1. Similar to any other route of administration, preparing and administering IM medications requires the nurse to be knowledgeable about the patient's medical history, medication allergies, and preferences, as well as on the previous administration times, adverse effects, and purpose of the medication. All this information can be obtained through discussion with the patient and by reviewing the Medication Administration Record (MAR) at the patient bedside.
2. In the case of IM injections, you should be particularly aware of the patient's preference for an injection site and administration process (i.e., whether the patient prefers a particular site and whether he/she prefers you to count down to administration or to swiftly administer the medication).
3. Select the most appropriate site for IM injection depending, upon the type of medication being delivered.
4. Adherence to the ten "rights"—right patient, right medication, right dose, right route, right time, right documentation, right education, right to refuse, right assessment, and right evaluation—at the three checkpoints of the safe medication administration process is imperative to prevent patient injury and harm. To learn about these ten "rights" in detail, please refer to the video entitled "Safety Checks for Acquiring Medications from a Medication Dispensing Device." Remember to wash or sanitize your hands before and after each patient encounter. Vigorous friction for at least 20 seconds should be applied while washing the hands with soap and warm water or while applying hand sanitizer.
5. Upon entering the medication preparation area (this area may be in a secured room or in a secured portion of the nurses' station), complete the first safety check of the ten "rights" of medication administration. Refer to the "Safety Checks for Acquiring Medications from a Medication Dispensing Device" video.
Preparing the IM injection
IM injection preparations are commonly provided in vials or ampules for withdrawal to a syringe. Before withdrawing, it is important that a nurse calculates the volume of the medication to be administered, according to the concentration provided on the container.
6. In the medication preparation area, prepare the IM injection according to the MAR, nurse drug guide, best practices, and institutional policies/procedures. Remove the medication from the box and removing the vial top.
7. In the medication preparation area, complete the second safety check using the ten "rights" of medication administration. Refer to the "Safety Checks for Acquiring Medications from a Medication Dispensing Device" video.
8. In addition to the medication to be administered, be sure to obtain all supplies needed for injection before entering the patient's room. These include an alcohol prep wipe, non-sterile gloves, and an adhesive bandage or a cotton ball and silk/paper tape.
Administration
9. Wash hands when entering the patient room and complete the third and final medication safety check, adhering to the ten "rights" of medication administration. Refer to the "Preparing and Administering Oral and Liquid Medications" video.
Prepare the patient and administer the IM medication
10. As with any medication administration, remind the patient of the medication purpose, any adverse reactions, and administration procedure.
11. Remove bed linens and the patient's gown or clothing to access the selected injection site. Perform injection site selection, as described in step 3, with the deltoid muscle preferred for small volumes and the ventrogluteal for large volumes in adults.
12. Clean gloves should be donned at this time. Make sure to assess if the patient has a latex allergy, or use non-latex gloves to avoid allergic reactions.
13. The z-track technique for IM administration should always be used. The z-track technique prevents medication from leaking into the subcutaneous tissue. Hold the syringe in your dominant hand, and with your non-dominant hand, remove the needle cap.
14. As with any injection, remove the needle smoothly, along the line of insertion; engage the safety device with the thumb of the dominant hand; and immediately place the needle and syringe directly into a "sharps" container.
15. If blood is present after injection, apply an adhesive bandage or cotton ball with silk/paper tape.
16. Replace all clothing and bed linens according to patient preference.
17. Finally, dispose gloves and waste into a garbage receptacle and wash hands with soap and water for at least 20 s, applying vigorous friction.
18. As with any medication, document the medication administration date, time, and location of in the electronic MAR.
19. Prior to leaving the room, remind the patient about any side effects/adverse effects associated with IM injections, such as pain at the site, redness, bruising, or swelling. These should be immediately reported to the nurse.
20. Leave the patient room and wash hands with soap and water for at least 20 s, applying vigorous friction.
Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
Intramuscular (IM) injections deposit medica…
1. Similar to any other route of administration, preparing and administering IM medications requires the nurse to be knowledgeable about the patient's medical history, medication allergies, and preferences, as well as on the previous administration times, adverse effects, and purpose of the medication. All this information can be obtained through discussion with the patient and by reviewing the Medication Administration Record (MAR) at the patient bedside.
2. In the case of IM injections, you should be particularly aware of the patient's preference for an injection site and administration process (i.e., whether the patient prefers a particular site and whether he/she prefers you to count down to administration or to swiftly administer the medication).
3. Select the most appropriate site for IM injection depending, upon the type of medication being delivered.
4. Adherence to the ten "rights"—right patient, right medication, right dose, right route, right time, right documentation, right education, right to refuse, right assessment, and right evaluation—at the three checkpoints of the safe medication administration process is imperative to prevent patient injury and harm. To learn about these ten "rights" in detail, please refer to the video entitled "Safety Checks for Acquiring Medications from a Medication Dispensing Device." Remember to wash or sanitize your hands before and after each patient encounter. Vigorous friction for at least 20 seconds should be applied while washing the hands with soap and warm water or while applying hand sanitizer.
