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06.08 IM Injections

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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

Reference Links

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Video Transcript

In this video, we’re going to look at proper administration technique for intramuscular medication administration. Of course, always follow your 5 rights and calculate the correct volume for administration.

Based on the volume of med and the size of your patient, choose an appropriate site and needle site. Draw up the med in an appropriate syringe and attach the appropriate needle. In this case, we have 2 mL, we’re going to use the patient’s right deltoid, and a 1 inch 23 gauge needle.

Clean the site with alcohol in circles starting at the center and working outward and make sure you let it dry.
We’re going to show you the Z-track method. Uncap you needle. Then, use the thumb and forefinger of your non-dominant hand in the shape of a C and pull the skin to the side.

Now hold the syringe like a dart in you dominant hand and insert the needle at a 90 degree angle.
Use your pointer finger to gently pull back on the plunger. If you don’t see blood right away, you’re good to go.
Inject the medication slowly

Then you’ll remove needle and release the skin – that creates the Z-track to prevent irritant meds from getting to the skin.
Now you can apply gentle pressure with gauze and cover the site with a band-aid.

Activate the safety device on your needle and/or throw the needle directly in the sharps container.

Document administration and monitor the patient for effects of the med!

That’s it! Now, go out and be your best self today. And, as always, happy nursing!

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