How

to Administer Injections?

Dr.U.P.Rathnakar
MD. DIH. PGDHM

www.pharmacologyfordummies.blogspot.com
www.scribd.com

INTRAMUSCULAR(IM)INJECTION
PreferredrouteFairlyrapidactingandlonglasting.
Medicationsthatareirritating[mild]maybegiveninto
thedeepmuscletissue.
Absorbedgraduallyintothebloodstream.
I.M.injectionisthesafest,easiest,andbesttoleratedof
theinjectionroutes.

GatherEquipment.
Needleandsyringe,
Antisepticpads,
Adhesivebandages(suchas
BandAid),
EmergencyTray.

GatherEquipment.

TheneedleNotlessthanoneinch
Notmorethanoneandonehalfincheslong
(20to22gauge).
Amaximumvolumeofmedicationoffivecc
perinjectioncanbeadministeredatonesiteto
anadult[Gluteal]

Preparation

Wash Hands
Check Expiration Date of Medication
Identify Patient Ref Case Record
Ask one question to patient "What is
your name?"
Draw Medication into Syringe

Prepare the Patient.

H/o

allergies
Females -pregnancy
Provide privacy for the patient if injecting
in the buttocks or lateral thigh.
Tell the patient about the injection
procedure.

PreparethePatient.

Besuretowakeupapatientifhehasbeen
sleeping.
Apatientmaybefrightenedand/orviolent.
Ifthisisthecase,youmustseekassistance.

I.M.usually given in the buttocks, thigh, or

the upper arm area.
Medication is more than 1 cc- give the
injection in the buttocks.
Buttocks- The muscles (gluteal) of this
area are thick and are utilized frequently in
daily activities, thus causing complete
absorption of drugs.

IM injection-Other sites
Deltoid

muscle
Dorsogluteal
Vastus lateralis
Rectus femoris

IMInjectionButtocks

Drawanimaginaryhorizontallineacrossthebuttocksfromhipbonetohipbone.
Thendivideeachbuttockinhalfwithanimaginaryverticalline
Thefourimaginarysectionsofthebuttockarereferredtoasquadrants.
Locationforaninjectionisintheupperouterquadrantofeitherbuttock.

IMInjectionButtocks

Giveninotherquadrants,irreparableinjurymaybedonetothe
sciaticnerveortheneedlemaypenetratetheglutealartery
If>5ccistobegiven,themedicationshouldbedividedinto2
dosesandinjectedintoseparatesiteswithamaximumof2.5cc
perdose.
Ifthepatientisreceivinganumberofintramuscularinjections
overaprolongedperiod,thesiteofinjectionshouldberotated.A
recordofsitesmustbekeptonthepatient'schartforthispurpose.

IMInjectionButtocks

Exposethebuttockstomakesureyoudonotmake
anerrorindeterminingthelocationofthe
injection.
Thepatientwillliefacedown[Orsideways]with
toestogetherandheelsapart.Thispositionrelaxes
themusclesofthebuttocks

Upper arm (deltoid muscle).

The injection site
Rectangular area bounded
on the top by the lower edge of the
acromion process,
on the bottom by the axilla,

Safe area for injection -about 3 fingers below the

shoulder joint.
Needle length of 1 inch is used because of the size
of the deltoid muscle.

Upper arm (deltoid muscle).

Maximum of one cc per injection for an adult. 0.5 cc or

less is more commonly used.
The shoulder should be completely exposed so you
can determine the exact location of the injection. The
clothing should not be rolled up to attempt to
administer an injection.
Patient is in a standing or sitting position, with the arm
at side and muscles relaxed. Direct the patient to hang
the arm loose.

Prepare Injection Site.

Clean the skin at the injection site

thoroughly with an antiseptic pad (sponge
with alcohol or Betadine).
Use a circular motion from the center of
the injection site outward. Place the
antiseptic pad between the last two
fingers of your hand for use later when
you complete the injection.

IM Injection.

Remove Needle Guard or Cover.

Pull the cover straight off, rather than
using a twisting motion or a sideward
motion because you may bend the
needle.
Avoid bending or touching the needle.

IM Injection
Stabilize Injection Site
Firm

the tissue at the injection site with the thumb and

forefinger[or ulnar border of free hand] so that it is
taut.
Makes it easier to inject the needle in exactly the right
place.
The needle enters more easily into taut or firm skin
than into loose skin.
Help the patient relax his muscles by distracting his
attention by asking a question or having the patient do
something like blow a breath out or look at an object
on the wall.

).