5. Upon entering the medication preparation area (this area may be in a secured room or in a secured portion of the nurses' station), complete the first safety check of the ten "rights" of medication administration. Refer to the "Safety Checks for Acquiring Medications from a Medication Dispensing Device" video.
Preparing the IM injection
IM injection preparations are commonly provided in vials or ampules for withdrawal to a syringe. Before withdrawing, it is important that a nurse calculates the volume of the medication to be administered, according to the concentration provided on the container.
6. In the medication preparation area, prepare the IM injection according to the MAR, nurse drug guide, best practices, and institutional policies/procedures. Remove the medication from the box and removing the vial top.
7. In the medication preparation area, complete the second safety check using the ten "rights" of medication administration. Refer to the "Safety Checks for Acquiring Medications from a Medication Dispensing Device" video.
8. In addition to the medication to be administered, be sure to obtain all supplies needed for injection before entering the patient's room. These include an alcohol prep wipe, non-sterile gloves, and an adhesive bandage or a cotton ball and silk/paper tape.
Administration
9. Wash hands when entering the patient room and complete the third and final medication safety check, adhering to the ten "rights" of medication administration. Refer to the "Preparing and Administering Oral and Liquid Medications" video.
Prepare the patient and administer the IM medication
10. As with any medication administration, remind the patient of the medication purpose, any adverse reactions, and administration procedure.
11. Remove bed linens and the patient's gown or clothing to access the selected injection site. Perform injection site selection, as described in step 3, with the deltoid muscle preferred for small volumes and the ventrogluteal for large volumes in adults.
12. Clean gloves should be donned at this time. Make sure to assess if the patient has a latex allergy, or use non-latex gloves to avoid allergic reactions.
13. The z-track technique for IM administration should always be used. The z-track technique prevents medication from leaking into the subcutaneous tissue. Hold the syringe in your dominant hand, and with your non-dominant hand, remove the needle cap.
14. As with any injection, remove the needle smoothly, along the line of insertion; engage the safety device with the thumb of the dominant hand; and immediately place the needle and syringe directly into a "sharps" container.
15. If blood is present after injection, apply an adhesive bandage or cotton ball with silk/paper tape.
16. Replace all clothing and bed linens according to patient preference.
17. Finally, dispose gloves and waste into a garbage receptacle and wash hands with soap and water for at least 20 s, applying vigorous friction.
18. As with any medication, document the medication administration date, time, and location of in the electronic MAR.
19. Prior to leaving the room, remind the patient about any side effects/adverse effects associated with IM injections, such as pain at the site, redness, bruising, or swelling. These should be immediately reported to the nurse.
20. Leave the patient room and wash hands with soap and water for at least 20 s, applying vigorous friction.
1. Similar to any other route of administration, preparing and administering IM medications requires the nurse to be knowledgeable about the patient's medical history, medication allergies, and preferences, as well as on the previous administration times, adverse effects, and purpose of the medication. All this information can be obtained through discussion with the patient and by reviewing the Medication Administration Record (MAR) at the patient bedside.
2. In the case of IM injections, you should be particularly aware of the patient's preference for an injection site and administration process (i.e., whether the patient prefers a particular site and whether he/she prefers you to count down to administration or to swiftly administer the medication).
3. Select the most appropriate site for IM injection depending, upon the type of medication being delivered.
4. Adherence to the ten "rights"—right patient, right medication, right dose, right route, right time, right documentation, right education, right to refuse, right assessment, and right evaluation—at the three checkpoints of the safe medication administration process is imperative to prevent patient injury and harm. To learn about these ten "rights" in detail, please refer to the video entitled "Safety Checks for Acquiring Medications from a Medication Dispensing Device." Remember to wash or sanitize your hands before and after each patient encounter. Vigorous friction for at least 20 seconds should be applied while washing the hands with soap and warm water or while applying hand sanitizer.
5. Upon entering the medication preparation area (this area may be in a secured room or in a secured portion of the nurses' station), complete the first safety check of the ten "rights" of medication administration. Refer to the "Safety Checks for Acquiring Medications from a Medication Dispensing Device" video.
Preparing the IM injection
IM injection preparations are commonly provided in vials or ampules for withdrawal to a syringe. Before withdrawing, it is important that a nurse calculates the volume of the medication to be administered, according to the concentration provided on the container.
6. In the medication preparation area, prepare the IM injection according to the MAR, nurse drug guide, best practices, and institutional policies/procedures. Remove the medication from the box and removing the vial top.
