B.P KOIRALA INSTITUTE OF HEALTH SCIENCE, DHARAN.

Procedure guideline for Intramuscular Injection

Submitted to: Ms. Dev Kumari Shrestha Associate Professor Department of maternal Health Nursing College of Nursing, BPKIHS.

Submitted by: Ms. Menuka Shrestha M.Sc. Nursing, 1st year, Batch-2011 College of Nursing, BPKIHS

Procedural Guideline for Administration of Intra-Muscular Injection

Introduction
An intramuscular injection is an injection given directly into the central area of a specific muscle. The blood vessels supplying that muscle distribute the injected medication via the cardiovascular system. It is one of several alternative methods for the administration of medications. It is used for particular forms of medication that are administered in small amounts. Depending on the chemical properties of the drug, the medication may either be absorbed fairly quickly or more gradually. Intramuscular injections are often given in the deltoid, vastus lateralis muscles and the ventrogluteal and dorsogluteal areas.

Purposes
Intramuscular injection is used for the delivery of certain drugs not recommended for other routes of administration, for instance intravenous, oral, or subcutaneous. The intramuscular route offers a faster rate of absorption than the subcutaneous route, and muscle tissue can often hold a larger volume of fluid without discomfort. In contrast, medication injected into muscle tissues is absorbed less rapidly and takes effect more slowly that medication that is injected intravenously. This is favorable for some medications.

Equipment Required
1. 2. 3. 4. 5. 6. Medication vial or ampoule Medication chart Sterile syringe and needle Alcohol swab-2 Clean gloves Vial of diluents(when necessary)

Procedure
1. 2. 3. 4. 5. 6. 7. Obtain client's medication record. Compare the medication record with the most recent physician's order. Assess client's medical and medication history. Assess client's history of allergies. Check date of expiration for medication. Observe verbal and non- verbal response toward receiving injection. Assess for contraindication.

8. Aseptically prepare correct medication dose from ampoule or vial. Check label of medication with the prescriber's order two times while preparing medication. 9. Take medication to client side. 10. Wash your hands. Apply clean gloves. 11. Maintain privacy of the client. 12. Check identification by asking clients name. 13. Explain steps of procedure to the client. 14. Select appropriate injection site. Inspect skin surface over sites for bruises, inflammation, or edema. 15. Note integrity and size of muscles, and palpate for tenderness or hardness. Avoid these areas. If injection is giving frequently, rotate sites. 16. Assist client to comfortable position. Position client depending on site chosen. 17. Relocate site using anatomical landmarks. 18. Cleanse site with an antiseptic swab. Apply swab at center of the site, and rotate outward in a circular direction for about 5cm. 19. Hold swab or gauge between third and fourth fingers of non dominant hand. 20. Remove needle cap or sheath from needle by pulling it straight off. 21. Hold syringe between thumb and forefinger of dominant hand. 22. Administer injection; Position non dominant hand just below site, and pull skin approximately 2.5- 3.5 cm down or laterally with ulnar side of hand to administer in a z-track. With dominant hand, insert needle quickly at 90-degree angle into muscle. After needle pierces skin, grasp lower end of syringe barrel with non dominant hand to end of plunger. Do not move syringe. Pull back on plunger 5-10 seconds. If no blood appears, inject medicine slowly. Wait 10 seconds then smoothly and steadily withdraw needle and release skin. 23. Withdraw needle while applying alcohol swab. 24. Apply gentle pressure. Do not massage site. 25. Assist client to comfortable position. 26. Discard uncapped needle or needle enclosed in safety shield and syringe into punctureproof and leak proof receptacle. 27. Replace articles used in proper place. 28. Remove gloves and wash hands. 29. Observe for any allergic reactions. 30. Inspect site, noting any bruising or indurations. 31. Observe client's response to medication at times that correlate with the medication's onset peak, and duration.

References
1. Potter Patricia A. Perry Anne Griffin. Fundamental of Nursing. Seventh edition. Reprinted 2011. MOSBY ELSEVIER. 2. Basavanthappa BT. Fundamental of Nursing. First edition. Reprinted 2004. JAYPEE. 3. Smith Sandra F. Duel Donna j. Clinical Nursing Skills. Fourth Edition. 1996. USA APPLETON & LANGE. 4. Intramuscular Injection. Available in http://en.wikipedia.org/wiki/Intramuscular_injection . Retrieved on 18th Jan 2012. 5. Guidelines for the Administration of intramuscular injection. Available in
http://www.royalfree.nhs.uk/documents/Equality/750%20IM%20&%20SC%20Aug%202008%20 (final).pdf. Retrieved on 18th Jan.2012.