INTRAMUSCULAR INJECTION
SUBMITTED TO SUBMITTED BY
DR. SHIVAM KUMAR PRIYANKA KUSHWAHA
SSOCIATE PROFESSOR MISS ( [Link] NURSING 4TH)
MISS DIKSHA GURU SHRI GORAKSHNATH
NURSING TUTOR COLLEGE OF NURSING
GURU SHRI GORAKSHNATH
COLLEGE OF NURSING SUBMITTED ON
INTRODUCTION
A medication administered into a
muscle is know as an intramuscular
injection . The intamuscular route allow
for rapid absorption of specific
medication choosing a muscle is
dependent on the medication volume
and age or size of the patient.
DEFINITION
Intramuscular injection is defines as introduction of
medicine into a muscles in the form of solution.
-According to I Clement
A form of parenteral administration of medication,
where a drug is injected into a deep muscle tissue
-According to Annama Jacob
PURPOSE
• To obtain a quick effect of medicine than is
oral administration and subcutaneous.
• Assures that the total dosage will be
administered and the same will be absorbed
for the systemic action of the drug.
• The medicine that is not suitable for
intavenous administration.
PRINCIPLES
• The knowledge of the anatomy and physiology
of the body is essential for the safe
administration of the injection .
• Injections are means of introducing infection
into the body, if carelessly given
• . Drugs that change the chemical composition
of the blood will endanger the life of the patient,
if not used cautiously.
• Any unfamiliar situation produces anxiety.
• Once a drug is injected it is irretrievable.
Antidote may be available for particular
medications but the best antidote is prevention.
• Organization and planning results in the
economy of time, material and effort.
GENERAL INSTRUCTION
• Give injections only on the doctors written onders .
• Follow strict aseptic techniques.
• Syringes and needles used for injections should be kept separate from those used
for other purpose Always have the syringe and needles in good order.
• Change the needle after withdrawing the drug from a rubber stopped container
before giving injection to the patient
• Observe the five rights of the administration of medicines
• Never use a drug whose expiry date is over
• Always have a patient relaxed and placed in a comfortable position
• Never allow the patient to walk soon after the injection
• Always give a test dose in case of penicillin and all types of sera.
• Expel the air from the syringe before the injection.
• Select the appropriate site for giving injections.
• Rotate the site for patients getting insulin to prevent lip
dystrophy.a
• Use correct technique of injection-The needle inserted
gently and quickly, and the drug injected slowly.
• After inserting the needle, always withdraw the piston to
make sure that it is not in a blood vessel in case of
intramuscular and subcutaneous injections.
• Solution for injection should be clear, sterile, nearly
neutral in reaction.
• Massage the area at the site of injection except in case
of intradermal injections.
• Injection should be charted immediately.
Site of Intramuscular Injections
[Link] gluteal site: Find out the greater trochanter of the femur and the
posterior superior iliac spine drawn an imaginary line between these two
bany prominences. Site will be upper and outer quadrant’
2. Vastus lateralis site: The site is at the outer aspect of the thigh. It is the
area between mid-anterior thigh and mid lateral thigh one hands span from
elbow and great
trochanter to one hands span above knee.
[Link] site: Place the tip of the index finger on the anterior superior
iliac spine of the patient the middle finger just below the iliac crest.
[Link] deltoid site: Locate the lower edge of the acromion process and form
a rectangle. The deltoid area is used to inject very small quantities of non-
irritating drugs.
Methods of Intramuscular Injection Administration
[Link] lock method: Expel the air from the syringe leaving 0.2 ml., stretch the skin
lightly with the index finger. Insert the full needle quickly into the muscle.
Withdraw the piston to confirm that the needle is not in the blood vessel. Push
the piston gently to give the medicine very slowly.
2.Z-tract method: Expel the air from the syringe, displace the skin laterally using
the side of your left hand. Insert the needle, aspirate the placement, inject the
medicine very slowly, marinating tissue displacement wait for ten seconds to
allow the medicine to disperse. Withdraw the needle allowing the displaced tissue
to return to its normal position.
PRELIMINARY ASSESSMENT
• To check the diagnosis and age of the patient.
• The purpose of injection
• To check the doctors order.
• To check the patient details.
• To check the nurses record about previous.
• To check the allergic reactions.
• To check the necessity for giving test dose.
• To check the levels of consciousness and follow
instructions.
• To check the site of injection.
• To check the patient's previous experiences..
Equipment
A tray containing
• Syringe and needles of various size (sterile) .
• Transfer forceps in a jar containing antiseptic
solution.
• Sterile cotton swabs and gauze pieces in sterile
container.
• Methylated spirit in a container.
