ADMINISTERING INTRAMUSCULAR INJECTION

DEFINITION
A form of parenteral administration of medication, where a drug is injected in to a deep muscle tissue
ARTICLES
A tray containing:
 Medication card
 Sterile medication
 Syringes and needles
 Alcohol swabs
 Clean gloves
 Kidney tray
INJECTION SITES
 Deltoid muscle
 Recommended for use with injections of small volume, usually equal or less than 1 ml.
 Not recommended for repeated injections
 To locate the site, palpate the lower edge of the acromion process.
 Inject in the upside-down triangle that forms with its base at the acromion process and its midpoint in
line with the axilla.
 The ventrogluteal site
 Recommended for injections requiring a larger volume to be administered, greater than 1 ml, and for
medications known to be irritating, viscous or oily.
 It is also given for narcotic, antibiotic, sedative and anti-emetic medications.
 To locate the ventrogluteal site, place the palm of your hand over the greater trochanter, with the
fingers facing the patient's head.
 The right hand is used for the left hip and left hand is used for the right hip. Place the index finger on
the anterior superior iliac spine and run the middle finger back along the iliac crest.
 The injection is given in the center of the triangle that is formed.
 Dorsogluteal site
 Not recommended for use in any patient due to its location near major blood vessels and nerves, as
well as having inconsistent depth of adipose tissue,
 Use of this site is associated with skin and tissue trauma, muscle fibrosis and contracture,
haematoma, nerve palsy and paralysis, as well as infectious processes such
as abscess and gangrene.
 Vastuslateralis muscle
 Recommended site for infants less than 7 months old and those unable to walk, with loss of muscular
tone.
 To locate the site, divide the front thigh into thirds vertically and horizontally to make nine squares
and inject in the outer middle square.
PROCEDURE
SL. NURSES ACTION RATIONALE
NO
1. Check the physicians order and identify the patient Avoids wrong patient
2. Explain the procedure to the patient, the purpose of the Reduces the anxiety and encourages
medication, the site of injection, expected effect co-operation
3. Wash hands Reduces cross infection.
4. Prepare medication from ampoule /vial
5. Wash hand and don gloves Reduces the spread of micro
organisms
6. Position the patient. Assist the patient to a supine, lateral or Proper positioning ensures muscle
prone position depending on site chosen. If ventrogluteal, relaxation of patient
have patient in supine position with knees flexed or lateral
position with upper leg flexed or prone with ‘toe in’
position
7. Select, locate, clean the site
8. Select a site free of lesions, tenderness, swelling, hardness,
localized inflammation and frequently used sites
9. Determine whether the size of muscle is adequate for
amount of medication to be injected
10. Clean with alcohol swab in circular motion moving from
center to periphery–moving outward up to 5cm
Transfer and hold the swab between 3rd and 4th of non-
dominant hand or place in tray. Allow site to dry.
Remove needle cover without contaminating the needle by Reduce the risk of accidental needle
pulling straight off prick.
11.
12. Confirm that medication is not dripping on needle prior to Medication on outside of needle can
injection. If it is drippinge3 change the needle. cause pain and irritation of
subcutaneous tissue when it passes
in to the muscle.
13. Inject the medication.
14. Grasp and pinch the area surrounding the injection site or It provides easy and less painful
spread skin at site as appropriate entry into muscle
15. Hold the syringe between the thumb and forefinger in a pen-
holding manner and pierce skin at site at a 90-degree angle
and insert the needle.
16. Aspirate by holding the barrel steady with non-dominant Aspiration helps in checking if
hand and pulling back the plunger with your dominant hand. needle is in blood vessel.
17. Withdraw needle if blood appears in the syringe, discard
and prepare new injection.

