PREPARING AND ADMINISTERING INTRAMASCULAR INJECTION

Intramuscular (IM) injections deposit medications into the muscle fascia, which has a rich
blood supply, allowing medications to be absorbed faster through the muscle fibers than they are
through the subcutaneous route.

Purpose:

1. To provide medication the client requires.

Equipment/ Materials Needed

1. 2 1/2-3 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
ASSESSMENT

1. Compare MAR or medication list against physician’s order. To ensure that the order was
transcribed correctly.

2. Assess the patient’s symptoms, knowledge of the medication to be received, history of allergies,
drug allergies, and types of allergic reactions. Assess patient data such as vital signs, laboratory values,
and allergies before preparing and administering medications by injection.

3. Identify the site of the previous injection. Alternating the sites for injection helps prevent tissue
damage and increases patient comfort and to decrease the risk of hypertrophy.

4. Assess the chosen site for adequate muscle mass, bruises, edema, tenderness, redness or other
abnormalities. 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.

5. Determine the appropriate needle and syringe to be used. Appropriate needle size and syringe
should be used during IM injection.

6. Determine the need for assistance. To determine if assistance is needed during the actual
procedure.

7. Determine other equipment needed. For the equipment to be readily accessible during the actual
procedure.
8. Gather needed equipment. To save time and energy.
9. Wash hands. Hand hygiene prevent the spread of microorganisms.
IMPLEMENTATION
Preparation
1. Check from the MAR the name of the drug order. To make sure that correct medication will be
prepared.

2. Take from shelf/drawer/or bioref the appropriate drug, check label and expiry date. To determine if
the drug is still safe for use.

3. Compare the medication label of the vial or ampule against the order on the MAR (1 st
check).This
prevents medication errors by providing additional check.
4. Calculate medication dosage accurately. To ensure that the right amount of medication is being
prepared.
5. Wash hands and observe other appropriate infection control. To prevent transmission of
microorganisms.
6. Prepare appropriate syringe and needle: The withdrawal needle is different from the actual needle
used during the administration of the medication.

a) Open a 2.5 or 3 mL syringe with needle gauge 22 or 23.

b) Change the needle gauge to 20 for withdrawal of drug solution.
c) Ensure that the needle is firmly attached to the syringe.
7. Prepare the medication from:
A. Vial
a) Mix the solution by rotating vial between palms of hands not by shaking. Shaking is
contraindicated because it may cause the mixture to foam.

b) Remove the protective cap or clean the rubber cap of previously open vial by an antiseptic in
circular motion. To decrease the potential for contamination of the needle and solution.

B. Ampule
a) Flick the upper stem of the ampule several times with a fingernail. To bring all medication down
from the top portion of the ampule.
b) Partially file the neck of the ampule several times if necessary. This facilitates easy breaking of
the neck of the ampule.

c) Place a piece of sterile gauze around the neck of the ampule and break off the top by bending it
towards you. Sterile gauze protects the finger from the broken glass and any glass fragments.
8. Withdraw accurate volume of correct medication from: (Does the 2 checking this time)
nd

A. Vial
a) Remove the cap from the needle, then draw up into the syringe the amount of air equal to the
amount of medication to be withdrawn. Air will allow the medication to be drawn out easily because
negative pressure will not be created inside the vial.
 b) Insert the needle into the upright vial thru the center of the rubber cap.
c) Inject the air into the vial keeping the bevel of the needle above the surface of the medication.
Bevel is kept above the medication level to avoid creating bubbles in the medication.
d) Adjust the needle tip below the medication level and gradually withdraw the medication.
Keeping the tip of the needle below the fluid level prevents air from being drawn into the syringe.
e) Hold the syringe and needle at eye level to determine the correct dosage of drug that is drawn
into the syringe. To withdraw an appropriate amount of medication.
f) Eject air remaining at the top of the syringe into the vial. To remove excess air that may be
harmful if in large amounts.
g) When correct amount of medication is obtained, withdraw the needle from the vial and replace
cap of the needle using scoop method. The scooping method prevents possible needle injuries.
h) If necessary, tap the syringe barrel to dislodge any air bubbles in the syringe. Tapping motion
will cause air bubbles to rise to the top of the syringe where it could be ejected out of the syringe.

