EMILIO AGUINALDO COLLEGE

Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph
`
SCHOOL OF NURSING

ADMINISTERING AN INTRAMUSCULAR INJECTION

NAME: ______________________________________________ SCORE: _____________________

YR/SEC/GRP: _________________________________________ DATE: ______________________

PERFORMED
ASSESSMENT MASTERED COMMENTS
YES NO
Assess:
 Client allergies to medication(s)
 Specific drug action, side effects, and adverse
reactions
 Client’s knowledge of and learning needs
about the medication
 Tissue integrity of the selected site
 Client’s age and weight to determine site and
needle size
 Client’s ability or willingness to participate

Determine:
 Whether the size of the muscle is appropriate
to the amount of medication to be injected.
An average adult’s deltoid muscle can usually
absorb 0.5 mL of medication, although some
authorities believe 1 mL can be absorbed by a
well – developed deltoid muscle. The gluteus
medius muscle can often absorb 1-4 mL,
although 4 mL may be very painful and may
be contraindicated by agency protocol.
EQUIPMENT
 Client’s MAR or computer printout
 Sterile medication (usually provided in an
ampule or vial or prefilled syringe)
 Syringe and needle of a size appropriate for
the amount and type of solution to be
administered
 Antiseptic swabs
 Clean gloves
PREPARATION
1. Check the MAR
 Check the label on the medication carefully
against the MAR to make sure that the correct
medication is being prepared.
 Follow the three checks for administering
medications and dose. Read the label on the
medication (1) when it is taken from the
medication cart, (2) before withdrawing the
medication, and (3) after withdrawing the
medication.
 Confirm that the dose is correct.
2. Organize the equipment.
PERFORMANCE
1. Perform hand hygiene and observe other
appropriate infection prevention
procedures.
2. Prepare the medication from ampule or vial
for drug withdrawal.
 Whenever feasible, change the needle on the
syringe before the injection.

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 Invert the syringe needle uppermost and
expel all excess air.
3. Provide or client privacy.
4. Prepare the client.
 Prior to performing the procedure, introduce
self and verify the client’s identity.
 Assist the client to a supine, lateral, prone, or
sitting position, depending on the chosen site.
If the target muscle is the gluteus medius
(ventrogluteal site), have the client in the
supine position flex the knee(s); in the lateral
position, flex the upper leg; and in the prone
position, toe in.
 Obtain assistance in holding an uncooperative
client.
5. Explain the purpose of the medication and
how it will help, using language that the
client can understand. Include relevant
information about effects of the medication.
6. Select, locate, and clean the site.
 Select a site free of skin lesions, tenderness
swelling, hardness, or localized inflammation
and one that has not been used frequently.
 If injections are to be frequent, alternate site.
Avoid using the same site twice in a row. If
necessary, discuss with the prescribing
primary care provider an alternative method
of providing the medication.
 Locate the exact site for the injection.
 Apply clean gloves.
 Clean the site with an antiseptic swab. Using a
circular motion, start at the center and move
outward about 5 cm (2 in.)
 Transfer and hold the swab between the third
and fourth fingers of your nondominant hand
in readiness for needle withdrawal or position
the swab on the client’s skin above the
intended site. Allow the skin to dry prior to
injecting medication.
7. Prepare the syringe for the injection.
 Remove the needle cover and discard without
contaminating the needle.
 If using a prefilled unit-dose medication, take
caution to avoid dripping medication on the
needle prior to injection. If this does occur,
wipe the medication off the needle with a
sterile gauze. Some sources recommend
changing the needle if possible.
8. Inject the medication using the Z-tack
technique.
 Use the ulnar side of the nondominant hand
to pull the skin approximately 2.5 cm (1 in.) to
the side. Under some circumstances, such as
for an emaciated client or an infant, the
muscle may be pinched.
 Holding the syringe between the thumb and
forefinger (as if holding a pen), pierce the skin
quickly and smoothly at a 90° angle and insert
the needle into the muscle.
 Hold the barrel of the syringe steady with

• VIRTUE • EXCELLENCE • SERVICE

 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph
`
SCHOOL OF NURSING
your nondominant hand and aspirate by
pulling back on the plunger with your
dominant hand. Aspirate for 5 to 10 seconds.
If blood appears in the syringe, withdraw the
needle, discard the syringe, and prepare a
new injection. Note, however, that as stated
previously, the practice of aspiration
immediately before the administration of an
IM vaccine injections is not necessary.
Aspiration should be used with the
dorsogluteal site (last resort) because needle
insertion is close to the gluteal artery.
Currently there is no clear evidence with other
sites. Thus, it is recommended that nursing
students consult the policy manual at the
institution where they are practicing to
determine the recommended guidelines for
IM injection technique.
 If blood does not appear, inject the
medication steadily and slowly (approximately
10 seconds per milliliter) while holding the
syringe steady if using the ventrogluteal site.
One study found that rapidly injecting
vaccines without aspiration caused less pain.
 After injection, wait 10 seconds if using the
ventrogluteal site.
9. Withdraw the needle.
 Withdraw the needle smoothly at the same
time angle of insertion. Release the skin.
 Apply gentle pressure at the site with a dry
sponge.
 It is not necessary to massage the area at the
site of injection.
 If bleeding occurs, apply pressure with a dry
sterile gauze until it stops.
10. Activate the needle safety device or discard
the uncapped needle and attached syringe
into the proper receptacle.
11. Remove and discard gloves.
 Perform hand hygiene.
12. Document all relevant information.
 Include the time of administration, drug
name, dose, route, and the client’s reactions.
13. Assess the effectiveness of the medication at
the time it is expected to act.
TOTAL SCORE

EVALUATED BY: CONFORME:

_____________________________ ____________________________________
Signature over Printed Name of the Faculty Signature over Printed Name of the Student

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