1. Mayo Clinic Scottsdale
Department of Family Medicine
Introduced by Coleen K. Brown, LPN
Performance Criteria
Teaching Patients How to Self-Administer an
IM Medication

2. Critical Elements
 The nurse provides general information
regarding the medication the patient will be
administering.
•
 Patient should demonstrate am
understanding of the following:
 Explains the correct dose that is to be
administered.
 Uses the correct technique for preparing the
medication.
 Washes hands prior to medication
preparation.
 Dosage calculation if required for correct
dose of ordered medication.
 Opening of vial or ampule (or preparing
medication from a powder if indicated).
 Correct technique for withdrawing the
medication.
 Withdraws the correct amount (understands
the markings on the syringe).
 Correctly identifies IM injection site using
appropriate landmarks.
 Identifies a minimum of two injection sites
that could be used.
 Uses correct technique for holding the
syringe and uses a darting motion to insert the
needle.
 Aspirates to check for blood in the syringe. Is
able to explain what to do if blood appears in
the syringe.
 Gently massages site following injection
using gauze or alcohol pad.
 Lists numbers to call for questions or issues
related to the injection and/or medication.

3. Locating IM injection sites
• Deltoid (shoulder)
• First find the lower edge of the acromial process and
the point on the lateral arm in line with the axilla.
Insert the needle 1” to 2” below the acromial process,
usually two to three fingerbreadths, at a 90-degree
angle or angled slightly toward the process. Typical
injection 0.5ml (range: 0.5ml to 2ml.
• Vastus Lateralis (leg)
• Use the lateral muscle of the quadriceps group, from
a handbreadth below the greater trochanter to a hand
breadth above the knee. Insert the needle into the
middle third of the muscle parallel to the surface on
which the patient is lying. You may have to bunch the
muscle before insertion. Typical injection 1ml to 4ml
(range: 1ml to 5ml; 1ml to 3ml for infants).

4. Identifying the Medication
• The name of the medication. Both brand and
generic names should be discussed.
• The number of milliliters (ml) contained in
the vial or ampule.
• The amount of medication contained in each
milliliter (ml) of liquid.
• How much medication is to be administered.
How much medication is contained in the
vial.
• The last date the medicine is safe to use. Be
certain that the medication is NOT out of
date.
• The color of the medication is correct. What
color should the medicine be? There are no
crystals or lumps in the vial.

5. Identify the Parts of the Syringe
• Familiarize yourself with the parts of
the syringe.
• Needle-the sterile part of the syringe
that goes through the skin.
• Hub-where the needle screws into the
barrel, be sure it is fastened tightly.
• Markings-commonly marked in
milliliters (ml) from 1 to 3.
• Plunger Tip- the part of the plunger
that pushes the medication.
• Barrel-the hollow body part of a
syringe that hold the medication.
• Plunger-what you push to inject the
medication into the muscle tissue.

6. Wash your Hands
• Before you start, wash
your hands with soap and
water and dry well.
• Use gloves if indicated.
This will protect you as
well as the person to
whom you are
administering the injection
to and allow you to grip
the syringe evenly.

7. Gather your supplies.
• What items do I need to give an
intramuscular (IM) injection?
• Alcohol wipes wrapped in foil.
• One sterile dry 2x2 in a paper
wrapper.
• An ampule or vial containing
the medicine.
• The correct size needle and
syringe. Your caregiver should
give you this information.
• You may want to use gloves for
your protection, or protection of
the person receiving the
injection.
• A small band aid dressing.

8. How do I get the medication out of
an ampule?
• An ampule is a tiny bottle with a narrow neck and thin hollow
top. The ampule may be scored to make it easier to break.
• Check the medication and expiration date. Discard any
medication that is not the correct color or contains lumps or
crystals.
• Gently flick the ampule with your finger to make sure the
medication is in the bottom of ampule.
• Wrap a wet alcohol swab around the neck of the ampule. Hold
firmly to the top and the wrapped neck with the fingers of your
writing hand, and the bottom with the fingers of your other
hand.
• Break the ampule at the scored mark.
• Place the bottom of the ampule on a flat surface and discard the
top in a puncture resistant container.
• Attach a filter needle to syringe. Remove the cap from the
needle.
• Carefully insert the needle into the base of the ampule and draw
back gently on the plunger to withdraw the contents.
• Withdraw the needle from the ampule and invert it, gently tap
the sides to remove air while pressing on the plunger, to the
desired marking or amount of medication you intend to
administer. Remove filter needle. Discard both filter needle and
ampule base in puncture resistant container. Attach sterile
needle to administer medication.