B. Ampule
a) Remove the cap of the needle and insert it into the center of the ampule not touching the rim and
withdraw the solution. To avoid contaminating the needle as well as the contents of the ampule.
b) Hold the ampule slightly to its side. To withdraw all medication.
9. After preparing the correct dosage of medication and before replacing the vial or ampule in the
rd
drawer or refrigerator, recheck the label and compare it to MAR (this is the 3 check). To prevent
medication error.
10. Place the prepared medication together with the MAR on the hypotray. This prepares for the
actual administration of medication.
11. Place other materials needed in performing injection in the hypotray. For them to be readily
accessible when needed.
12. Wash hands and prepare for an injection. For infection control.
Administering Intramuscular Injection
13. Change the needle of the syringe with needle gauge 22 or 23. Presence of medication outside the
needle irritates the subcutaneous tissue as it passes into the muscle.
14. Invert the syringe with needle uppermost and expel all excess air. To prevent injecting air into
the client. This may be harmful if in large amount.
15. Approach the client and recheck ID. To ensure that medication is administered to the correct
client.

16. Explain the purpose of medication and how it will help using the language the client can
understand. Knowing what is happening helps minimize patient anxiety. Let the patient know there may
be mild burning at the injection site.
17. Provide privacy. Position the client appropriately and comfortably. To allay patient’s anxiety.
18. Select a site free of lesion, tenderness, swelling, hardness or localized inflammation and the one
that was not been used frequently. (if injections are to be frequent, avoid using the same site twice in a
row). Contraindications for using a specific site include tissue injury and the presence of nodules,
lumps, abscesses, tenderness, or other pathology.
19. Using appropriate landmarks, locate the exact site for injection. To ensure correct site for IM
injection.
20. Put on right size of non-sterile gloves. Gloving is done for aseptic purposes.
21. Clean the site with antiseptic swab using circular motion from the center moving outward. To
decrease the potential of introducing microorganisms to the patient through the needle.
22. Allow the site to dry. This will help reduce the discomfort of the injection and prevents stinging
during injection.
23. rd th
Hold a dry cotton ball/gauze between the 3 and 4 finger of your non dominant hand in
readiness for needle withdrawal or place the cotton ball/gauze in the client’s skin above the intended
site. 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 ball/gauze after injection.
24. Remove the needle cap by pulling it straight off the needle. Hold syringe between thumb and
forefinger on dominant hand as if holding a dart. This prevents needle from touching side of the cap
and prevents contamination.
25. Inject the medication using the Z tract 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) For emaciated client or infant, pinch the muscle.
Pulling the skin and subcutaneous tissue or pinching the muscle makes it firmer and facilitates needle
insertion.

26. Inject the needle into the muscle by piercing the skin quickly and smooth while holding the
syringe between the thumb and index finger at angle of 90°. Using a quick motion lessens the client’s
discomfort.
27. 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. Movement of the needle once injected
can cause additional discomfort for the patient.
28. Aspirate for 5-10 seconds. If blood appears in the syringe, withdraw the needle, discard the
syringe and prepare a new injection. This step determines whether the needle has been inserted into a
blood vessel.
29. If blood does not appear in the syringe, inject the medication steadily and slowly (approximately
10 seconds per mL) while holding the syringe steadily. 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.

30. Once the medication is completely injected, remove the needle using a smooth, steady motion.
Remove the needle at the same angle at which it was inserted. Using a smooth motion prevents any
unnecessary paint to the patient.
31. Cover injection site with sterile cotton ball/gauze, using gentle pressure. Covering prevents
infection at the injection site. Massaging the site can result to tissue irritation.
32. Discard the uncapped needle with syringe into a proper receptacle. Placing sharps in
appropriate puncture-proof and leak-proof receptacles prevents accidental needle-stick injuries.
33. Remove gloves then wash hands. This step prevents the spread of microorganisms.
34. Document all relevant information which includes time of administration, drug name, dose,
route, and client’s reaction. Documentation is done for legal purposes as well as to chart the
medication being administered to the patient.
35. Assess effectiveness of the medication and occurrence of adverse reaction at the time it is
expected to act. Assess for effectiveness of the medication (onset, peak, and duration). Assess injection
site for pain, bruising, burning, or tingling. To determine patient’s response to the medication being
provided.

EVALUATION

36. Conduct 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
ADDITIONAL INFORMATION
37. Some medications require documentation of lot numbers per agency policy
38. Chart the medication, time, dose and route given, pre administration assessments, and your
signature.
39. 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.
40. Chart any therapeutic or adverse effects of the medication.
41. 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.
42. 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.
43. For parenteral medications, chart the site of injection.