Intramuscular Injection

 Compare patient's name and medication data on order and MAR. Assess for contraindications to medication or IM injections.

  1. Prepare correct medication dose from ampule or vial. Select appropriate injection needle: 1- to 1½-inch needle (22- to 27-gauge for aqueous solution or 18- to 25-gauge for viscous or oil-based solution) for adults; 5/8- to 1-inch needle for children.
  2. Identify patient by checking identification bracelet and name. Compare with MAR.
  3. Provide privacy, perform hand hygiene, and apply disposable gloves.
  4. Select injection site with no bruises, induration, atrophy, or signs of infection.
  5. Assist patient to comfortable position: lying on side or back with flexed knee and hip (ventrogluteal site); lying supine with knee slightly flexed (vastus lateralis site); or seated or supine with hand on hip or lower arm flexed across abdomen or lap (deltoid site).
  6. Clean site with antiseptic swab, rotating from center outward for 5 cm (2 inches).
  7. With nondominant hand just below site, pull skin 2.5 to 3.5 cm down or laterally for Z-track administration. Hold this position until medication is injected.
  8. In nondominant hand, hold swab or gauze square and remove needle cap or sheath. Between thumb and forefinger of dominant hand, hold syringe as if holding a dart.
  9. Insert needle quickly, perpendicular (at roughly 90 degrees) to patients body.
  10. Stabilize syringe barrel with nondominant hand, while holding skin back.
  11. With dominant hand, pull back on plunger 5 to 10 seconds. If no blood appears, inject medication at rate of 1 ml/10 sec. Avoid moving syringe.
  12. Wait 10 seconds. Then withdraw needle smoothly; release skin, and place antiseptic swab or sterile gauze gently on site. Apply gentle pressure. Do not massage site.
  13. For ventrogluteal and vastus lateralis sites, encourage leg exercises.
  14. Dispose of used supplies, remove gloves, and perform hand hygiene.