9. How do I get the Medicine out of a vial?
• A vial is a small bottle
with a plastic or metal
top covering a rubber
stopper.
• The vial may hold
enough liquid for
several doses or only
one dose.
• The medicine may be
liquid or powder.

10. If the Medicine is a powder it has to
be made into a liquid.
• Your caregiver will order the correct sterile liquid for
injection to add to the powder, this may be referred
to as “diluent” on the package instructions included
from the manufacturer. Use only the liquid your
caregiver ordered as recommended by the
manufacturer. Never use tap water. Never substitute a
liquid that is not intended to mix with your
medication.
• Take the metal or plastic top off the sterile liquid vial
and the medicine vial. Do not remove the rubber
stopper.
• Wipe the top of both vials with the alcohol wipe and
allow to dry.
• Do not touch the tops of the vials after wiping them.
• The vial containing powder medicine is pressurized,
so, you will need to withdraw the correct amount of
air equal to the amount of liquid you are putting in.
In this case, read the written orders from the
caregiver or manufacturer for the correct amount
needed.
• Uncap the needle and puncture the top of the powder
vial and withdraw air in the amount of sterile liquid
you are going to put in. If you are putting in one
milliliter (ml) then you draw out 1ml of air. With
draw the needle.

11. If the medicine is a powder it has to
be made into a liquid.
• Puncture the top of the sterile liquid vial with the
needle tip and press the extracted 1ml of air into it.
• Invert the sterile liquid vial as shown in the diagram
and withdraw the ordered amount, in this case 1ml or
to the “1” marking on the barrel of the syringe by
drawing back on the plunger with your hand.
Withdraw the needle from the vial.
• Insert the needle back into the powder medication
vial and slowly insert the contents of the syringe by
pressing on the needle plunger.
• Gently roll or swirl the medicine vial to mix the
contents into a liquid form.
• Look at the vial once mixed. Is it the correct color?
Discard of all medications that appear cloudy, lumpy
or crystallized if they are supposed to be clear. Check
with your caregiver or pharmacist as to what the
medicine should look like.

12. Drawing up the correct medication
amount from the vial.
• Read the label, what day is the last
day this medication is safe to use?
• Is this the right medication? Be
sure you know both the brand name
and generic names of your
medication. If you are not sure, ask
your caregiver.
• What color is this medication
supposed to be? Discard any
medication that contains lumps or
crystals or is not the right color or
consistency.
• How much medication is in 1
milliliter of liquid?
• How much medication has my
caregiver ordered for me?

13. Drawing up the correct medication
amount from the vial.
• Wash your hands. Use soap and water.
• Remove the metal or plastic cap from the medication vial.
• Clean the top of the rubber stopper with an alcohol wipe and
allow to dry. Do not touch the top of the vial once it is cleaned.
• Grasp the syringe firmly in the hand you hold a writing
instrument with. Check to be sure the needle is tight by holding
the needle cap and twisting gently clockwise into the hub with
your free hand, and remove the cap from the needle.
• Remember, the medication vial is pressurized. Read the
caregiver instructions, if you are to draw up 1ml of liquid in the
vial, draw up 1ml of air into the syringe to inject or replace
what you intend to remove.
• Puncture the rubber stopper of the medicine vial with the needle
and press the needle plunger to inject the air into the vial.
• Invert the medication vial and withdraw the correct amount of
medication into the syringe. Watch the markings until the tip of
the needle plunger is at the correct marking or amount.
• Remove the needle from the vial and gently tap the side of the
syringe while it is pointed upward to remove any air. You can
press gently on the plunger to depress air contained within the
syringe out until the medicine is at the tip of the needle. Check
to be sure you are at the correct marking for the amount you
intend to inject.
• Remember, you may only recap a clean needle, do not recap it
once it has been used for an injection.
• To recap a clean needle, place the needle cap on a hard surface
and scoop it on to the needle and syringe, then press the cap
firmly locking it on to the hub.

