Im Injection
IM injections deposit medication deep into muscle tissue. This route of administration provides rapid systemic action and absorption of relatively large doses (up to 4 mL in appropriate sites). IM injections are recommended for patients who can’t take medication orally, when IV administration is inappropriate, and for drugs that are altered by digestive juices. Because muscle tissue has few sensory nerves, IM injections allow for less painful administration of irritating drugs.
The site for an IM injection must be chosen carefully, taking into account the patient’s general physical status and the purpose of the injection. IM injections shouldn’t be administered at inflamed, edematous, or irritated sites or at sites that contain moles, birthmarks, scar tissue, or other lesions. IM injections may also be contraindicated in patients with impaired coagulation mechanisms, occlusive peripheral vascular disease, edema, and shock; after thrombolytic therapy; and during an acute myocardial infarction (MI) because these conditions impair peripheral absorption. IM injections require sterile technique to maintain the integrity of muscle tissue.
Equipment
Patient’s medication administration record ▪ prescribed medication ▪ sterile syringe and needle of appropriate size and gauge ▪ gloves ▪ alcohol pads ▪ Optional: gauze pad, 1″ tape, ice, filter needle.
The prescribed medication must be sterile. The needle may be packaged separately or already attached to the syringe. (See Selecting the appropriate syringe and needle.)
Preparation of Equipment
Verify the order on the patient’s medication record by checking it against the doctor’s order.1 Also note whether the patient has any allergies, especially before the first dose. Perform hand hygiene.2,3,4 Avoid distractions and interruptions when preparing and administering medications to prevent medication errors.5
Check the prescribed medication for color and clarity. Also note the expiration date.6 Never use medication that is cloudy or discolored or that contains a precipitate unless the manufacturer’s instructions allow it. Remember that for some drugs (such as suspensions), the presence of drug particles is normal. Observe for abnormal changes. If in doubt, check with the pharmacist.
Choose equipment appropriate to the prescribed medication and injection site, and make sure it works properly. The needle should be straight, smooth, and free of burrs.
For Single-Dose Ampules
Wrap an alcohol pad around the ampule’s neck and snap off the top, directing the force away from your body. Attach a filter needle to the syringe and withdraw the medication, keeping the needle’s bevel tip below the level of the solution. Tap the syringe to clear air from it. Cover the needle with the needle sheath.
Before discarding the ampule, check the medication label against the patient’s medication record.1 Discard the filter needle and the ampule. Attach the appropriate needle to the syringe.
Selecting the Appropriate Syringe and Needle
For an IM injection, the size of the syringe and the gauge and length of the needle are determined by several factors, including the amount and viscosity of the medication, the injection site chosen, and the patient’s weight and amount of adipose tissue. Needles used for IM injections are longer than subcutaneous needles because they must reach deep into the muscle.
The volume of medication administered IM is usually 1 to 4 mL, so a 3- or 5-mL syringe is usually appropriate. The appropriate gauge of the needle is determined by the medication being administered. Biologic agents and medications in aqueous solutions should be administered with a 20G to 25G needle. Medications in oil-based solutions should be administered with an 18G to 25G needle.
Needle length depends on the injection site, the patient’s size, and the amount of subcutaneous fat covering the muscle. Patients who are obese may require a longer needle (1½″ or longer) and thin or emaciated patients may require a shorter needle (½″ to 1”).9 Needle lengths are based on the injection site chosen for an adult patient:
Vastus lateralis:½″ to 1″
Deltoid: ½″ to 1½″
Ventrogluteal: ½″ to 1½″
For Single-Dose or Multidose Vials
Reconstitute powdered drugs according to instructions. Make sure all crystals have dissolved in the solution. Warm the vial by rolling it between your palms to help the drug dissolve faster.
Wipe the stopper of the medication vial with an alcohol pad, and then draw up the prescribed amount of medication. Read the medication label as you select the medication, as you draw it up, and after you have drawn it up to verify the correct dosage.1
Don’t use an air bubble in the syringe. Modern disposable syringes are calibrated to give the correct dose without an air bubble.
Gather all necessary equipment and proceed to the patient’s room.
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.7
If your facility uses a bar code scanning system, scan your identification badge, the patient’s identification bracelet, and the medication’s bar code or follow the procedure for your facility’s bar code system.
Provide privacy and explain the procedure to the patient.
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