Name: ___________________________________________________________________ Date: ______________

Evaluator/Signature: ________________________________________________________ Grade: _____________

ADMINISTERING INTRAMUSCULAR INJECTIONS

Definition:

Purposes:

●
●
●

Equipment:

● Medication chart or the medication ticket

● Vial or ampule of the correct medication
● Syringe and needle (e.g. 2-ml syringe, 25-gauge needle, 3/8 or 5/8 inch long)
● Antiseptic swabs
● Disposable gloves
● Dry sterile gauze for opening an ampule (optional)

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

Special Considerations:

1. Check the medication chart and the medication ticket.

● Check the label of the ampule carefully against the medication chart/ticket to make sure the correct medication is being prepared.
● Follow the three checks for administering medications. Read the label on the medication (1) when it is taken from the medication cabinet, (2) before withdrawing
the medication, (3) after withdrawing the medication.
● Check for allergies.

2. Organize the equipment.

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

 PERFORME

ACTION RATIONALE D REMARKS

YES
NO
1. Wash hands and observe other appropriate
infection control procedures.

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

2. Prepare the drug dosage from a vial or ampule.
If the medication is particularly irritating to
subcutaneous tissue, change the needle on the
syringe before the injection.
3. Provide for client privacy.

4. Prepare the client.

 Check the client’s identification band.
 Assist the client to a supine, lateral,
prone or sitting position, depending on
the chosen site. If the target is the
gluteus medius, have the client in a
supine position, flex the knees; in the
lateral position, flex the upper leg; and
in the prone position, “toe in”.
 Obtain assistance in holding an
uncooperative client.
5. Explain the purpose of the medication and how
it will help, using language that the client can
understand.
6. Select the intramuscular site for adequate
muscle mass. The skin surface over the site
should be free of bruises, abrasions, and
infection. Determine if the size of the muscle is
appropriate to the amount of medication to be
injected. An average adult’s deltoid muscle can
usually absorb 0.5 mL of medication, although
some authorities believe 2 mL can be absorbed
by a well-developed deltoid muscle, and the
gluteus medius muscle can absorb 1-5 mL,
although 5 mL may be very painful.
ACTION RATIONALE PERFORME REMARKS
D

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

 YES NO
8. If injections are to be frequent, alternate sites.
Avoid using the same site twice in a row. If
necessary, discuss an alternate method of
providing the medications with the physician
prescribing it.
9. Establish the exact site for the injection.

10. Put on clean gloves.

11. Clean the site with an antiseptic swab. Using a

circular motion, start at the center and move
outward about 5 cm.
12. Place and hold the swab between the third and
fourth fingers of the non-dominant hand in
readiness for needle withdrawal or position the
swab on the client’s skin above the intended
site. Allow skin to dry prior to injecting the
medication as this will help reduce the
discomfort of the injection.
13. Remove the needle cover without
contaminating the needle.

14. Use the non-dominant hand to spread the skin

at the site.

15. Holding the syringe between the thumb and

forefinger, pierce the skin quickly at a 900
angle, and dart the needle into the muscle.

ACTION RATIONALE PERFORME REMARKS

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

 D
YES NO
16. Aspirate by holding the barrel of the syringe
steady with your non-dominant hand and by
pulling back on the plunger with your dominant
hand. If blood appears in the syringe, withdraw
the needle, discard the syringe, and prepare a
new injection.
17. If blood does not appear, inject the medication
steadily and slowly (approximately 10 sec per
milliliter), while holding the syringe steady.
18. After injection, wait 10 seconds.

19. Withdraw the needle smoothly at the same

angle of insertion.
20. Apply gentle pressure at the site with a dry
gauze or cotton ball.
Variation for a Z-Tract Injection

21. After preparing the medication, attach a clean

sterile needle to the syringe.
22. With the non-dominant hand, pull the skin and
subcutaneous tissue about 2.5-3.5 cm (1-1½ in)
to one side at the injection site.
23. Insert the needle and medication as in steps 14-
16. Withdraw the plunger with the dominant
hand while holding the syringe to ascertain
placement of the needle.
24. Maintain traction while removing the needle
and then permit the skin to return to its normal
position.
25. Do not massage.

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

 PERFORME
ACTION RATIONALE D REMARKS
YES NO
26. Maintain traction while removing the needle
and then permit the skin to return to its normal
position.
27. Do not massage.

28. Document the medication given, dosage, time,

route, assessments, and your signature. Many
agencies prefer that medication administration
is recorded on the medication record. The
nurse’s notes are used when PRN medications
are given or when there is a special problem.
29. Assess the effectiveness of the medication
when it is expected to act.

Variation for Heparin Injection

3. Select the site on the abdomen above the level
of the iliac crests.
4. Use a ½ in., #25 or #26 gauge needle, and
insert it at a 900 angle. Draw 0.1 mL of air into
the syringe when preparing the heparin, and
inject it after the heparin.
5. Check agency practices regarding aspiration.

6. Do not massage the site after the injection.

7. Alternate sites of subsequent injections.

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

 Learner’s Reflection: (What did you learn most of the activity? What is its Instructor’s Comments:
impact to you?)

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41