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clinical patient care

Intramuscular (IM) Injection

An intramuscular (IM) injection places medication into a muscle.

16 steps4 criticalLimit 5 minAlways tested

Steps

  1. 1Check the order and clarify anything that is unclear
  2. 2Critical stepPerform hand hygiene
  3. 3Critical stepVerify the medication against the order, including the expiration date, using the rights of medication administration
  4. 4Confirm the patient's identity with two identifiers, ask about allergies, and explain the procedure
  5. 5Put on nonsterile gloves if contact with blood or body fluids is likely or skin is not intact
  6. 6Choose a site that suits the patient and the medication: ventrogluteal, vastus lateralis or deltoid, free of pain, infection or abrasions
  7. 7Clean the site with an alcohol swab in a circular motion and let it dry
  8. 8Critical stepStabilize the skin around the injection site with your nondominant hand; if the Z-track method is ordered or the medication calls for it, pull the skin to the side and keep holding it
  9. 9Insert the needle quickly at a 90 degree angle, like a dart
  10. 10Aspirate only if agency policy and the manufacturer call for it; CDC says aspiration is not necessary before injecting vaccines
  11. 11Inject the medication slowly and steadily
  12. 12Leave the needle in for 10 seconds, then withdraw it smoothly at the same angle and release the skin
  13. 13Critical stepApply gentle pressure with gauze and do not rub the site; assess the site
  14. 14Activate the needle safety feature and place the needle and syringe straight into a sharps container without recapping
  15. 15Remove gloves and perform hand hygiene
  16. 16Document the medication given, including the site used, and anything else your facility requires

What graders are watching for

Tips
  • The ventrogluteal site is generally recommended for adults and is the preferred site for oily and irritating solutions; avoid the dorsogluteal site.
  • Z-track: hold the skin to the side through the injection and the 10 second wait, and release only after the needle is out.
  • Aspiration: follow agency policy and the manufacturer; CDC says it is not necessary for vaccines.

Common mistakes

  • Using the dorsogluteal site.
  • Rubbing the site afterward.
  • Releasing the Z-track skin too early.
  • Aspirating on vaccines out of habit.
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