This document provides instructions for administering an intramuscular injection. It discusses selecting an appropriate injection site, such as the ventrogluteal site for clients over 7 months. The nurse should use a 21-23 gauge needle that is 1-2 inches long depending on the client's size and injection site. The nurse should clean the injection site with an alcohol swab, pinch the skin if using the Z-track technique, insert the needle quickly at a 90 degree angle, aspirate to check for blood, slowly inject the medication, hold pressure on the site afterwards, and document the injection. The goal is to safely deliver the medication into the muscle while avoiding nerves and blood vessels.

1. Administering
an Intramuscular Injection
Presented By
Mrs.Usha Rani Kandula, MSc(N),
Assistant professor in Adult health nursing, Department of
Clinical nursing, Arsi University, College of health sciences,
Asella, Ethiopia, Institutional email:
usharani2020@arsiun.edu.et.

2. Intramuscular Injection
-Intramuscular (IM) injections are used to promote rapid drug absorption
and to provide an alternate route when the drug is irritating to
subcutaneous tissue.
-The IM route enhances the absorption rate because there are more
blood vessels in the muscles than in subcutaneous tissue;
-however, the absorption rate may be affected by the client’s circulatory
status.
-The medication volume and appropriate size of the syringe and needle
for administering an IM injection to a particular site.

3. -4 ml for a large muscle (gluteus medius) in a well developed adult.
-1 to 2 ml for less developed muscles in children, elderly, and thin
clients.
-0.5 to 1.0 ml for the deltoid muscle.
-When more than 4 ml is ordered, the medication can be divided into
two different sites.
-There are four common sites for administrating IM injections (see the
accompanying display).
-Injection sites are identified by using appropriate anatomic landmarks.

5. -The primary site for administering an IM injection in clients over 7
months old is the ventro gluteal (VG) site.
-The gluteus medius is a well-developed muscle, free of major nerves
and large blood vessels.
-Research shows that injuries—including fibrosis, nerve damage,
abscess, tissue necrosis, muscle contraction, gangrene, and pain—
have been associated with all the common sites (dorso gluteal, deltoid,
and vastus lateralis, for example) except the VG site.

6. -The nurse should avoid using the deltoid and dorso-gluteal sites in
infants and children.
-There is a risk of striking the sciatic nerve when using the dorso-
gluteal site. -The deltoid muscle is not well developed in infants and
children.

9. -The nurse will need to decide on the gauge and length of the needle
on the basis of the consistency of the solution, the site, and how far the
needle must be injected to reach the muscle.
-A 21- to 23-gauge needle will accommodate the consistency of most
drugs and will minimize tissue injury and subcutaneous leakage.
The needle’s length is determined by the site:
• 1 1/2-inch needle, VG site for average-sized adults
• 1-inch needle, VG site for children
• 1-inch needle, deltoid or vastus lateralis

10. -An obese client usually requires a 2-inch needle to ensure that the
needle will reach a large muscle such as the gluteal muscle.
-The nurse should administer an IM injection at a 90° angle.

11. Z-Track Injection
-The Z-track (zigzag) technique refers to a method used in
administering IM injections .
-This technique was traditionally used when administering imferon, an
iron preparation, which can cause permanent discoloration in the
subcutaneous tissue.
-Today, the technique is used commonly when administering
ventrogluteal and dorsogluteal injections.

12. Equipment
 Medication administration report (MAR)
 Sterile 3-ml syringe and long bevel, 20 to 22 gauge, 1- to 2-inch
needle (average-sized, adult client receiving a drug in an aqueous
solution)
 Medication as prescribed
 Alcohol swab
 Nonsterile gloves
 Sterile 2 × 2 gauze pad

13. Sl.No Action Rationale
1 Check with client and the chart for any
known allergies.
Prevents the occurrence of
hypersensitivity
reactions.
2 Wash hands. Reduces the transmission of
microorganisms.
3 Follow the five rights. Promotes client safety.
4 Prepare the medication from an
ampule or vial; refer to Procedure 29-2
or 29-3 as appropriate.
Add 0.1 to 0.2 ml of air to the syringe. Ensures that all the medication is expelled
from the needle’s shaft.
Take medication to the client’s room
and
place on a clean surface.

14. Sl.No Action Rationale
5 Check the client’s identification
armband.
Accurately identifies the client.
6 Explain the procedure to the client;
provide for privacy.
Reduces the client’s anxiety and
enhances
cooperation.
7 Place the client in an appropriate
position to expose the site.
Provides access to the site, promotes
relaxation of muscles, and decreases the
discomfort from the injection.
Deltoid: sitting position.

15. Sl.No Action Rationale
Ventrogluteal:
Side-lying: flex the knee, pivot the leg
forward from the hip about 20° so it can
rest on the bed.
Supine: flex the knee on the injection
side.
Prone: point toes inward toward each
other to internally rotate the femur.
8 Don nonsterile gloves. Decreases contact with blood and body
fluids.

16. Sl.No Action Rationale
9 Select and clean the site. Avoids potential problems that may
decrease
the rate of the drug’s absorption.
Assess the client’s skin for redness,
scarring, breaks in the skin, and
palpate for lumps or nodules.
Select site using the anatomic
landmarks.
Avoids tissue containing large nerves and
blood vessels.
Cleanse the area with an alcohol swab,
cleanse from inside outward using
friction;
wait 30 seconds to allow to dry.
Removes the surface microorganisms and
prevents the introduction of alcohol into
subcutaneous tissue to avoid irritation.
10 Prepare for the injection.

17. Sl.No Action Rationale
Remove the needle cap by pulling it
straight
off, and expel any air bubbles from the
syringe.
Maintains the sterility of the needle;
ensures
the correct dosage in the syringe.
Pull the skin down or to one side (Z-
track
technique) with nondominant hand.
Decreases the risk of medication’s leaking
into needle track and the subcutaneous
tissue;
reduces complications and discomfort.
11 Administer the injection. Ensures that the needle is injected into the
muscle.
Ventrogluteal: quickly insert the needle
using a dartlike motion and steady
pressure at a 90° angle to the iliac
crest in the middle of the V (Figure 29-
24).

18. Sl.No Action Rationale
Aspirate by pulling back on the plunger,
and
observe for blood.
If blood appears, remove the needle
and
discard.
If blood does not appear, inject the
medication slowly, about 10 sec/ml.
Promotes comfort and allows time for the
tissues to expand and begin absorbing the
medication.
Wait 10 seconds after the medication
has
been injected, then smoothly withdraw
the
needle at the same angle of insertion.
Allows the medication to diffuse through
the
muscle.
Apply gentle pressure at the site with a
dry, sterile 2 × 2 gauze; do not
Decreases tissue irritation.

19. Sl.No Action Rationale
Discard the needle and syringe in a
sharps
container; do not recap the needle.
Prevents needlesticks.
12 Position client for comfort; encourage
client receiving ventrogluteal injections
to perform leg exercises (flexion and
extension).
Promotes the absorption of the
medication.
13 Remove gloves, wash hands. Prevents transmission of microorganisms.
14 Record on the MAR the dosage, route,
site, and time.
Provides documentation that the
medication
was administered.
15 Inspect the injection site within 2 to 4
hours and evaluate the client’s
response to the medication.
Alerts the nurse to hypersensitivity
reactions;
the peak plasma level is dependent on the
drug’s half-life.

24. Thanking you