A nurse, while in nursing school, learns how to give IM (intramuscular) injections. Nurses must prepare to handle many different types of medical care for patients of all ages. One of the many procedures that nurses perform is the intramuscular injection (IM). The process can be very painful if not conducted in the proper manner. Serious medical issues can arise if intramuscular (IM) injections are not performed correctly. It takes a great deal of skill and practice to perform intramuscular injections on patients so nurses must get all the practice that they can in order to master this nursing skill.
How to Give Intramuscular (IM) Injections
Intramuscular injections are part of medical procedures in which medications are injected directly into the muscles. There are certain medications that can only be administered from injections into the patient’s muscles. Depending of the amount or type of medication, intramuscular injections may be necessary. Intramuscular injections are provided for patients who need fast acting medications administered to them.
IM Injection Sites
There are 3 sites that are perfect for intramuscular injections. The best locations to administer intramuscular injections are the:
- Deltoid Muscle
- Ventrogluteal Muscle
- Vastus Lateralis Muscle
Update: Due to recent research, the dorsogluteal site is NO longer recommended as a potential site for a intramuscular injection. WHY? The site is very close to important structures such as the sciatic nerve and blood vessels. In addition, large amounts of fatty tissue can be found at this site, which can lead to a subcutaneous type of injection rather than an intramuscular injection. Therefore, this IM injection site is now AVOIDED.
Selecting the best site is important to prevent injury and proper absorption of the medication. Large muscle sites with little fatty tissue are the best sites for intramuscular injections. Palpate the muscle prior to administering an injection to ensure the muscle is able to support the medicine to be administered. Medical professionals may suggest a particular site to patients so that they experience the least amount of pain during the injections.
Intramuscular injections can be performed using 18-23 gauge needles. For viscous and large amounts of medication be sure to use larger needles. It is possible that patients will faint during the injection process so nurses should take precautions to prevent any type of injury to the patient while administering the intramuscular injection.
Steps on How to Give an IM Injection
Gather supplies: syringe, alcohol pads, 23-gauge, syringe, 1-inch needle, and 2-inch-by-2-inch gauze pad, and adhesive tape.
- Perform hand hygiene and don gloves.
- Use an alcohol pad to prepare the injection site. Wait a few seconds until the alcohol is completely dry before proceeding with the injection.
- Select the best site to administer the intramuscular injection. The deltoid muscle is usually the best site to administer the injections, but medications with volumes greater than 2.5 ml should be injected in the gluteus maximus muscle or one of the other muscles mentioned previously.
- Before penetrating the muscle with the needle, it is important to maintain a 90-degree angle to the patient’s skin. This angle penetrates as little of the patient’s skin as possible. Muscles do not contain as many nerves as skin does so re-positioning the needle while it is in the muscle may cause a great deal of pain in the muscle tissue.
- Inject the medication into the injection site as quickly and firmly as possible. If the patient is very thin or the muscle is very small, you may have to slightly pinch the skin at the injection site (once the needle is inserted release the skin). Inject the needle up to the hub using a controlled manner.
- Inject the medication slowly, so that the patient does not experience trauma to the tissue. The injection speed should be approximately 1 mL per 10 seconds for most vaccinations and medications.
- Remove the needle and engage the safety on the device.
- Secure the site with a band-aid or gauze and tape.
- Doff gloves and perform hand hygiene and document.