06.08 IM Injections

Overview

1. Purpose
   1. Some medications need to be administered into muscle tissue
   2. The site, needle length, and needle size will depend on the volume of medication being administered and the size/age of the patient

Nursing Points

General

1. Supplies needed
   1. Required medication vial
   2. Appropriate size syringe
      1. 1 mL
      2. 3 mL
      3. 5 ml
   3. Appropriate size needle
   4. Alcohol pad
   5. Band-aid
2. Injection sites
   1. Deltoid
   2. Vastus Lateralis
   3. Ventrogluteal
3. Needle size
   1. Infant → ⅝”-1” → 25-27g
   2. Children → ⅞”-1 ¼” → 22-25g
   3. Adult → 1” – 1 ½” → 22-25g
4. NOTES
   1. MAX 5 mL volume in adults
   2. Inject at 90 degree angle
   3. Aspirate to avoid vascular administration
   4. Z-track method
      1. Used for irritant meds

Nursing Concepts

1. Steps and Nursing Considerations
   1. Verify provider order
   2. ALWAYS follow 5 rights BEFORE preparing medication
      1. Right Patient
      2. Right Drug
      3. Right Dose
      4. Right Route
      5. Right Time
   3. ALWAYS prepare medications at the patient’s bedside
   4. Gather supplies
   5. Perform hand hygiene
   6. Don clean gloves
   7. Let the patient know what meds they will be receiving
   8. Draw up medication in appropriate syringe
   9. Select appropriate site
   10. Select appropriate needle size and attach needle
   11. Clean the site with alcohol in circles starting at the center and working outward – LET DRY
   12. Using thumb and forefinger of non-dominant hand, pull skin taut – or to the side if using Z-track method
   13. Insert the needle at a 90 degree angle
       1. Hold the syringe like a dart in your dominant hand
   14. Use your pointer finger (dominant) to pull back on the plunger slightly
       1. If you see blood, remove the needle immediately
       2. If not, proceed
   15. Inject medication slowly
   16. Remove needle, release skin
   17. Apply gentle pressure with gauze
   18. Apply band-aid to site
   19. Activate safety and/or dispose of needle in sharps container
   20. AFTER administration
       1. Document administration and patient’s response
       2. If using barcode medication administration
          1. Scan all meds before preparing
          2. Confirm administration AFTER giving to patient
   21. Discard all used supplies
   22. Remove gloves
   23. Perform hand hygiene
   24. For PRN meds, return in 15-30 minutes to evaluate response

Patient Education

1. Indication and possible side effect(s) of medication(s)
2. Signs to report to nurse or provider