leaves a zig zag path that seals the
laterally about an inch using non needle track wherever tissue planes slide
dominant hand. across each other. Drug cannot escape
from the muscle tissue.
b.Inject medication with airlock at 90
degree angle.

c.Hold needle in place for 10 sec.

d.Withdraw the needle slowly and steadily Supporting the skin surface with the cotton
while supporting at the hub of syringe and swab helps to reduce discomfort. Applying
needle. With non dominant hand, suppot counter traction prevents pulling of tissues
the skin surface using the cotton swab for when needle is withdrawn.
applying counter traction at the site.

Apply gentle pressure at the site with a dry Massaging may irritate tissues at the
sponge and if bleeding is present, continue injection site.
applying pressure till bleeding stops.Do not
Massage.
Record in nurses note Recording& reporting is mandatory
After Care :Discard the uncapped needle
and syringe into appropriate receptacle.
Remove gloves, wash hands.Remove
procedure including the name of
medication, dose, sites&response of pt.

Assess effectiveness of medication. For Further steps.

.
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Special points:
1.Maximum volume to be administered in a single site is 1ml
for older infants and small children.
2.Avoid tracking any medication through superficial tissues.