BARTOLABA, LYCA R.

PREPARING AND ADMINISTERING INTRAMUSCULAR INJECTION

PURPOSE:
1. To provide medication the client requires.

Equipment / Materials Needed

1. 2 ½ -3 mL syringe
2. needle gauge 21-23 for injection
3. needle gauge 20-21 for medication withdrawal
4. vial or ampule of correct and sterile medication
5. clean gloves
6. alcohol swab
7. clean hypo tray with paper lining
8. waste receptacle
9. ballpen and jotdown notebook
10. MAR

EXPECTED BEHAVIOR RATIONALE

ASSESSMENT
Assess
1. Client allergies to medications. Assess patient data such as vital signs,
laboratory values, and allergies before
2. Specific drug action, side effects preparing and administering medications
and adverse effects. by injection.

3. Clients knowledge of and learning
needs about the medication.
4. Tissue integrity the selected sites.
5. Client’s age and weight to
determine site and needle size.
6. Client’s ability or willingness to
participate.
PLANNING
7. Determine the need for assistance.
8. Determine the appropriate size of
needle and syringe to be used.
Alternating the sites for injection helps
prevent tissue damage and increases
patient comfort and to decrease the risk of
hypertrophy.
Muscle mass must be large enough to
absorb the amount of medication
prescribed. Abnormalities at the site will
increase patient discomfort and alter the
absorption rate of the medication.
Appropriate needle size and syringe
should be used during IM injection.
To facilitate smooth flow of administering
intramuscular medications.
This prevents injury due to sudden
movement after needle insertion.
Appropriate needle size and syringe
should be used during the injection.
BARTOLABA, LYCA R.

IMPLEMENTATION
Preparation of the drug:
9. Check the MAR.
a. Check the label on the To make sure that the correct medication
medication carefully against is being prepared.
the MAR.
b. Follow the three checks for Properly identifying medication decreases
administering medications (1) risk of inadvertently administering the
when it is taken from the wrong medications.
medication cart/box (2) before
withdrawing the medication
and (3) after withdrawing the
medication.
c. Confirm that the dose is To ensure that the right amount of
correct. medication is being prepared.
d. Prepare appropriate syringe The withdrawal needle is different from
and needle the actual needle used during the
- Open a 2.5 or 3ml syringe administration of the medication.
with needle gauge 22 0r 23
- Change the needle to gauge
20 for withdrawal of drug
solution.
- Ensure that the needle is
firmly attached to the
syringe.
e. Organize the equipment. To save time and effort.

Performance
10. Perform hand hygiene and observe
other appropriate infection
prevention procedures
11. Prepare the medication from the
ampule or vial for drug
withdrawal.
Hand hygiene prevents the spread of
microorganisms.
To follow the correct and appropriate
action in the preparation of the
medication.

Note: refer to drug preparation from

ampule / vial
12. Provide for client privacy.
13. Prepare the client.
a. Prior to performing the
procedure, introduce self and
verify the client’s identity.
b. Explain the purpose of the
medication and how it will
help, using language that the
To alleviate client’s anxiety and to acquire
client’s cooperation.
This ensures that the right client receives
the right medication.
Explaining the procedure allays anxiety
and enhance cooperation of client during
injection.
BARTOLABA, LYCA R.

client can understand. Include

relevant information about Information can facilitate acceptance of
effects of the medication. and compliance with the therapy.
c. Assist the client to a supine, Appropriate positioning promotes
lateral, prone or sitting relaxation of the target muscles.
position, depending on the
chosen site. If the target
muscle is the gluteus medius
(ventrogluteal site), have the
client in the supine position
flex the knees. In the lateral
position, flex the upper leg;
and in the prone position, toe
in.
d. Obtain an assistance in holding This prevents injury due to sudden
an uncooperative client. movement after needle insertion.
14. Select, locate and clean the site. These conditions could hinder the
a. Select a site free of skin absorption of the medication and may also
lesions, tenderness, swelling, increase the likelihood of injury and
hardness, or localized discomfort at the injection site.
inflammation and one that has
not been used frequently.
b. Apply clean gloves. Gloving is done for aseptic purposes.