Administration

Holdthebarrelofsyringe
firmlybetweenthethumb
andindexfingerofthe
dominanthand

(2)Movetheneedletiptoaboutonehalfinchfromtheinjectionsite,withthebevelup,andpositiontheneedle
ata90degreeangletotheskinsurface.(Allintramuscularinjectionsareinsertedata90degreeangleinto
themuscularlayerbelowtheskin.)
(3)Plungetheneedlefirmlyandquicklyintothemuscletothedepthoftheneedlewithasteadystraightforward
motion.Aquickinsertionoftheneedlewillminimizethepainforthepatient.

).

Holdthebarrelofsyringefirmlybetweenthethumbandindexfingerofthe
dominanthand

Movetheneedletiptoaboutone
halfinchfromtheinjectionsite,
withthebevelup,andpositionthe
needleata90degreeangletothe
skinsurface.(Allintramuscular
injectionsareinsertedata90
degreeangleintothemuscular
layerbelowtheskin.)

(3)Plungetheneedlefirmlyandquicklyintothemuscletothedepthoftheneedlewithasteadystraightforward
motion.Aquickinsertionoftheneedlewillminimizethepainforthepatient.

).

Holdthebarrelofsyringefirmlybetweenthethumb
andindexfingerofthedominanthand
Movetheneedletiptoaboutonehalfinchfromthe
injectionsite,withthebevelup,andpositionthe
needleata90degreeangletotheskinsurface.

Plungetheneedlefirmlyandquicklyintothe
muscletothedepthoftheneedlewithasteady
straightforwardmotion.Aquickinsertionof
theneedlewillminimizethepainforthe
patient.

Aspirate

Release the hold on the skin.

Move the free hand to the syringe.
Pull back the plunger until slight resistance
Check for blood entering the syringe.
If blood appears in the syringe,

is felt.

do not inject
CAUTION:
Aspiration avoids injecting medication into a blood
vessel,
Which would endanger the life of the patient.

Inject Medication.
Stabilize

the syringe with one hand.

Place the thumb of the dominant hand on the plunger
and the index and middle fingers under the hook of the
syringe barrel.
Push the plunger into the syringe barrel with a slow,
continuous downward movement as far as the plunger
will go.
Make sure that all the medication is injected. Any
medication that is left in the needle at the end of the
injection may dribble into the subcutaneous tissue as it is
withdrawn. Tissue injury may result.

IM injection Finish
Place

the alcohol pad you are holding just above the injection

site
Remove the needle straight out in same direction as the injection
with a quick, outward motion.
Massage Injection Site. Rub the injection site with the alcohol
pad with a firm, circular motion for about five seconds.
Massaging helps to disperse the medicine so that it can be
absorbed more quickly.
Cover Injection Site. Place an adhesive bandage over the
injection site to protect clothes from possible bloodstains and
protect the injection site from possible infection.

Post injection Patient Care

Observe

the patient for unusual reactions.

Any medication can cause anaphylactic
reactions.
Give appropriate information regarding the
medication and required waiting time to the
patient

Disposal of syringes
Place

the needle and syringe in a nonpermeable container or destroyer. Proper

disposal -prevents cross contamination, drug
abuse, and injury by needles.
Record Administration of i.m. Injection.
Record the information in the patient's
medical record
Prompt recording prevents other personnel
from administering the same

Intradermal injection

Sitesofintradermalinjection

Intradermal

1. Palmer(inner)forearm
2. Subscapularregionoftheback
3. Upperchest

PositionofneedleIntradermal

 Equipments

For injection
Preparation
2. Emergency
Check medication
Identify and explain
Wash
1.

Cleanse

skin
Load medication
26G[1/4 inch]
Procedure
Stabilize the site
Inject at 150 angle into
dermis
Raises a wheal
Aspiration not required
no large BV in dermis
Mark the site
Dispose the needle

Subcutaneous injection

 Equipments

For injection
2. Emergency
Check medication
Identify and explain
Wash
1.

Preparation

Cleanse

skin
Load medication
23-25G[1/2 inch][0.5-3cc]
Stabilize the site
Pierce at 450 angle
Aspiration
Procedure
Inject
Massage
Dispose the needle

Subcutaneousinjection
Sitesandneedleposition

Vastuslateralisarea

Deltoidarea

Venipuncture

Venipucture
IV administration and drawing blood sample

Sites
Veins of fore arm
Ante-cubital fossa
Veins over back of
hand
Feet
Thigh
Scalp-Children

Steps
Assessment-Vital

signs,
history, Identification, status
of vein
Equipment
Wash
Prepare pt and medication
Procedure
Dispose needle
Record and report

Venipucture
IV administration and drawing blood sample
Apply

tourniquet 4-6 inches above

Position arm below the level of heart-Capillary
filling
Cleanse Needle bevel up
Pierce skin until backflow is visible
Remove tourniquet[Retain if drawing blood]
Slowly push
Watch for bulging

Dr.U.P.Rathnakar
MD. DIH. PGDHM

www.pharmacologyfordummies.blogspot.com
www.scribd.com