Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

Name: ___________________________________________ Grade: _________

Year & Section: ____________________________________ Date: __________
Group No: ________________________________________

PROCEDURE CHECKLIST
INTRAMUSCULAR INJECTION
Instruction: Below is the grading scale which will be used in rating your performance.
5 EXCELLENT 95 - 100
4 VERY SATISFACTORY 88 - 94
3 SATISFACTORY 82 – 87
2 FAIR 76 – 81
1 NEEDS PRACTICE 70 – 75

A. PURPOSE
 To provide a medication the client requires (see specific drug action)

B. ASSESSMENT
 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 to 4 mL, although 4 mL may be very painful and may be
contraindicated by agency protocol.

C. PLANNING

Assignment
The administration of IM injections is an invasive technique that involves
the application of nursing knowledge, problem-solving, and sterile technique.
Assignment to AP would be inappropriate. The nurse, however, can inform the
AP of the intended therapeutic effects and specific side effects of the medication
and direct the AP to report specific client observations to the nurse for follow-up..

D. 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 situation
to be administered
 Antiseptic swabs
 Clean gloves

Source: Berman, A., Snyder, S., Frandsen, G. 2016. Kozier & Erbs Fundamentals of Nursing: Concepts, Process,
and Practice. Eleventh Edition. Pearson Education, Inc.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

E. IMPLEMENTATION
PREPARATION 5 4 3 2 1 REMARKS
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 the medication 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 5 4 3 2 1 REMARKS

Source: Berman, A., Snyder, S., Frandsen, G. 2016. Kozier & Erbs Fundamentals of Nursing: Concepts, Process,
and Practice. Eleventh Edition. Pearson Education, Inc.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

1. Perform hand hygiene and observe other

appropriate infection prevention
procedures.
2. Prepare the medication from the ampule or
vial for drug withdrawal.
 Whenever feasible, change the needle
on the syringe before the injection.
 Invert the syringe needle uppermost and
expel all excess air.
3. Provide for client privacy
4. Prepare the client
 Prior to performing the procedure,
introduce self and verify the client's
identity using agency protocol.
 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
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
sites. Avoid using the same site twice in
a row. injections. If necessary, discuss
with the prescribing primary care
provider an alternative method or
providing the medication.
 Locate the exact site for the injection.
See the discussion of sites earlier in this
chapter.
 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

Source: Berman, A., Snyder, S., Frandsen, G. 2016. Kozier & Erbs Fundamentals of Nursing: Concepts, Process,
and Practice. Eleventh Edition. Pearson Education, Inc.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

on the client's skin above the intended

site. Allow skin to dry prior to injecting
medication.
7. Prepare the syringe for 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-tract
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 your nondominant hand and
aspirate by pulling back on the plunger
with your dominant hand.
 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.
 After the injection, wait 10 seconds if
using the ventrogluteal site.
9. Withdraw the needles
 Withdraw the needle smoothly at the
same 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 and
discard the attached syringe into the proper
receptacle.
11. Remove and discard the gloves

Source: Berman, A., Snyder, S., Frandsen, G. 2016. Kozier & Erbs Fundamentals of Nursing: Concepts, Process,
and Practice. Eleventh Edition. Pearson Education, Inc.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

 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.

F. EVALUATION

 Conduct appropriate follow-up, such as desired effect (e.g., relief of pain or

vomiting); any adverse reactions or side effects; local skin or tissue reactions at
injection site (e.g., redness, swelling, pain, or other evidence of tissue damage).
 Compare to previous findings, if available.
 Report significant deviation from normal to the primary care provider

Date/Time: ______________________________
Clinical Instructor: ________________________

Source: Berman, A., Snyder, S., Frandsen, G. 2016. Kozier & Erbs Fundamentals of Nursing: Concepts, Process,
and Practice. Eleventh Edition. Pearson Education, Inc.