c. Using appropriate landmarks, To ensure correct site for IM injection.

locate the exact site for
injection.
d. Clean the site with an
antiseptic swab. Using a
circular motion start at the
center and move outward
about 5cm (2 in.)
e. Allow the site to dry.
15. Hold the swab or dry cotton ball
between the third and fourth
fingers of your nondominant hand
in readiness for needle withdrawal
or place the cotton ball/gauze in
the client’s skin above the
intended site.
16. Remove needle cap by pulling it
straight off the needle. Hold
syringe between thumb and
forefinger on dominant hand as if
To decrease the potential of introducing
microorganisms to the patient through the
needle.
This will help reduce the discomfort of the
injection and prevents stinging during
injection.
The cotton ball.gauze will be used when
the medication has been injected and the
needle is withdrawn.
This allows for easy access to dry cotton
balls / gauze after injection
This prevents needle from touching side
of the cap and prevents contamination.
BARTOLABA, LYCA R.
holding a dart.
17. Inject the medication using the Z-
track technique.
a.For adequate amount of muscle, use
the ulnar side of the non-dominant
hand to pull the skin
approximately 1 inch at the side.
b. Holding the syringe between the
thumb and forefinger (as if holding
a pen), oierce the skin quickly and
smoothly at a 900 angle
c. After the needle pierces the skin,
hold the barrel of the syringe
steady with your non-dominant
hand and aspirate by pulling the
plunger with dominant hand.
d. Aspirate for 5-10 seconds. If blood
appears in the syringe, withdraw
the needle, discard the syringe and
prepare a new injection.
e. If blood does not appear in the
syringe, inject the medication
steadily and slowly (approximately
10 seconds per mL) while holding
the syringe steadily.
*After injection, wait 10 seconds
if using ventrogluteal site.
18. Withdraw the needle.
a. Once medication is completely
injected, remove the needle
using a smooth, steady motion.
Remove the needle at the same
angle at which it was inserted.
b. Apply gentle pressure at the
site with a dry cotton ball,
using gentle pressure.
19. Discard the uncapped needle with
syringe into a proper receptacle.
20. Remove gloves then wash hands.
21. Document all relevant information
Pulling the skin and subcutaneous tissue
or pinching the muscle makes it firmer
and facilitates needle insertion.
Using a quick motion lessens the client’s
discomfort.
Movement of the needle once injected can
cause additional discomfort for the
patient.
This step determines whether the needle
has been inserted into a blood vessel.
Injecting the medication slowly promotes
comfort and allows time for tissue to
expand and begun absorption of the
medication. Holding the syringe steadily
minimizes discomfort.
Waiting permits the medication to
disperse into the muscle tissue, thus
decreasing the client’s discomfort.
Using a smooth motion prevents any
unnecessary pain to the patient.
Use of an alcohol swab may cause pain or
a burning sensation.
Massaging the site may cause the leakage
of medication from the site and result
irritation
Placing sharps in appropriate puncture-
proof and leak-proof receptacles prevents
accidental needle-stick injuries.
This step prevents the spread of
microorganisms.
Documentation is done for legal purposes
BARTOLABA, LYCA R.