18. Inject the medication slowly and steadily if blood does not Injecting medication slowly helps
appear in the syringe on aspiration. the dispersal of medication into
muscle tissue thus decreasing
patient’s discomfort. Holding the
syringe steadily minimizes
discomfort.
19. Withdraw the needle slowly and steadily while supporting
at the hub of syringe and needle.
 20. With non–dominant hand, support the skin surface using the Swab helps to reduce discomfort.
cotton swab for applying counter traction at the site Applying counter traction prevents
supporting the skin surface with the cotton swab pulling of tissues when needle is
withdrawn.
Apply gentle pressure at the site with a dry sponge and if Massaging may irritate tissues at the
bleeding is present, continue applying pressure till bleeding injection site.
21.
stops. Do not massage.
22. Discard the uncapped needle and syringe into appropriate
receptacle.
23. Remove gloves, wash hands
24. Record procedure including the name of medication, dose, Reduces chances of medication error
site and response of the patient.
25. Assess effectiveness of medication.
SPECIAL CONSIDERATION
 Use Z- track technique for administering oily preparations.
ADMINISTERING INTRAVENOUS INJECTIONS
DEFINITION
Introducing a single dose of concentrated medication directly in to the systemic circulation
An IV bolus may be given as follows
1. Directly in to the vein
2. In to an existing iv line through an injection port
3. Through a saline or heparin lock
A saline lock consists of an indwelling catheter or needle attached to a plastic tube with a sealed injection port
on end
PURPOSES
 Used in emergencies with critically unstable patient
 To achieve immediate and maximum effect of a medication
DISADVANTAGES
1. There is no time to correct in case of medication errors
2. Direct irritation to the lining of blood vessels
ARTICLES(EXISTING LINE)
 Clean gloves
 Medication in ampoule or vial
 Syringe
 Sterile needle
 Alcohol swab
 Wrist watch
 Medication card
Articles(fresh line)
 Intravenous lock)
 Medication in vial or ampoule
 Syringe
 Vial of heparin flush solution
 Sterile needles
 Alcohol swab
 Medication card

PROCEDURE
SL. NURSING ACTION RATIONALE
NO
1. Check physicians order for name of medication, Ensures safety and accuracy in medication
dosage, and route of administration administration
2. Collect information necessary to administer drug Allow nurse to give drug safely and to
safely including action, purpose, side-effects, normal monitor patients response to therapy
dose, time of onset, time of peak action, and nursing
implications
3. If drug is to be given through an existing IV line, IV medication may not be compatible with
determine type of additive in iv solution, if any additives
4. Assess the condition of needle insertion site for signs Drugs should not be administered if site is
of infiltration or phlebitis edematous or inflamed.
5. Check patients history of drug allergies Iv bolus delivers drug rapidly. Allergic
reaction could prove fatal.

6. Assemble supplies in medication room Ensures sterile preparation of medication

7. Wash hands and don gloves Reduces transmission of infections

8. Check patients identification by asking name and Ensures that drug is administered to the
compare with medication card correct patient
9. IV push (existing line)
 Explain procedure to patient and encourage
Informs patient of planned therapies
patient to report symptoms of discomfort at
iv site
 Select injection port of iv tubing close to
patient. Whenever possible injection port
should be three-way port or other needless
devices.
 Connect syringe to IV line in needless
systems remove cap of needleless injection]
port. Clean port with antiseptic solution,
 insert standard tip of syringe containing Cleaning of port before insertion prevents
prepared medication introduction n of microorganisms
 In needle system select port indicating site
for needle insertion. Clean port with
Ensures that medications being delivered in
antiseptic swab insert small gauze needle of
the blood stream
syringe containing drug through center of
port.
 Occlude the intravenous line by pinching Rapid injection of an iv drug can be fatal
tubing just above the injection port. Pull
gently back on the syringes plunger to
aspirate for a blood return.
 After noting blood return, inject Determines development of infiltration in
medications slowly over several minutes. to the tissues surrounding vein

 Observe iv site or during injection for sudden

swelling
 Release tubing after injecting medications, Rapid infusion can cause circulatory over
withdraw syringe and recheck the fluid load
infusion rate
10. Dispose off uncapped needles and syringe in Prevents accidental needle sticks
Proper container
11. Remove gloves and wash hands Reduces transmission of microorganisms

12. Observe patient closely for adverse reactions during Iv injections act rapidly
administration

13. Record drug, dose, route and time on medication Timely documentation prevents medication
errors.
14. Report any adverse reactions to nurse in Adverse reactions to iv bolus may
necessitate emergency measures.
Charge or physician

