IM injections is an important skill needed for nurses to front-line in their job. this power-point gives all needed information for the students to learn about intramuscular administration of drugs.

1. Intramuscular Injection

2. Intramuscular Injection

3. Intramuscular Injection

4. INTRODUCTION
The IM route provides faster
medication absorption than the
subcutaneous route because of the
greater vascularity of the muscle.
RN is responsible to chose needle
size and gauge.
The angle of insertion for an IM
injection is 90 degrees

5. CONT…
 A normal, well-developed adult patient
tolerates 2 to 5 Ml of medication into a
larger muscle without severe muscle
discomfort.
 Children, older adults, and thin patients
tolerate only 2 mL of an IM injection. Do not
give more than 1 mL to small children and
older infants, and do not give more than 0.5
mL to smaller infants

6. INDICATIONS
•Muscles have more blood supply ,so
quicker action of drugs.
• More amount of drug can be
administered than the intradermal
and subcutaneous tissue.

7. CONTRA-INDICATIONS
•Avoid sites of lesions, lumps,
tissue injury, presence of
nodules other pathology.
•Avoid sites near to large blood
vessels, nerves and bones.

8. Intramuscular Administration
 Administered into a muscle or muscle
group
 Onset: variable
 Volume: up to 4ml
 Equipment: gloves, 1-5 ml syringe,
needle (18-23 g, ⅝ to 3 inch needle),
alcohol swab
 RN is responsible to chose needle
size and gauge.
 Administration angle: 90°

9. Sites for intra muscular
injections
•Deltoid
•Vastus Lateralis
•Ventro Gluteal
•Dorso Gluteal
•Rectus Femoris

10. Deltoid administration
 Deltoid site is easily accessible, this
muscle is not well developed in many
adults. There is a potential or injury
because the axillary, radial, brachial,
and ulnar nerves, as well as the brachial
artery, lie within the upper arm under
the triceps and along the humerus. Use
this site for small medication volumes
(2 mL or less).

11. Intramuscular Administration
Deltoid



Palpate lower edge of
acromion process.
Place 4 fingers across
the deltoid muscle with
the top finger along the
acromion process. This
forms the base of a
triangle.
Draw an imaginary line at
the axilla. This forms the
apex of the triangle.
• Injection site is the center of
the triangle, 3 finger widths (1-2
inches) below the acromion
process.

12. Deltoid Injection Site

13. Vastus Lateralis
•It is thick and well developed in
both adults and children.
•The area is divide into 3 parts
from the greater trochanter of
femur and lateral femoral
condyle.

14. Intramuscular Administration
Vastus Lateralis
•One hand above the knee.
•One hand below the greater
trochanter.
•Locate midline of anterior
thigh and midline of lateral
thigh.
•Injection site is the middle
lateral area of the thigh

16. VENTROGLUTEAL SITE
It is the site where the gluteus medius
muscle lies over the gluteus minimus

17. ADVANTAGES OF VENTROGLUTEAL
SITE
1.No large nerves or blood vessels in this
area.
2.Provides greatest thickness of gluteal
muscles.
3.It is sealed off by bone.
4.Contains less consistency fat than
buttock area.
5.Most suitable for adults and children
over 1 yr

18. PROCEDURE-VENTRO GLUTEAL
1.Place patient on side-lying position, bent the
knees and raise it slightly to chest.(use
alternate hands for hips).
2.Place the nurses heel of hand over the greater
trochanter of patient with fingers pointing
towards head of patient.
3.Index finger should rest on anterior superior
iliac spine, middle finger stretched dorsally.
4.Midpoint of triangle formed between index
finger ,middle finger and iliac crest is the site.

20. DORSO GLUTEAL SITE
• It is composed of the thick gluteal
muscles of the buttocks.
• CONTRA-INDICATION
• Not used for children below 3
years ,because these muscles are
developed by walking.
• Most dangerous site because of sciatic
nerve location

21. PROCEDURE FOR DORSOGLUTEAL
1.Patient is positioned in prone position with
toes facing inwards or side-lying position with
upper knee flexed and in front of the lower
leg.
2. Palpate the posterior superior iliac spine and
draw an imaginary line to the greater
trochanter.(This line is parallel and lateral to
the sciatic nerve ).
3.Injection site is parallel and superior to this
site.

