How to give IM injections
It’s Lea’s first day of clinical exposure. Today, they are assigned at the medical ward. Since they are new to this, they are assigned to a patient each and asked by their Clinical Instructor to observe everything that happens during the shift. An hour after the start of their duty shift, she watches as the staff nurse in charge checks the chart of the patient assigned to her and prepares medication. Upon checking the chart herself, Lea discovers that the patient is due for an IM injection.
Hmmm, an IM injection. She’s sure she’s read about that somewhere. They even discussed it in class, but she hasn’t actually experienced doing it. Because of this, she follows the staff nurse and observes how it is done. Below are the steps in administering IM injections:
ADMINISTERING AN IM INJECTION USING MEDICINE FROM A VIAL
- Gather supplies: medicine vial, alcohol wipe, syringe with the appropriate gauge and inch needle.
- Wash your hands.Check the date on the medicine vial to make sure the medicine is not expired.
- Clean the top of vial with an alcohol wipe. Be sure that the cover has been removed on new vials.
- Let the top of the vial dry.
- Carefully remove the needle cover. Do not touch the needle.
- Pull air into the syringe equal to the amount of the medicine dose you need.
- Stick the syringe needle into the top of the medicine vial.
- Inject the air into the vial. Leave the vial upright.
- Leave the needle in the vial and turn the vial and syringe upside down.
- Pull down slowly on the plunger, drawing the medicine into the syringe. You may need to push the plunger up and down 2 to 3 times to slowly rid the syringe of air bubbles.
- Pull the medicine into the syringe to the dose you need.
- Remove the needle and syringe from the vial.
- Use alcohol to clean the area of the body to be injected.
- Hold the muscle of the injection site firmly between your thumb and fingers of one hand.
- With the other hand, hold the needle and syringe like a pencil. Using a quick dart-like motion, insert the needle at a 90-degree angle through the skin and into the muscle.
- Release your hold on the skin and muscle.
- Pull back slightly on the plunger to see if blood is present. If there is blood, remove the needle and syringe and start over with a new needle and syringe. If there is no blood, inject the medicine.
- Push the plunger slowly down to inject the medicine into the muscle. Some medicines are gels and require force to inject into the muscle.
- Take the needle out.
- Apply pressure at the injection site and gently rub the site.
- Apply a bandage if needed.
- Discard the used needle and syringe properly.
- Store the medicine vial as directed.
Sites for injection
If many injections need to be given, injections should be given in different sites (rotated) each time. An injection should be separated from the previous site by 1 inch (2.5 cm). There are 4 main sites that can be used for IM injections and the ideal site depends on the patient’s age, size, and amount of medicine in the injection.
- Thigh (vastuslateralis muscle).The site is located in the middle, outer sides of the thighs and can be located by dividing the thigh into thirds between the knee and hip.This site is usually used for infants and toddlers. The maximum amount of medicine that should be injected in this muscle is 4 mL.
- Top of upper arm (deltoid muscle). You can locate this site by placing the palm of a hand centered on the person’s shoulder. Your fingers should be pointing toward the floor. The thumb and the other fingers are separated to make an upside down V shape. The IM injection should go in the middle of the V shape. This site is usually used for children age 3 and older and adults. This site can be used in children under 3 years of age if the muscle mass is adequate. The maximum amount of medicine that should be injected in this muscle is 1 mL.
- Hip (ventrogluteal or gluteus medius muscle).One method to locate this site is to place the heel of your hand on the person’s hip, on the upper side of his or her leg. Your hand should be placed so your fingers are facing his or her head. You should feel the upper edge of the bony pelvis with your ring finger and little finger. Point your thumb to his or her groin. Spread your index finger and middle finger into a V shape and give the injection between those fingers. This site can be used for children age 7 months and older and adults. There is no maximum amount of medicine for this injection site.
- Buttocks (dorsogluteal muscle). One method to locate this site is to divide one buttock into 4 quarters. The quarters are formed by dividing the buttock in half from top to bottom and also in half from side to side. The injection should be given in the upper, outer quarter. This site can be used for children and adults. The maximum amount of medicine that should be injected in this muscle is 4 mL. This site does have a high risk of hitting a nerve, blood vessel, or bone.