33 - Nursing Skills Laboratory Online!



Administering an Intramuscular Injection

Goal: The patient receives the medication via the intramuscular route.

*Indicates a critical behavior that must be performed in order to pass the skill successfully.

1. *Gather equipment. Check each medication order against the original primary care provider’s order.

Check the patient's chart for allergies.

2. *Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and a

adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.

3. *Perform hand hygiene.

4. Read the MAR and select the proper medication from the patient's medication drawer or unit stock.

5. *Compare the label with the MAR. Check expiration dates and perform calculations, if necessary.

6. If necessary, remove the cap that protects the rubber stopper on each vial.

7. *Cleanse the rubber tops with antimicrobial swabs.

8. While the cap is on, draw back an amount of air into the syringe that is equal to the dose of medication

to be withdrawn.

9. *Hold the vial on a flat surface. Pierce the rubber stopper in the center with the needle tip and inject the

measured air into the space above the solution. Do not inject air into the solution. Keep the needle in the vial. Invert vial. Hold the vial in one hand and use the other to withdraw the medication. Touch the plunger at the knob only. Draw up the prescribed amount of medication while holding the syringe at eye level and vertically. Check that there are no air bubbles in the syringe. Turn the vial over, set on flat surface, and then remove needle from vial.

10. *Check the amount of medication in the syringe with the medication dose and discard any surplus.

Passively recap the needle. If it is the agency policy, change the needle to a new 1-1.5” needle

for administration.

11. *On a patient label, write the drug, dose, and route. Attach to the syringe so you can still see the

medication and markings.

12. Transport MAR, medications, and alcohol swab to the patient's bedside, keeping the medications

in sight at all times.

13. Ensure that the patient receives the medications at the correct time.

14. *Identify the patient. Ask patient to state their name and date of birth and compare the information

stated with that on the wrist band and the MAR. Scan the patient’s arm band.

15. *Ask patient about allergies and check allergy bracelet (if present). Explain the purpose and action of

the medication to the patient. If medication is for pain, assess pain using the 0-10 pain scale

“where 0 is no pain and 10 is the worst pain you could imagine.”

16. *Close the door to the room or pull the bedside curtain. Tell the patient the medication and the

amount (mg, mEq, unit, etc.) Scan each med as you are checking it against the MAR for the third

and final check.

17. Complete necessary assessments before administering medications.

18. *Put on clean gloves.

19. *Select an appropriate administration site (see below).

20. Assist the patient to the appropriate position for the site chosen. Drape as needed to expose only

area of site to be used.

21. *Identify the appropriate landmarks for the site chosen.

22. *Clean the area around the injection site with an antimicrobial swab. Use a firm, circular motion while

moving outward from the injection site. Allow area to dry.

23. Remove the needle cap by pulling it straight off with one hand while holding the syringe in your

dominant hand between the thumb and forefinger. Discard the cap in trash can. This removes

the temptation to recap, thereby decreasing the likelihood of a possible needle-stick injury with a

contaminated needle.

24. *Without touching the area you just cleaned, displace the skin in a Z-track manner by pulling the skin

to one side about 1" with your

nondominant hand and hold the skin and tissue in this position.

25. *Quickly dart the needle into the tissue at a 90-degree angle so that the needle is perpendicular to the

patient's body.

26. *As soon as the needle is in place, use your thumb and forefinger of your nondominant hand (while

still maintaining Z-track) to hold the lower end of the syringe. Move your dominant hand to the end of the plunger.

27. *Inject the solution slowly (10 seconds per milliliter of medication).

28. Once the medication has been instilled, wait up to 10 seconds (if possible) before withdrawing the

needle and continue to hold syringe and the skin taut.

29. *With your nondominant hand (still holding the syringe and Z-track), withdraw the needle smoothly

and steadily at the same angle at which it was inserted.

30. Do not massage area after removing needle. If needed, apply gentle pressure at the site with a dry

gauze.

31. *NEVER recap a used needle. Engage the safety shield or needle guard, if present. Discard the

needle and syringe in sharps receptacle.

32. *Remove gloves and dispose of them properly.

33. *Leave the patient in a comfortable position with the bed in the lowest position, side rails up, call bell

within reach and the bed locked.

34. *Perform hand hygiene.

34. *Document patient’s pain level before medication administered. Evaluate patient's response to

medication within an appropriate time frame and document. Assess injection site within 30 min after

administration.

*The deltoid takes a 1 inch needle. All lower body IM sites take 1 to 1-1/2 inch needle length

* Deltoid muscle can hold 1-2ml of medication

* Dorsogluteal, ventrogluteal, and vastus lateralis muscles can hold 3-4 ml of medication

Callahan, B. (Ed.) (2019) Clinical nursing skills: a concept based approach to learning. Boston: Pearson

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