Injections
Administering Intramuscular Injections
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Take the Review Test:
Safety
Ensure that the Six Rights of Medication Administration are observed: right medication, right dose, right patient, right route, right time, and right documentation. Follow the principles of sterile technique when administering an intramuscular injection.
- Wear gloves to reduce the risk of contact with bloodborne pathogens.
- Do not use an injection site in an area with bruising, induration, muscular atrophy, reduced blood flow, or signs of infection.
- Ensure that the position for injection is not contraindicated by the patient’s medical condition.
- To prevent administration of the medication directly into a blood vessel, aspirate when giving all intramuscular injections except vaccines.
- Rotate intramuscular injection sites to decrease the risk of tissue hypertrophy.
- In older adults and thin patients, do not administer a volume of more than 2 mL by intramuscular injection. In infants and small children, do not administer a volume of more than 1 mL.
Equipment
(Roll cursor over items to see labels)
3 mL syringe with 21-gauge, 1 1/2 inch needle with safety device
Small gauze pad
Alcohol swab
Vial or ampule of medication
Clean gloves
Marker
Tape
PrintableDelegation
The skill of administering an intramuscular injection cannot be delegated to nursing assistive personnel (NAP). Before delegating related skills, be sure to inform NAP of the following:
- Outline expected therapeutic effects and potential side effects of the medication, and instruct NAP when to report them.
- Instruct NAP to report any change in the patient’s condition.
Preparation
- Check the accuracy and completeness of the medication administration record (MAR) or computer printout against the prescriber’s written medication orders. Confirm the patient’s name, medication name and dosage, route of administration, and time of administration. Clarify incomplete or unclear orders with the health care provider.
- Note if the patient has allergies.
- Review the medication reference information for medication action, purpose, normal dose, side effects, time of peak action and nursing implications.
- Review the patient’s previous verbal and nonverbal responses to the injection.
- Assess for contraindications to intramuscular injections, such as muscle atrophy, reduced blood flow, and circulatory shock.
- Review the MAR to note the locations of previous injections.
- When drawing up medication for injection away from the patient’s bedside, label the syringe with the name and amount of medication it contains.
Follow-up
- Return to the room 15 to 30 minutes after the injection; ask the patient if he or she feels any acute pain, burning, numbness, or tingling at the injection site.
- Inspect the site, noting any bruising or induration. Apply a warm compress if necessary.
- Observe the patient’s therapeutic response to the medication at times that correlate with the onset, peak, and duration of the medication. Watch for any adverse effects.
- Confirm the patient’s understanding of the medication’s purpose, action, possible side effects, and self-administration technique if applicable.
Documentation
- Document the medication administered by intramuscular injection, its concentration, dosage or strength, time, date, and site of administration. This documentation must be made on the MAR immediately after administration, not before.
- Document any patient teaching and validation of the patient’s understanding.
- Document and report to the health care provider any withheld doses and/or the patient’s response to the medication, including any side effects.
Review Questions
1. Which action by the nurse ensures patient safety when administering an intramuscular injection?
Putting on clean gloves before administration
Rotating injection sites- Aspirating for blood return when administering a vaccine
- Injecting the medication quickly
INCORRECT. Wearing clean gloves will protect the nurse from exposure to bloodborne pathogens, but doing so will not affect patient safety.
CORRECT. Rotating injection sites is important in order to prevent hypertrophy of tissue.
INCORRECT. It is unnecessary to aspirate when giving an IM vaccine.
INCORRECT. Intramuscular medications must be injected slowly, at a rate no faster than 10 sec/mL.
2. When preparing an intramuscular injection, what can the nurse do to reduce the patient’s risk for infection?
- Wear clean gloves.
- Use a 3-mL syringe.
- Clean the injection site with an alcohol swab.
- Massage the injection site.
INCORRECT. Wearing clean gloves will protect the nurse from exposure to bloodborne pathogens, but doing so will not reduce the patient’s risk for infection.
INCORRECT. Selecting an appropriate syringe size will not affect the patient’s risk for infection.
CORRECT. Cleaning the injection site with an alcohol swab before administering an intramuscular injection will reduce the patient’s risk for infection.
INCORRECT. Massaging the site after an injection is not appropriate technique and will not reduce the patient’s risk for infection.
3. What can the nurse do to minimize the patient’s risk for injury when delivering an intramuscular injection?
- Instruct the patient to relax.
- Insert the needle at a 45-degree angle.
- Pull back on the plunger after inserting the needle.
- Pull the skin taut at the injection site when inserting the needle.
INCORRECT. Encouraging the patient to relax may decrease discomfort, but will not reduce the patient’s risk for injury.
INCORRECT. For an intramuscular injection, the needle must be inserted at a 90-degree angle.
CORRECT. Pulling back on the plunger will allow the nurse to determine if the needle is in a blood vessel, rather than in muscle tissue.
INCORRECT. Pulling the skin taut when inserting the needle will not reduce the patient’s risk for injury.
4. Which site is most commonly used for intramuscular injections?
CORRECT. The ventrogluteal site is the preferred IM injection site for adults and children, not for infants and toddlers.
INCORRECT. The abdomen is used for subcutaneous injections.
INCORRECT. The deltoid site is an appropriate choice for small volumes, but it is not the preferred site for intramuscular injections.
INCORRECT. The dorsogluteal site is contraindicated for intramuscular injections.
5. Which action by the nurse helps to ensure that the medication is delivered into the muscle when administering an intramuscular injection?
- Using a 1-inch needle
- Inserting the needle at a 45- to 60-degree angle
- Withdrawing the needle immediately after delivering the medication
- Aspirating for blood return before injection medication
INCORRECT. Selection of needle length will vary, depending on the age and size of the patient.
INCORRECT. For an intramuscular injection, the needle must be inserted at a 90-degree angle.
INCORRECT. To prevent medication from leaking out of the muscle tissue, the needle is left in place for about 10 seconds once the medication has been delivered.
CORRECT. Aspirating for blood return ensures that the medication will be delivered into muscle tissue, and not into a blood vessel.
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