Intramuscular medications

Question 1

PPE

Answer 1

Hand hygiene, disposable gloves, sharps box

Question 2

Indications

Answer 2

administration of drugs
via intramuscular route

Hydrocortisone - Life threatening asthma, COPD exacerbation, adrenal crisis
Adrenaline 1:1000 - Anaphylaxis, Life threatening asthma
Glucagon - Hypoglycemia

Question 3

Contraindications

Answer 3

when other routes are more
clinically appropriate

Infection at site

Cardiac arrest

Question 4

Cautions

Answer 4

Absorption impaired in cold, hypovolaemic and hemodynamically compromised patients

Question 5

Confirm medication indications

Answer 5

Using JRCALC or PGD to confirm
medication:
Indications
Contraindications
Cautions
Side effects

Question 6

Confirm medication 5 R’s

Answer 6

1. Right drug
2. Right dose/presentation
3. Right route
4. Right patient (inc. age)
5. Right time

Question 7

Check medication

Answer 7

Expiry date
Integrity of packaging
Clarity of contents (if relevant)

Question 8

Allergies

Answer 8

Confirm patient has no allergies or
previous sensitivities to
medication.

Question 9

Prepare equipment

Answer 9

Select syringe, select needle, drawing up needle, alcohol prep wipe, gauze, sharps box

Question 10

Inform patient

Answer 10

Inform the patient on:
Medication they are to receive
Potential effects
The procedure

Gain consent

Question 11

Prepare patient

Answer 11

Select injection site appropriate to
the patient and the drug involved

Expose site by removing clothing,
as necessary.

Position patient to expose and
relax the muscle.

Question 12

Open ampoule

Answer 12

Ensure all liquid is in the main body
of the ampoule.

Place a disposable ampoule opener
over the cone-shaped top of the
ampoule.

With the dot facing
away from you, snap the neck of
the ampoule and dispose the top
of the ampoule in the sharps bin.

Ensure no glass fragments within
remaining ampoule.

Question 13

Draw up drug

Answer 13

With a drawing up needle, draw
medication into the syringe.

Dispose empty ampoule in the
sharps bin

Question 14

Remove air

Answer 14

Holding the syringe upright, gently
tap the barrel to encourage any air
bubbles to rise to the top of the
syringe.

Remove the air bubbles by gently
pressing the plunger.

Dispose of the needle used to draw
up the drug into the sharps bin.

Question 15

Inject drug

Answer 15

Locate site

Prepare site by antiseptic swabbing in circles

Use Z-track method to hold skin
taut over site

Push needle firmly and quickly into
injection site at 90°, using a dart
like method, in one continuous
motion.

Pull plunger back and inspect it for blood return.

If no blood returns into syringe,
push plunger in to inject drug at
rate of 1 mL per 5–10 seconds.

If blood does return, withdraw
needle, discard, prepare new
syringe and repeat.

Once drug has been injected, hold
needle in place for 10 seconds.
Withdraw needle quickly and
discard immediately into sharps
waste container.

Question 16

Post injection

Answer 16

Release Z-track tension.
Press over site for 10 seconds.

Place small plaster over site.

Monitor patient for drug
effectiveness and adverse effects.

Question 17

Report

Answer 17

Document dose, delivery, time, and
effects of the drug.
Record the batch number and
expiry date.
Hand over, including therapeutic
benefit/adverse reaction.