Definition
Intramuscular injection, often abbreviated as IM, is the administering of medication directly into the deep muscle tissue.
Articles
A tray containing:
- Medication card.
- Sterile medication (in ampoule/vial).
- Syringes and needles of appropriate size.
- Alcohol swabs.
- Clean gloves.
- Kidney tray.
Procedure
| Nursing action | Rationale | |
| 1. | Before procedure. Check physician’s order and identify patient. | Prevents errors in medication administration. |
| 2. | Explain procedure to patient, the purpose of medication, the site of injection, expected effect and how he has to cooperate. | Reduces anxiety and encourages cooperation. |
| 3. | During procedure Wash hands. | Reduces spread of microorganisms. |
| 4. | Prepare medication from ampoule/vial. | |
| 5. | Wash hands and don gloves. | Reduces spread of microorganisms. |
| 6. | Position patient. Assist patient to a supine, lateral or prone position depending on site chosen. If ventrogluteal, have patient in supine position with knees fixed or lateral position with upper leg flexed or prone with “toe in position. | Proper positioning ensures muscle relaxation of patient. |
| 7. | Select, locate and clean site: Select a site free of skin lesions, tenderness, swelling, hardness, localized inflammation and one that has not been frequently used. | |
| Determine whether size of muscle is adequate for amount of medication to be injected. | An average adult’s deltoid muscle can absorb 0.5-1 ml, and gluteal muscle can absorb 1-4 ml. | |
| Locate the exact site for injection. | ||
| Don gloves. | ||
| Clean with alcohol swab in circular motion moving from center to periphery-moving outward up to 5 cm. | ||
| Transfer and hold swab between 3rd and 4th finger of non-dominant hand or place in tray. Allow site to dry. | Cotton swab is kept in readiness for removal of needle. | |
| 8. | Remove needle cover without contaminating the needle by pulling straight off. | Reduces risk of accidental needle prick. |
| 9. | Confirm that medication and dosage are correct. | |
| 10. | Ensure that medication is not dripping on needle prior to injection, if it is dripping, change needle. | Medication on the outside of needle can cause pain and irritation of subcutaneous tissue when it passes into the muscle. |
| Hold syringe upright and tap to remove any air bubble trapped. | Prevents risk of air bubble entering the blood circulation. | |
| Push medicine up till the tip of the syringe where the needle hub rests. | ||
| 11. | Inject the medication Grasp and pinch the area surrounding the injection site or spread skin at site as appropriate. | Provides easy and less painful entry into muscle. |
| Hold the syringe between the thumb and forefinger in a pen holding manner and pierce skin at site at a 90° angle and insert the needle. | Grasping and pinching the area aids needle penetration in patient with thick muscle. | |
| Aspirate by holding the barrel steady with non-dominant hand and pulling back the plunger with your dominant hand. | Aspiration helps in checking if needle is in a blood vessel. | |
| Withdraw needle if blood appears in the syringe; discard and prepare new injection. | ||
| Inject the medication slowly and steadily if blood does not appear in the syringe on aspiration. | Injecting medication slowly helps the dispersal of medication into muscle tissue thus decreasing patient’s discomfort. Holding syringe steadily minimizes discomfort. | |
| 12. | Intramuscular injection site recommended for infants is vastus lateralis muscle. For older children, ventrogluteal or Dorso gluteal muscles are preferred. Deltoid muscle to be avoided as it may be insufficiently developed. | |
| 13. | Z-track technique a. Pull skin to one side, downward or laterally about an inch using non-dominant hand. | Allows medication to disperse evenly. |
| b. Inject medication with airlock at 90°angle. | This leaves a zig zag path that seals the needle track wherever tissue planes slide across each other. | |
| c. Hold needle in place. | Drug cannot escape from the muscle tissue. | |
| d. Withdraw the needle and release the skin. | ||
| 14. | Withdraw the needle slowly and steadily while supporting at the hub of syringe and needle. With non-dominant hand, support the skin surface using the cotton swab for applying counter traction at the site. | Supporting the skin surface with the cotton swab helps to reduce discomfort. Applying counter traction presents pulling of tissues when needle is withdrawn. |
| 15. | Apply gentle pressure at the site with a dry sponge and if bleeding is present, continue applying pressure till bleeding stops. Do not massage. | Massaging may irritate at the injection site. |
| 16. | After procedure Discard the uncapped needle and syringe into appropriate receptacle. | |
| 17. | Remove gloves, wash hands. | |
| 18. | Record procedure including the name of medication, dose, site and response of the patient. | Reduces chances of medication error. |
| 19. | Assess effectiveness of medication. |
Special Consideration
- For newborns, infants, and small children, the recommended site for intramuscular injection is the vastus lateralis.
Paediatric Variations
- A syringe that can measure very small amounts of solution, such as 0.5 ml syringe for less than 0.5 mL medication or a tuberculin syringe should be selected.
- The needle length should be sufficient to penetrate the subcutaneous tissue and deposit the medication in the muscle.
- The needle gauge should be small to deliver the fluid safely, e.g. 25-30 gauge.
- If the muscle is grasped or bunched, the needle length recommended for insertion is 25 mm. If muscle is stretched or flattened, a needle length of 16 mm is recommended.
Special Points
- Maximum volume to be administered in a single site is 1 ml for older infants and small children.
- If the medication has been drawn from a vial, use a new needle to inject into muscle.
- Avoid tracking any medication through superficial tissues.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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