• Bowl with water.
• Kidney tray and paper bag.
• Drug order sheet.
• Water for injection.
• File to cut upon the ampoules.
• Small covered tray (Sterile) to carry the
prepared injection to the bed side.
Preparation of the Patient and
Environment
• Identify the patient correctly.
• Explain the procedure to the patient.
• Provide privacy.
• Keep the patient's attention away from the
injection by friendly conversation.
• Place the patient in a comfortable and relaxed
position .
• Select a site suitable for the route.
PROCEDURE
1. Check physician's order and identify patient.
2. Explain procedure to patient, the purpose of medication, the site of injection, expected effect and how
he has to cooperate.
3. Wash hands.
4. Prepare medication from ampoule/vial.
5. Wash hands and don gloves.
6. Position patient:Assist patient to a supine, lateral or prone position depending on site chosen. If
ventrogluteal, have patient in supine position with knees flexed or lateral position with upper leg flexed
or prone with "toe in" position.
7. Select, locate and clean site
a. Select a site free of skin lesions, tenderness, swelling, hardness, localized inflammation and one that
has not been frequently used.
b. Determine whether size of muscle is adequate for amount of medication to be injected.
c. Locate exact site for injection.
d. Don gloves.
[Link] with alcohol swab in circular motion moving from center to periphery-moving outward up to 5
cm.
f. Transfer and hold swab between 3rd and 4th finger of non- dominant hand or place in tray. Allow site
to dry. Remove
8. Remove needle cover without contaminating the needle by pulling straight off.
9. Confirm that medication and dosage are correct
10. Ensure that medication is not dripping on needle prior to injection. If it is dripping change needle.
11. Inject the medication
a. Grasp and pinch the area surrounding the injection site or spread skin at site as appropriate.
b. Hold the syringe between the thumb and forefinger in a pen-holding manner and pierce skin at site at a
90 degree angle and insert the needle
c. Aspirate by holding the barrel steady with non-dominant hand and pulling back the plunger with your
dominant hand.
d. Withdraw needle if blood appears in the syringe, discard and prepare new injection.
e. Inject the medication slowly and steadily if blood does not appear in the syringe on aspiration
12. Z-track technique:
A. Pull skin to one side, downward or laterally about an inch using non-dominant hand.
B. Inject medication with airlock at 90 degree angle.
C. Hold needle in place for 10 seconds.
D. Withdraw the needle and release the skin.13. Withdraw the needle slowly and steadily while supporting at the
hub of syringe and needle. With non-dominant hand, support the skin surface using the cotton swab for applying
counter traction at the site.
12. Z-track technique:
A. Pull skin to one side, downward or laterally about an inch using non-dominant hand.
B. Inject medication with airlock at 90 degree angle.
C. Hold needle in place for 10 seconds.
D. Withdraw the needle and release the skin.13. Withdraw the needle slowly and steadily while supporting at
the hub of syringe and needle. With non-dominant hand, support the skin surface using the cotton swab for
applying counter traction at the site.
14. Apply gentle pressure at the site with a dry sponge and if bleeding is present, continue applying pressure
till bleeding stops. Do not massage.
15. Discard the uncapped needle and syringe into appropriate receptacle.
16. Remove gloves, wash hands.
17. Record procedure including the name of medication, dose, site and response of the patient.
18. Assess effectiveness of medication.
After Care.
• Inspect the area for bleeding.
• Help the patient to dress up .
• Ask the patient to take rest for 15 minutes .
• Check the limb movement to confirm there is no nerve
injury.
• Watch for the signs and symptoms of allergic reaction .
• Replace the equipment in the proper place .
• Hand wash.
• Record the procedure on the nurse's record.
SUMMARY
Till now we have discussed about the
introduction, definition, purpose, principle,
general instructions, equipment,
preliminary assessment, preparation of
patients and environment, procedure, after
care .
CONCLUSION
Intramuscular injection commonly result in pain, redness and
swelling or inflammation around the injection site.
These side effects are generally mild and last no more than a
few days at most, rarely never a blood vessel around the
injection site can be damaged, resulting in severe pain or
paralysis
BIBLIOGRAPHY
• Clement I ; procedure textbook of Nursing foundation;2nd
edition; Jaypee publication; page no:224-28
• Jacob Annamma; Textbook of clinical Nursing Procedure
the art of Nursing Practice;3rd edition; Jaypee brother
publication; page no:274-76.
• Ghai Shandhya ; Textbooks of clinical nursing procedure;
Chandigarh CBS Publishers;3rd edition:page no:181-87.
• Clement I ; textbook of nursing foundation; Jaypee
publication;622-625.
