This document provides information about intramuscular injections. It begins by defining an intramuscular injection as injecting medication into deep muscle tissue using a long needle. Medication is absorbed intermediately through the large blood supply in muscle tissue. Common sites for injections include the ventrogluteal, vastus lateralis, rectus femoris, and deltoid muscles. The procedure, required supplies, and potential complications are also outlined. Complications can include fibrosis, nerve damage, abscess, infection, and allergic reaction.

1. INTRMUSCULAR
INJECTION
Presented by: Ganga Tiwari
Bsc Nsg 4th year, Teaching learning
TU, IOM, MNC, Kathmandu Nepal

2. Introduction
 It is a form of parenteral administration
of medication. Where a drug is
injected into the deep muscle tissue,
in the form of solution.
 Medication administered in IM
injection usually is absorbed
intermediately
 Muscle tissue having a large blood
supply promotes quick absorption.

3. Contd..
 Longer and heavier gauge (20 to 22)
needle is required to reach deep
muscle tissue. An obese patient
requires 3 inch and a thin patient
require ½ to 1 inch needle.
 Amount: Up to 3 ml of medication can
be given by this route.
 Angle of injection is 72 to 90 degrees.

4. Common sites
 Ventro gluteal
 Vastus lateralis
 Rectus femoris
 Deltoid
 ventrogluteal

5. Ventrogluteal site

7. Vastus lateralis and rectus
femoris.

8. Vastus lateralis
 Lacks major nerve and blood vessels.
 Rapid drug absorption.
 Preferred site for infants( less than 1
year) and children receiving
immunization.
 Also used for adults.

9. Rectus femoris
 It is also the site of choice for infants
and children.
 It can be used for adults.

10. Deltoid

11. Deltoid
 Easily accessible but muscles not well
developed in most patient.
 Used for small amount of drugs( up to
1 ml)
 Not used for infants and children with
underdeveloped muscle.
 Potential for injury to radial ulnar ,
brachial nerve and artery.
 Recommended side for site for
hepatitis , tetanus and rabies
vaccines.

12. Dorsogluteal site

14. Dorsogluteal site
 This site has been associated with
significant injury. causing pain
,temporary and permanent paralysis
.Mainly due to sciatic nerve injury.
 Also there is chance of subcutaneous
tissue irritation.

15. Articles required
 Cardex
 Medication tray
 Kidney tray
 Medication ( ampule / vial/ prefilled
syringe)
 ampule cutter or opener
 Sterile syringe and needle
 Disposable gloves
 Spirit swab
 Dry gauze piece or cotton.

16. Procedure
 Check the medication instructions,
Identify the patient.
 Explain the procedure to the patient the
purpose of medication, the site of
injection, expected effects and how to
co- operate.
 Wash hands
 Prepare the necessary articles prepare
the necessary medication from vial or
ampule) and bring the articles in the
patient bed site.

17. Contd..
 Maintain the privacy.
 Select the appropriate site by
inspecting muscle size and integrity
consider volume of medication to be
injected.
 Position the patient according to the
site selected (supine, lateral, prone,
sitting depending upon the site).
 Locate the exact site for injection.

18. Contd..
 Wear gloves.
 Clean the area around the injection
site with a spirit swab. Allow
antiseptic to dry.
 Confirm the medication and the dose
is correct.
 Remove the needle without
contaminating the needle by pulling it
straight off.

19. Contd..
 Ensure that medication is not dripping
on the needle prior to injection. If it is
dripping change the needle.
Medication on outside the needle can
cause pain and irritation of
subcutaneous tissue when it passes
into the muscle.

20. Contd..
 Grasp and pinch the area surrounding
the injection site or spread skin at the
site as appropriate. Hold the dry
cotton in between third and fourth
finger.
 Hold on syringe between thumb and
the fore finger in a pen holding
manner and pierce skin at 90 degree
angle and insert the needle.

21. Contd..
 Aspirate by holding barrel steady with
non-dominant hand and pulling back the
plunger with the dominant hand.
Aspiration helps in checking if the needle
is in blood vessel.
 Withdraw needle if blood appears in the
syringe, discard it and prepare new
injection.
 Inject the medication slowly and steadily
if blood does not appear in the syringe
on aspiration

22. Contd..
 Withdraw the needle slowly and
steadily while supporting the hub of
the syringe with non-dominant,
Support the skin surface using cotton
swab for applying counter traction at
the site.
 Apply gentle pressure at the site with
dry cotton. If bleeding is continue
applying pressure till the bleeding
stops.

23. Contd..
 Discard the uncapped needle and
syringe into the puncture proof
container. And other soiled articles in
the appropriate container.
 Remove gloves and wash hands.
 Document the medication.
 Assess effectiveness of medications

24. Z track method
 This method is used for intramuscular
injection while administering
medications which irritates the skin
and subcutaneous tissue.
 It minimizes irritation as it seals the
medication in muscle tissue.

25. Contd..
 To use z- track method
 Apply a new needle to the syringe
after preparing the medication so that
no medication remains on the needle
shaft.
 Then choose an IM site preferable in
larger and deep muscle such as
ventrogluteal muscle.

26. Contd..
 Pull the overlying skin and the
subcutaneous tissue approximately
2.5 to 3.5 (1 to 1 ½ inches) laterally to
the side with the ulnar site of the non-
dominant. Hold the skin in this position
until you administer the injection.

27. Contd..
 After preparing the site with antiseptic
swab .Inject the needle deep into the
muscle.
 Slowly inject the medication if no blood
appears on aspiration.
 Keep the needle inserted for 10 seconds
so the medication disperses evenly.
 This leaves the zig –zag path that seals
the needle track.
 The medication can’t escape from the
muscle tissue.

28. Z track method

29. Z track method

30. Complications
 Fibrosis
 Nerve damage(mainly sciatic ,brachial, radial
and ulnar nerve damage leading to the
paralysis)
 Abscess
 Tissue necrosis
 Infection.
 Periostitis
 Injury to the blood vessels and bone
 Cellulitis.
 Allergic reaction
 Hemorrhage in case of bleeding disorders.

31. Fibrosis

32. Abscess

33. Allergic reaction

34. Cellulitis

35. Questions ????
1.What is intramuscular injection?
2.What are the purposes of
intramuscular injection?
3.What are the common sites for IM
injection?
4.What are the articles required for IM
injection?
5. What are the complications of IM
injection?

36. References
 Basvanthappa,B.T.(2004).
Fundamentals of Nursing. New Delhi
:Jaypee Brothers.
 Perry, A.G. and Potter, P.A.
(2007).Basic Nursing Essentials For
Practice .(sixth edition): Mosby
 Giri, M. and Sharma,P. (2013).
Essential Fundamental Of
Nursing.(first edition).Kathmandu:
Medhavi Publication.

37. References
 Pathak ,S.and Devkota ,R.(2011).A Textbook
Of Fundamentals of Nursing.(second
edition).Kathmandu:Vidyarthi Prakashan.
 Taylor,C.R. and Lillis,C.(2008). Fundamental
Of Nursing.(Volume1):Lipincott William and
Willikins
 Health learning material center. Institute Of
Medicine,Tribhuvan University.Fundamental
Of Nursing (Second Edition
,reprint,2010).Kathmandu Dillibazar. Heidel
Press.
 Skidmere,L.(2009).Nursing Drug
Referance:Mosby

38. THANK YOU !!