23. RECTUS FEMORIS
• IT BELONGS TO THE QUADRICEPS
GROUP OF MUSCLES.IT IS SITUATED
IN THE ANTERIOR ASPECT OF THE
THIGH

24. Intramuscular Administration
RECTUS FEMORIS
• One hand above the knee.
• One hand below the greater
trochanter.
• Locate midline of anterior
thigh.
• Injection site is the middle
anterior area of the thigh.

25. PROCEDURE

26. STEPS OF IM INJECTION
• ASSESSMENT
1. Assess any drug allergy
2. Specific drug’s action, side-effects
and adverse reactions
3. Client knowledge about the
medication.
4. Client’s age and weight to determine
the site and needle size.

27. • PLANNING
1. CHECK THE PATIENT FILE WITH
PHYSICIAN’S ORDER.
2. GATHER ALL NEEDED EQUIPMENTS: A
tray containing:
• Sterile medication(ampule,vial,prefilled
syringe)
• Syringe and needle of appropriate size.
• Antiseptic swabs and clean gloves
• Kidney tray

29. • IMPLEMENTATION:Medicine
preparation
1. PEFORM THE 3 CHECKS:-Read the
label
When medicine is taken from cart
or cupboard.
Before withdrawing the medicine .
After withdrawing and before
giving the medicine.

30. 2. Also check the expiry date of the drug.
3. Confirm the correct dose and organize
the equipments near the patient.

31. IMPLEMENTATION:PERFORMANCE
1. Perform hand hygiene and wear a clean
glove.
2. Prepare medication from the ampule or
vial .
3. Change the needle after drug withdrawal.
4. Invert syringe to upside and expel the air.
5. Provide privacy to the client.
6. Introduce yourself and explain procedure

32. 7. Position the patient according to the
site.
8. Locate and clean the site –clean site
in a circular movement- start from
centre and move outward about 5
cm.
9. Transfer and hold the swab between
the third and fourth finger of your
non-dominant hand .

34. 10.Remove needle cover without
contaminating needle.
11.Use the Z track method if needed.
12.Holding the syringe between thumb
and forefinger pierce the skin to
muscles quickly and smoothly at 90*
angle.
13.Aspirate by holding barrel of syringe
with non-dominant hand(for 5 to 10
sec).

35. Cont…
14.If blood doesn’t appear inject the medicine.
15.After injection wait for 10 sec to permit the
drug to disperse and remove the needle at the
same angle.
16.Apply gentle pressure with dry sterile
gauze/cotton.
17.Discard all items as per protocol
18.Document in drug chart and nurses notes.
19.Look for effectiveness of medication.

36. Z-track IM Administration
 Method used with irritating
medications
–
–
Vistaril
Iron
 Used to “trap” medication in muscle
and prevent “tracking” of solution
through tissues.

37. Z-track IM Administration
 Prepare medication
 Change needle after drawing up med
 Gather supplies
 Identify site
 Wear gloves
 Cleanse site with alcohol
 Displace skin laterally 1-1 ½ inches from
injection site
 While holding skin, insert needle with a
darting motion, at a 90° angle.

38. Z-track IM Administration









Stabilize needle with thumb and forefinger.
Aspirate.
If no blood, then inject medication slowly and
steady
Wait 10 seconds
Quickly withdrawal needle
Then release skin
Cover site with swab and DO NOT
MASSAGE
DO NOT RECAP. Activate safety feature.
Place needle in sharps container uncapped
Remove gloves

39. ADVANTAGES
• Rapid absorption, except for oily preparations
and suspensions.
• Pain from irritating drug is less because
administration of drug is deep inside the
muscle.
• Allows administration of a larger volume than
does in subcutaneous administration.
• Allows more rapid absorption than
subcutaneous and oral route of administration.

40. Disadvantages
• It may cause irritation and local
reactions.
• Poses risk for tissue and nerve
damage if the site is improperly
located.
• Cannot be used where tissue is
damaged or peripheral circulation is
decreased.