7. In the medication preparation area, complete the second safety check using the ten "rights" of medication administration. Refer to the "Safety Checks for Acquiring Medications from a Medication Dispensing Device" video.
8. In addition to the medication to be administered, be sure to obtain all supplies needed for injection before entering the patient's room. These include an alcohol prep wipe, non-sterile gloves, and an adhesive bandage or a cotton ball and silk/paper tape.
Administration
9. Wash hands when entering the patient room and complete the third and final medication safety check, adhering to the ten "rights" of medication administration. Refer to the "Preparing and Administering Oral and Liquid Medications" video.
Prepare the patient and administer the IM medication
10. As with any medication administration, remind the patient of the medication purpose, any adverse reactions, and administration procedure.
11. Remove bed linens and the patient's gown or clothing to access the selected injection site. Perform injection site selection, as described in step 3, with the deltoid muscle preferred for small volumes and the ventrogluteal for large volumes in adults.
12. Clean gloves should be donned at this time. Make sure to assess if the patient has a latex allergy, or use non-latex gloves to avoid allergic reactions.
13. The z-track technique for IM administration should always be used. The z-track technique prevents medication from leaking into the subcutaneous tissue. Hold the syringe in your dominant hand, and with your non-dominant hand, remove the needle cap.
14. As with any injection, remove the needle smoothly, along the line of insertion; engage the safety device with the thumb of the dominant hand; and immediately place the needle and syringe directly into a "sharps" container.
15. If blood is present after injection, apply an adhesive bandage or cotton ball with silk/paper tape.
16. Replace all clothing and bed linens according to patient preference.
17. Finally, dispose gloves and waste into a garbage receptacle and wash hands with soap and water for at least 20 s, applying vigorous friction.
18. As with any medication, document the medication administration date, time, and location of in the electronic MAR.
19. Prior to leaving the room, remind the patient about any side effects/adverse effects associated with IM injections, such as pain at the site, redness, bruising, or swelling. These should be immediately reported to the nurse.
20. Leave the patient room and wash hands with soap and water for at least 20 s, applying vigorous friction.
Q1: What are the main advantages of administering intramuscular injections?
Intramuscular injections deposit medications deep into muscle tissue, which is well perfused for quick drug uptake and allows administration of large volumes. Skeletal muscles have fewer pain-sensing nerves than subcutaneous tissue, making this route less painful for irritating drugs like chlorpromazine. IM injections suit patients unable to take oral medications or uncooperative patients.
Q2: Which medications are commonly delivered by intramuscular injection?
Common medications administered via intramuscular injection include antibiotics, hormones, and vaccinations. The route's ability to deliver large volumes and provide rapid uptake makes it ideal for these drug classes. Before administering any IM injection, nurses must verify the medication is appropriate for the patient's medical conditions, allergies, and current clinical status.
Q3: What patient factors should nurses assess before administering an intramuscular injection?
Nurses must assess the patient's muscle mass to determine appropriate needle size and verify previous injection sites to ensure no adverse reactions occurred. Additionally, nurses should confirm the medication is suitable given the patient's medical conditions, allergies, and clinical status. These assessments ensure safe and effective drug delivery tailored to individual patient needs.
Q4: What are the recommended sites for intramuscular injections?
Recommended IM injection sites include the deltoid muscle of the shoulder, vastus lateralis of the thigh, and ventrogluteal or gluteus medius muscles of the hip. The dorsogluteal muscle should be avoided due to increased risk of hitting blood vessels, nerves, or bone. Site selection depends on muscle mass, accessibility, and patient comfort.
Q5: Why is the dorsogluteal muscle not recommended for intramuscular injections?
The dorsogluteal muscle is associated with an increased risk of hitting blood vessels, nerves, or bone, making it an unsafe injection site. This anatomical risk makes alternative sites like the deltoid, vastus lateralis, ventrogluteal, or gluteus medius muscles preferable. Nurses should prioritize safer injection locations to prevent complications and ensure patient safety.
Q6: How does intramuscular injection differ from other medication administration routes?
Intramuscular injections deposit medication deep into muscle tissue for rapid uptake and large-volume administration, unlike preparing and administering subcutaneous medications. The well-perfused muscle tissue enables quick drug absorption, while fewer pain-sensing nerves reduce discomfort. This route suits patients unable to take oral medications and those requiring faster therapeutic effects.
Q7: What pre-administration checks must nurses perform for intramuscular injections?
Before administering an IM injection, nurses must verify the medication is appropriate for the patient's medical conditions, allergies, and clinical status. Assess muscle mass to select the correct needle size and check previous injection sites for adverse reactions. Following safety checks and ten rights of medication administration ensures safe, effective delivery and prevents complications.
Chapters in this video
0:00
Overview
0:49
Considerations for Site and Needle Selection
2:56
Preparation
7:10
Administration
12:07
Summary
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