Equipment
■ Syringe and needle appropriate for volume and site.
■ Alcohol prep pad or CHG-alcohol product.
■ Gauze pad or adhesive bandage.
■ Medication.
■ Procedure gloves.
■ Biohazard (sharps) container.
■ Small piece of gauze or cotton ball.
■ Small adhesive bandage.
Assessment
■ Identify the site of the previous injection.
■ Assess the site for adequate muscle mass, bruises, edema, tenderness, redness, or other abnormalities.
■ Assess for factors that affect absorption of the medication (e.g., decreased IM blood flow, as found in shock).
Post-Procedure Reassessment
■ Observe for bruising or oozing at the site of injection.
■ Observe for local reactions at site (e.g., pain, swelling, redness).
Key Points
■ Maintain sterile technique and standard precautions.
■ Use a 1- to 5-mL syringe and a 21- to 25-gauge, 1- to 3-in. needle (longer needle if the patient is obese).
■ The usual volume per injection is no more than 3 mL.
■ Select an appropriate injection site; identify the site using anatomical landmarks.
■ Be Smart! The ventrogluteal site is preferred. The deltoid site is acceptable for smaller doses and adult vaccines.
■ Be Smart! When giving more than one injection, rotate sites.
■ Position the patient so that the injection site is well exposed and the patient is able to relax the appropriate muscles. Ensure good lighting.
■ Cleanse the site with an antiseptic swab; allow the site to dry.
■ With the side of your nondominant hand, displace the skin away from the injection site, about 2.5 to 3.5 cm (1 to 1.5 in.).
■ Hold the syringe like a dart and briskly insert the needle at a 90° angle to the skin surface. Insert fully.
■ Stabilize the syringe with the thumb and forefinger of your nondominant hand. Keep displacing the skin with your other three fingers.
■ Be Safe! Aspirate before injecting.
■ Press the plunger at a 90° angle and slowly to inject the medication.
■ Wait for 10 seconds; then remove the needle smoothly along the line of insertion. Release the skin.
■ Engage the safety needle device, and dispose of supplies in a biohazard container.
■ Gently blot the site with a gauze pad, and apply an adhesive bandage as needed.
Documentation
■ Record scheduled medications on the MAR.
■ Record PRN medications, including the reason given and response.
■ Record medication, time, dose, and route given.
■ Document therapeutic and adverse drug effects, nursing interventions, and teaching.
■ Document assessment data before, during, and after injection (e.g., pain, bruising, or bleeding at the site).
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| Displacing the skin and subcutaneous tissue over the muscle |
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| Giving an IM injection while stabilizing the syringe |
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