which includes time of as well as to chart the medication being

administration, drug name, dose, administered to the patient.
route and client’s reaction.
22. Assess effectiveness of the Assess for effectiveness of the medication
medication and occurrence of (onset, peak, and duration). Assess
adverse reaction at the time it is injection site for pain, bruising, burning,
expected to act. or tingling
To determine patient’s response to the
medication being provided.
EVALUATION To know if there are any reactions that the
23. Conduct follow- up such as: patient has shown because of the
a) desired effect medication.
b) adverse effect
c) local skin and tissue reaction
d) relate to previous findings
e) report significant deviation from
normal to physician
ADDITIONAL INFORMATION
1. Some medications require
documentation of lot numbers per
agency policy
2. Chart the medication, time, dose and
route given, pre administration
assessments, and your signature.
3. Do not document before giving the
drug; do not document for anyone
else; do not ask another nurse to
document a drug you have given.
4. Chart any therapeutic or adverse
effects of the medication.
5. Record the scheduled medications on
the MAR. Record PRN medications
in the nurse’s notes, as well, including
the reason the drug was given and the
patient’s response.
6. If the client is unable or refuses to
take the medication, document on the
MAR that the medication was not
administered, along with the reason,
and inform the physician.

7. For parenteral medications, chart the

site of injection.
BARTOLABA, LYCA R.

RETURN DEMONSTRATION EVALUATION TOOL FOR:

INTRAMUSCULAR INJECTION

Name: _____________________________________ Grade: _____________

Time started:____________ Time ended:________Date of RD:________________________

RATING COMMENTS
AREA FOR EVALUATION
5 4 3 2 1 0
SKILLS (35%)
ASSESSMENT
Assesses
1. Client allergies to medications.
2. Specific drug action, side effects
and adverse effects.

3. Clients knowledge of and learning

needs about the medication.
4. Tissue integrity the selected sites.
5. Client’s age and weight to
determine site and needle size.
6. Client’s ability or willingness to
participate.
PLANNING
7. Determines the need for
assistance.

8. Determines the appropriate size of

needle and syringe to be used.
IMPLEMENTATION
Preparation of the drug:
9. Check the MAR.
a. Check the label on the
medication carefully
against the MAR.
b. Follow the three checks
for administering
medications (1) when it is
taken from the medication
cart/box (2) before
withdrawing the
medication and (3) after
withdrawing the
medication.
c. Confirm that the dose is
BARTOLABA, LYCA R.

correct.
d. Prepare appropriate
syringe and needle
Performance
10. Performs hand hygiene.
11. Prepare the medication from the
ampule or vial for drug
withdrawal.
Ampule:
a. Flicks the upper stem of the
ampule several times with a
fingernail.
b. Uses an ampule opener or places a
piece of sterile gauze or alcohol
wipe between your thumb and the
ampule neck or around the
ampule neck, and breaks off the
top by bending it toward you to
ensure the ampule is broken away
from yourself and away from
others.
c. Disposes of the top of the ampule
in the sharps container.
d. Withdraws the medication.
- Places the ampule on a flat
surface.
- Attaches the fwithdrawing
needle to the syringe.
- Removes the cap from the
needle and inserted the
needle into the center of
the ampule. Did not touch
the rim of the ampule with
needle tip or shaft.
e. Replaces the withdrawing needle
with a regular needle, tighten the
cap at the hub of the needle, and
push solution into the needle to
the prescribed amount.
f. Disposes the withdrawing needle
by placing in a sharp containers.
Vials
a. Attaches withdrawing needle, to
draw up premixed liquid
medications from multidose vials.
b. Ensures that the needle is firmly
BARTOLABA, LYCA R.

attached to the syringe.

c. Removes the cap from the needle,
then draw up into the syringe the
amount of air equal to the volume
of the medication to be
withdrawn.
d. Inserts the needle into the upright
vial through the center of the
rubber cap (maintaining the
sterility of the needle).
e. Injects air into the vial, keeping
the bevel of the needle above the
surface of the medication.
f. Withdraws the prescribed amount
of medication using either of the
following methods:
Method 1:
Holds the vial down (i.e. with the base
lower than the top), move the needle tip
so that it is below the fluid level, and
withdraw the medication. Avoid drawing
up the last drops of the vial.