SPECIAL CONSIDERATIONS

 Some medications can only be pushed safely when the patient is being continuously monitored for
dysrhythmias, blood pressure changes or other adverse effects.so check the instructions before
administering medications.
 At times a saline or heparin lock will not yield a blood return even though the lock is patent.
 If iv medications is compatible with iv fluids stop the iv fluids, clamp the iv line flush with 5 ml of
normal saline, give the iv bolus over the appropriate amount of time, flush with another 5ml of normal
saline at the same rate as the medication was administered and then restart the iv fluids at the prescribed
rate.
 CHECKLIST FOR IM INJECTION
STEP YES NO
 Check the physicians order and identify the patient
 Explain the procedure to the patient, the purpose of the medication, the site of injection,
expected effect
 Wash hands
 Prepare medication from ampoule /vial
 Wash hand and don gloves
 Position the patient. Assist the patient to a supine, lateral or prone position depending
on site chosen. If ventrogluteal, have patient in supine position with knees flexed or
lateral position with upper leg flexed or prone with ‘toe in’ position
 Select, locate, clean the site
 Select a site free of lesions, tenderness, swelling, hardness, localized inflammation and
frequently used sites
 Determine whether the size of muscle is adequate for amount of medication to be
injected
 Clean with alcohol swab in circular motion moving from center to periphery–moving
outward up to 5cm
 Transfer and hold the swab between 3rd and 4th of non-dominant hand or place in tray.
Allow site to dry.
 Remove needle cover without contaminating the needle by pulling straight off
 Confirm that medication is not dripping on needle prior to injection. If it is drippinge3
change the needle.
 Inject the medication.
 Grasp and pinch the area surrounding the injection site or spread skin at site as
appropriate
 Hold the syringe between the thumb and forefinger in a pen-holding manner and pierce
skin at site at a 90-degree angle and insert the needle.
 Aspirate by holding the barrel steady with non-dominant hand and pulling back the
plunger with your dominant hand.
 Withdraw needle if blood appears in the syringe, discard and prepare new injection.
 Inject the medication slowly and steadily if blood does not appear in the syringe on
aspiration.
 Withdraw the needle slowly and steadily while supporting at the hub of syringe and
needle.
 With non–dominant hand, support the skin surface using the cotton swab for applying
counter traction at the site supporting the skin surface with the cotton swab
 Apply gentle pressure at the site with a dry sponge and if bleeding is present, continue
applying pressure till bleeding stops. Do not massage.
 Discard the uncapped needle and syringe into appropriate receptacle.
 Remove gloves, wash hands
 Record procedure including the name of medication, dose, site and response of the
patient.
 Assess effectiveness of medication.
 CHECKLIST FOR IV INJECTIONS
STEPS YES NO
1. Check physicians order for name of medication, dosage, and route of administration
2. Collect information necessary to administer drug safely including action, purpose, side-
effects, normal dose, time of onset, time of peak action, and nursing implications
3. If drug is to be given through an existing IV line, determine type of additive in iv
solution, if any
4. Assess the condition of needle insertion site for signs of infiltration or phlebitis
5. Check patients history of drug allergies

6. Assemble supplies in medication room

7. Wash hands and don gloves

8. Check patients identification by asking name and compare with medication card
9. IV push (existing line)
10. Explain procedure to patient and encourage patient to report symptoms of discomfort
at iv site
• Select injection port of iv tubing close to patient. Whenever possible
injection port should be three-way port or other needless devices.
• Connect syringe to IV line in needless systems remove cap of needleless
injection] port. Clean port with antiseptic solution, insert standard tip of
syringe containing prepared medication
11. In needle system select port indicating site for needle insertion. Clean port with
antiseptic swab insert small gauze needle of syringe containing drug through center of
port.
• Occlude the intravenous line by pinching tubing just above the injection
port. Pull gently back on the syringes plunger to aspirate for a blood return.
12. After noting blood return, inject medications slowly over several minutes.
• Observe iv site or during injection for sudden swelling
• Release tubing after injecting medications, withdraw syringe and recheck
the fluid infusion rate
13. Dispose off uncapped needles and syringe in
14. Proper container
15. Remove gloves and wash hands

16. Observe patient closely for adverse reactions during administration

17. Record drug, dose, route and time on medication
18. Report any adverse reactions to nurse in
19. Charge or physician