Intramuscular injection

Authors: Rednenko V.V., Rednenko L.I., Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• Workplace for injections and intravenous infusions (see PS1 - Preparing of the workplace for injections and intravenous infusions)
• Medication in ampule or vial
• needle of size 0.8x 40 mm (green needle hilt, G22);
• 5 ml syringe with needle of size 0.8x 40 mm (green needle hilt, G22) or needle of size 0.6x35 mm (blue needle hilt, G23 - used for children and adults with poor development of the muscle layer and subcutaneous fat)
• medical records

Clinical situation:

• You are a nurse at a hospital’s therapeutic department. The doctor prescribed to the patient a intramuscular administration of the medication. Follow doctor's prescription

Order of the skill performance:

Preparatory stage:

• inform the patient about the injection, get verbal consent to giving it, ask him to take the required position
• withdraw the required medication into a syringe from an ampule (vial) and change the needle (see PS5 - Withdrawing of medicine from an ampule  into a syringe) or (PS6 - Withdrawing of medicine from a vial into a syringe)

Maine stage:

• select, examine and palpate a injection site with your dominant hand (superior outer quadrant of gluteus maximus muscle)
• 
• take two swabs with your dominant hand, wet it with skin antiseptic;
• treat the skin at the injection site 2-3 times in one direction:
  
  • with one swab a “large field” (10x10 cm in size);
  • wtithe second one the "small field" (size 5x5 cm) ;
• place the used swabs in the container “Disinfection of dressings, PPE”;
• wait until the disinfectant has completely evaporated from the surface of the skin;
• take one swab and wet it with skin antiseptic;
• keep this swab with fourth and fifth finger of non dominant hand
• take the syringe with a medication from the opened package with your dominant hand, place the second finger on the needle hilt, grasp the syringe barrel with others fingers;
• place the package in the "Package" container;
• remove a cap from the needle with your non dominant hand, holding the needle hilt with the index finger of your dominant hand, place the cap in the "Plastic" container
• put the syringe in your dominant hand: place the fifth finger on the needle hilt, grasp with other fingers the syringe barrel
• stretch the skin of injection site with the first and second fingers of you non dominant hand (if patient has a weak muscle layer, it is necessary to form the skin and muscle in the fold)
• 
• insert the needle with a quick movement into the base of the fold at an angle of 90° to the skin surface to a depth of 3/4 of the needle;
• pull little back the plunger with non dominant hand (if blood enters syringe, move needle slightly back and check it again, if no blood appears, inject the medication)
• administer the medication by pressing on the syringe plunger with the first finger of the non dominant hand;
• press the swab with antiseptic to the injection site
• 
• remove the needle with a quick movement

Final stage:

• disinfect syringe and injection needle (see PS3 - Disinfection of disposable syringes and injection needles);
• take off the gloves, place it in the container “Disinfection of dressings, PPE” (see Removal contaminated gloves); 
• wash your hands (see Hygienic hand washing)
  
• register the medication administration in medical records;
• observe the patient for 5-7 minutes to detect an allergic reaction