Intramuscular Injection Notes

Medication Administration and Checks

  • Avoid distractions and interruptions during medication preparation.
  • Triple Check: Verify the medication label against the order three times.
    • First check: When retrieving the medication.
    • Second check: After drawing up the medication.
    • Third check: At the patient's bedside before administration.
  • Check the medication expiration date when retrieving it.
  • Administer the medication at the correct time, following agency policy.
  • Give time-critical medications (stat and now doses) at the exact specified time.

Patient Identification and Assessment

  • Perform hand hygiene and ensure patient privacy.
  • Introduce yourself to the patient.
  • Identify the patient using two identifiers (e.g., name and date of birth).
  • Inquire about any allergies.

Bedside Verification and Patient Education

  • Access the electronic Medication Administration Record (MAR) at the bedside.
  • Compare the medication label with the MAR (third check).
  • Explain to the patient:
    • Why they are receiving the medication.
    • What the medication does.
    • Potential side effects.
  • Encourage the patient to ask questions.

Injection Site Selection and Preparation

  • Caution the patient about potential stinging or burning sensations during the injection.
  • Select an appropriate injection site:
    • Acceptable sites: vastus lateralis, deltoid muscle, and ventrogluteal (preferred).
  • Examine the patient's muscle mass and palpate the muscle.
  • Avoid areas of tenderness or hardness.
  • Site Rotation: If the patient receives frequent injections, rotate the injection sites.
  • Inspect the area for bruising, inflammation, and edema.
  • If the skin is bruised or shows signs of infection, use a different site.
  • Help the patient find a comfortable position that will accommodate the chosen injection site.
  • Expose only the portion of the body where the injection will be administered.

Locating Ventrogluteal Site

  • Apply clean gloves.
  • Use anatomical landmarks to locate the ventrogluteal site:
    • Place the heel of your hand over the greater trochanter of the patient's hip with the wrist almost perpendicular to the femur.
    • Point the thumb toward the patient's groin.
    • Point the index finger to the anterior superior iliac spine.
    • Extend the middle finger back along the iliac crest toward the buttock.
    • The index finger, middle finger, and iliac crest form a V-shaped triangle.
    • The injection site is the center of this triangle.
  • Mark the site with an unopened alcohol wipe if needed.

Cleansing the Injection Site

  • Clean the injection site:
    • Begin at the center and move outward
    • At least 5 centimeters (or 2 inches) in a circular pattern.
  • Administer anesthetic:
    • Apply an anesthetic cream (e.g., EMLA) about one hour before injection or,
    • Use a vapor coolant spray (e.g., ethyl chloride) just before giving the injection.
  • Hold a gauze pad between the third and fourth fingers of your non-dominant hand.
  • Remove the needle cap or sheath by pulling it straight off.

Administering the Injection

  • Hold the syringe with the thumb and forefinger of your dominant hand like a dart.
  • Remind the patient to relax.
  • Pull the patient's skin laterally about 2.5 to 3.5 centimeters (one to one and a half inches) using the ulnar side of your non-dominant hand just below the injection site. Hold this position until the needle is inserted.
  • If the patient has little muscle mass, grasp the body of the muscle between your thumb and forefinger.
  • Quickly pierce the muscle at a 90-degree angle to the skin with your dominant hand.
  • Stabilize the syringe by grasping the lower end of the barrel with the fingers of the non-dominant hand.
  • Attempt to aspirate by pulling back on the plunger with your dominant hand.
    • If blood appears, you are not in the muscle. Remove and discard the needle and syringe, then start over.
    • If no blood appears, proceed to inject the medication.
  • Inject the medication slowly at a rate of 1 milliliter every 10 seconds.
  • Wait 10 seconds and smoothly withdraw the needle.
  • Engage the needle safety mechanism.
  • Release the skin and place a gauze pad over the injection site.
  • Apply gentle pressure, but do not massage the area.
  • Apply a bandage to the puncture site if necessary.
  • Discard the needle and attached syringe in a puncture-proof, leak-proof container.
  • Help the patient into a comfortable position.
  • Discard the used gauze.
  • Remove your gloves and perform hand hygiene.

Documentation and Follow-Up

  • Immediately document the injection in the MAR:
    • Medication name
    • Dose given
    • Injection site
  • Follow-up care:
    • Remain with the patient for several minutes to watch for signs of an allergic reaction.
    • Return to the patient's room in 15 to 30 minutes to check for any acute reaction at the injection site.

Intramuscular Injection Sites

  • Four basic types of IM injection sites:
    • Deltoid
    • Vastus Lateralis
    • Dorsal gluteal (not used anymore)
    • Ventrogluteal

Deltoid

  • Locate the acromion process (shoulder bone).
  • Measure a few finger widths below the acromion process.
  • The injection site is in the triangle-shaped muscle a few inches down from the acromion process.

Vastus Lateralis

  • Located on the thigh, between the knee and hip.
  • Use the middle section of the thigh where there is a large, meaty portion.
  • Reserved for high-volume IM injections.
  • Preferred site for children because their other muscles are not well developed.

Dorsal Gluteal (Not Recommended)

  • Located by drawing a line from the bony prominence to the hip to end of the spine.
  • Not used anymore due to the risk of hitting the sciatic nerve.

Ventrogluteal

  • Triangle can be drawn to find muscle.

Common Reasons for IM Injections

  • Vaccines
  • Hormone injections
  • Certain antibiotics
  • Steroids

Injection Volume

  • Typical volume: 1 mL to maximum of 3 mL.
  • Above 1 mL, consider splitting the dose into two injections based on patient's muscle mass.

Needle Sizes

  • Needle size (gauge and length) is indicated on the package.
  • IM injection needles typically have a blue hub.
    • Example: 1-inch, 22-gauge needle
  • Heparin needles often have orange or brown caps.
  • Needle gauge and length vary based on the medication and injection site.
    • Green hub: 20 gauge, 1.5 inches long.
    • Pink hub: 18 gauge, 1.5 inches long (for thicker injections).