Intramuscular Injections

Question 1

Equipment

Answer 1

• Alcohol gel
• Gloves x2 sets
• Apron
• Green needle x1
• Syringe
• Patient’s drug chart
• Ampoule of drug (+ diluent if needed)
• Wipe
• Cotton wool
• Clean receptacle
• Sharps bin

Question 2

Complications

Answer 2

• Local infection and abscess formation
• Sciatic nerve injury
• Local fibrosis with repeated injections
• Drug specific complications
• Pain or discomfort (should resolve)

Question 3

Performance of task

Answer 3

Away from patient…

• Collect equipment
• Wash hands
• Don gloves and apron
• Open syringe packet and tear top off the ampoule (after checking, name/dose/route/date) (aseptically)
• Attach these together and draw up required amount (check drug chart) - Draw up correct amount + a little bit more in case of spills
• Flick bubbles out / push out with plunger
• Apply a needle (green) to the syringe
• Change gloves if any reason to believe they are dirty
• Approach patient MANIKIN, (would close door/draw curtains)
• Wash hands
• Don gloves (if not already wearing them)
• Check bed and safety rails are positioned correctly
• Ask patient to turn to lateral position (state this)
• Identify upper outer quadrant of buttock (make this clear)(use greater trochanter as landmark)
• Assess site- inflammation, oedema, infection, skin lesions (state)
• Clean skin with wipe and allow to dry (state)
• Stretch the skin around injection site with thumb and forefinger (make it clear you know not to touch intended puncture site)
• Warn of sharp scratch
• Quickly but gently inject needle into skin at 90 degrees (common sense: if thin/old, use lesser angle or don’t insert needle fully)(90 degrees for exam)
• Insert needle fully - to hub
• Aspirate! - pull plunger BACK a little and see if blood appears (if yes, remove needle, apply pressure and start again with new equipment)
• Inject drug slowly (~1ml/5-10 secs)
• Remove needle
• Apply pressure
• Dispose of needle + syringe

Question 4

After the procedure

Answer 4

Record administration of drug in prescription sheet (state you would do this)
Check welfare

Question 5

Aftercare

Answer 5

Monitor patient for signs of redness, bleeding, swelling, pain
Observe for minimum of 15 mins for sign of drug reaction

Question 6

What would you say to inform the patient about IM injections?

Answer 6

‘today I am going to give you an injection in buttock and as this is a deep muscle, it won’t be too painful and will make you feel better soon’

Question 7

List 5 main injection sites. How do you choose?

Answer 7

Choose site depending upon: general physical status, age, amount of medication to be given

• Upper arm (Deltoid) - most accessible, but only for 1-2mls
• Upper outer quadrant of buttock (Dorsogluteal site) - best site for deep IM injections (can withstand large and repeated injections)(but lowest drug absorption rate and have to avoid sciatic nerve)
• Lateral aspect of the thigh (Vastus lateralis) - easier for deep IM injections if the patient can’t turn onto their side
• Anterior aspect of the thigh (Rectus femoris) - good for self administration and infants
• Ventrogluteal site (Gluteus medius)

Question 8

What do the different colours of needles show?

Answer 8

Size of the needle
The needle (for IM) must be long enough to penetrate the muscle - needle should be inserted all the way to the hub to ensure full length used.
For IM:
Green (21G)or Blue (23G) needles are used depending on weight/amount of fat of patient
(Green for assessment)