Method 2:
Inverts the vial, ensure the needle tip is
below the fluid level, and gradually
withdraw the medication
g. Holds the syringe and vial at eye
level to determine that the correct
dosage of drug is drawn into the
syringe. Eject air remaining at the
top of the syringe into the vial.
h. Withdraws the needle from the
vial, and replace the cap over the
needle using the scoop method,
thus maintaining its sterility.
i. Taps the syringe barrel to
dislodge any air bubbles present
in the syringe.
j. Replaces the withdrawing needle,
if used, with a regular needle of
the correct gauge and length.
Eject air from the new needle and
verify correct medication volume
before injecting the client.
12. Provides client privacy.
BARTOLABA, LYCA R.

13. Introduces self and verify the

client’s identity.
14. Explains the purpose of the
medication and how it will help,
using language that the client can
understand. Included relevant
information about effects of the
medication.
15. Assists the client to a supine,
lateral, prone or sitting position,
depending on the chosen site. If
the target muscle is the gluteus
medius (ventrogluteal site), have
the client in the supine position
flex the knees. In the lateral
position, flex the upper leg; and in
the prone position, toe in.
16. Obtain an assistance in holding an
uncooperative client.
17. Select a site free of skin lesions,
tenderness, swelling, hardness, or
localized inflammation and one
that has not been used frequently.
18. Don clean gloves.
19. Locates the exact site for injection
using the correct landmark.
20. Cleans the site with an antiseptic
swab. Using a circular motion
start at the center and move
outward about 5cm (2 in.)
21. Allows the site to dry.

22. Holds the swab or dry cotton ball

between the third and fourth
fingers of your nondominant hand
in readiness for needle withdrawal
or place the cotton ball/gauze in
the client’s skin above the
intended site.
23. Removes needle cap by pulling it
straight off the needle. Hold
syringe between thumb and
forefinger on dominant hand as if
holding a dart.
24. Inject the medication using the Z-
BARTOLABA, LYCA R.

track technique.
a. For adequate amount of
muscle, uses the ulnar side of
the non-dominant hand to pull
the skin approximately 1 inch
at the side.

b. Holds the syringe between the

thumb and forefinger (as if
holding a pen), oierce the skin
quickly and smoothly at a 900
angle
c. After the needle pierces the
skin, holds the barrel of the
syringe steady with your non-
dominant hand and aspirate by
pulling the plunger with
dominant hand.
d. Aspirates for 5-10 seconds. If
blood appears in the syringe,
withdraw the needle, discard
the syringe and prepare a new
injection.
e. If blood does not appear in the
syringe, inject the medication
steadily and slowly
(approximately 10 seconds per
mL) while holding the syringe
steadily.
*After injection, wait 10 seconds
if using ventrogluteal site.
25. Removes the needle using a
smooth, steady motion. Remove
the needle at the same angle at
which it was inserted.
26. Applies gentle pressure at the site
with a dry cotton ball, using
gentle pressure.
27. Discards the uncapped needle
with syringe into a proper
receptacle.

28. Removes gloves then wash hands.

29. Documents all relevant

information which includes time
BARTOLABA, LYCA R.

of administration, drug name,

dose, route and client’s reaction.
30. Assesses effectiveness of the
medication and occurrence of
adverse reaction at the time it is
expected to act.

EVALUATION
31. Conducts follow- up such as:
a) desired effect
b) adverse effect
c) local skin and tissue reaction
d) relate to previous findings
e) report significant deviation from
normal to physician
KNOWLEDGE (15%)
1. Gives rationale of the procedure.
2. Explains the elements and
mechanics of the procedure.
3. Knows the elements of nursing
process as applied
4. States Principles applied in the
procedure.
ATTITUDE: (10%)
1. Is well groomed.
2. Wears prescribed, neat, and clean
uniform.
3. Arrives on time for the RD.
4. Speaks to CI and client tactfully.
5. Minimizes use of energy, time, and
effort
6. Utilizes supplies efficiently.
7. Considers client’s safety, privacy, and
comfort.
8. Is well organized.
9. Keeps working area clean at all times.
10. Gives high value for aesthetics.

Comments: _______________________________________________________________

Clinical Instructor’s signature: ____________________________________

BARTOLABA, LYCA R.