14. How do I inject the medicine into a
muscle?
• Wash your hands carefully with soap and water. Put on gloves
if necessary. Open the foil covering the alcohol wipe.
• Wipe the area where the needle will go into the muscle with an
alcohol wipe and allow to dry. Do not blow or fan the area to
dry it.
• By grasping the cover of the needle firmly with one hand and
the barrel of the syringe with your writing hand be sure the
needle is correctly fastened to the hub of the syringe and
remove the cover from the needle.
• Hold the syringe in the hand you use to write with firmly as you
would a writing instrument.
• Depress and grasp the muscle and skin where you plan to give
the injection with your free hand. Keep holding the skin a little
to the side of where you plan to give the shot.
• Use your wrist to insert the needle at a 90 degree angle (straight
in) as if you were using a dart. The needle should go through
the skin easily.
• Let go of the skin with your free hand but leave the needle in
place.
• Pull back gently on the plunger just a little to be sure you are
not in a blood vessel with your free hand or your thumb. (IF
blood comes back, remove the needle immediately. Do not
inject the medicine. If this happens, dispose of the syringe and
start over with a new one. When you give the second shot do it
on the other side).
• Push down on the plunger gently and inject the medicine. Do
not force the medicine by pushing hard on the plunger. Some
medicines hurt more when injected quickly.
• After all of the medicine is injected, pull the needle out at the
same angle it went in and dispose of the syringe and needle in a
puncture resistant container.
• Use the sterile gauze or alcohol wipe to gently press where the
needle went in.
• Apply a small band aid dressing if necessary.

15. How do I get rid of used syringes
and needles?
• Your caregiver or pharmacist may have
provided you with a hard plastic
container made especially for used
needles and syringes like the one in this
picture (puncture resistant). This is
called a “sharps” container. Place the
used syringe into the container as
directed. When this container is full,
secure it tightly as directed on the label
and bring it to the appropriate medical
waste disposal area.
• Keep this container safely out of the
reach of children or pets.
• Call your caregiver or pharmacist to
find out what your state or local
requirements are for disposing of used
syringes or needles.

16. Outcome Criteria
• Wash your hands with soap and water, use
gloves if indicated.
• Gather your supplies: alcohol wipes,
medication, syringe and needle, puncture
proof container, band-aid dressing.
• Check the medication and expiration date.
• Clean the vial with alcohol wipe and allow to
dry.
• Check the syringe and needle.
• Inject air to the vial and invert container to
withdraw the correct amount of medication.
• Remove excess air from syringe by tapping
gently pn the side and expel with plunger.
• Clean the injection site with alcohol wipe and
allow to dry.
• Insert needle into appropriate muscle site at a
90 degree angle using a darting motion, draw
back gently. Remember, if the needle is in a
blood vessel, remove and start over.
• Inject the medication slowly by pressing the
plunger with your thumb.
• Remove needle and discard in puncture
resistant container.
• Gently press the site with gauze or alcohol
wipe and apply band-aid dressing if needed.

17. Bibliography
• Images:
• www.nursesdrughandbook.com
• Accessed 3/27/2006
• /safe_drug_admin/identifying_injection_sites/Deltoid
.jpg
• www.nursesdrughandbook.com
• Accessed 3/27/2006
• /safe_drug_admin/identifying_injection_sites/Vastusl
ateralis.jpg
• pharmlabs.unc.edu
• Accessed 3/27/2006
• /parenterals/equipment/parts_of_syringe.gif
• Text knowledgebase
courtesy of review:
• www.micromedex.com/MICROMEDEX (R)
Healthcare Series-The CareNotes(TM) S
• ystem Vol.36 Pages 1-8
• Accessed 2/1/2006
• How to give an IM injection.
• /Carenotes.sys&txtype=view_doc&t=7287&d=286