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I cannot believe my journey as a student nurse is almost at its end. As I write this blog, I am currently just over half way through my management placement. Careers Live will be in Nottingham for the first time later this month. With a full programme of speakers and the chance to meet employers — it could be a gateway to your next career move.

Giving an IM (intramuscular) injection

An intramuscular IM injection is the administration of medication through the cutaneous and subcutaneous layers, into the muscle. The IM route is often used for medications that will not irritate soft tissue and can be suitably dissolved. The delivery of medication into skeletal muscles, with fewer pain receptors and good blood perfusion, minimises pain. The dorsogluteal site: the injection is administered into the gluteus maximus muscle in the buttock. The upper outer quadrant of this area must be used to avoid any damage to the sciatic nerve.

The vastus lateralis site: a large muscle in the thigh free from major nerves and vascular structures. The deltoid site: this site, on the lateral upper aspect of the arm, is used for the administration of smaller volumes of solution. The ventrogluteal site: the injection is administered into the gluteus medius and maximus muscles of the hip area.

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The debate continues as to whether skin cleansing is necessary when the patient is physically clean and hand hygiene is maintained Workman, Local trust policy should be noted and adhered to. When the skin is to be cleansed, an alcohol swab should be used and the site allowed to dry for 30 seconds. The needle should be long enough to penetrate the muscle and still leave at least one third of its length exposed to facilitate its removal should it snap from the hub.

If this happens the needle should be withdrawn and the process repeated with a sterile needle. By stretching the skin downwards or sideways at the site before injection the track is closed when the skin is released, preventing leakage. IM injections can be an unpleasant experience for patients, making appropriate explanation and psychological support vital. Extra caution is required when administering IM injections to children. Injection sites may vary depending on age. Look at the skin to ensure there are no signs of infection, damage or poor blood supply.

There must also be consideration of muscle mass to ensure patient safety and comfort. Where frequent IM injections are given the injection sites should be rotated to prevent damage, protect the administration route and maximise patient comfort. The use of a rotation chart may be considered. The nurse must have a good knowledge of the appropriate technique and anatomy to avoid any damage to surrounding structures. IM injections should be avoided in patients with thrombocytopenia a decreased number of platelets , in whom clotting problems may occur.

London: Whurr Publishers. Is it true that applying pressure to an injection site before giving an intramuscular injection reduces pain and, if so, why? Nurses in Bradford are now at the forefront of delivering Botox treatments to patients with debilitating eye conditions through a new nurse-led clinic. A university in the West Midlands is set to expand its nurse training services to an additional campus, as part of a drive to help reduce nursing shortages in the area.

Nurse leaders behind the EndPJParalysis campaign are hosting a free hour global digital summit this week to share best practice around tackling complications associated with hospitalisation. Sophie Ukekeruke 18 June, pm. Thanks for this article. It is similar to other articles I have read. However, I have just learnt about avoiding patients with thrombocytopaenia. Unsuitable or offensive? Report this comment. Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions.

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Menu Home News Back. Your browser is no longer supported For the best possible experience using our website we recommend you upgrade to a newer version or another browser. Cook, I. Optimal technique for intramuscular injection of infants and toddlers: a randomised trial. Medical Journal of Australia, 2 : p. Crawford, C. To aspirate or not: an integrative review of the evidence.

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Nursing, 42 3 : Department of Health, UK. Diggle, L. Effect of needle length on incidence of local reactions to routine immunisation in infants aged 4 months: randomised controlled trial. BmJ, : Dougherty L and Lister S. Chichester: Wiley-Blackwell. Ford L. The safe management of medicines for children.

How To Give An Intramuscular Injection (IM Injection)

Trigg E and Mohammed TA. Greenway K. DOI: Lynn P. Macqueen S. Malkin B. Nursing Times : Mitchell, J. Aaohn Journal. Ogston-Tuck, S. Intramuscular injection technique: an evidence-based approach. Nursing Standard, 29 4 : Plotkin, S.

Review into intramuscular injections

Atlanta, GA: Saunders Elsevier. Pratt, R. The need for skin preparation prior to injection: point—counterpoint.

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British Journal of Infection Control, 6 4 : Royal College of Paediatricians and Child Health Position Statement on Injection Technique. Schechter, N. Pain reduction during pediatric immunizations: evidence-based review and recommendations. Pediatrics, 5 :. Shin, H. Subcutaneous tissue thickness in children with type 1 diabetes. Journal of advanced nursing, 54 1 : Taddio A. World Health Organization Best practices for injections and related procedures toolkit. Geneva: WHO. Going home Real stories Take a virtual tour of Great Ormond Street Hospital Wards and departments Ward and admissions information Departments Conditions and treatments Conditions we treat Medicines information Health dictionary General medical conditions Procedures and treatments General health advice Clinical outcomes Clinical guidelines Our people Staff A-Z Our research Our vision Research and innovation Taking part in research Our research infrastructure Collaborate with us Contact us Research activity Our history of medical breakthroughs Information for researchers Our research facilities Publications and Research Reviews.

You are here Home Conditions and treatments Clinical guidelines Administration of medication via intradermal, subcutaneous and intramuscular injections Administration of medication via intradermal, subcutaneous and intramuscular injections The aim of these guidelines is to facilitate the safe administration of injections non-intra venous for patients at Great Ormond Street Hospital for Children NHS Foundation Trust GOSH. This route is commonly used for immunisations. Subcutaneous injection SC : Administering medication below epidermis and dermis layers into the subcutaneous tissue Ford et al This route is commonly used for insulin and heparin.

Intradermal injection ID : Delivers medication to the dermis, just below the epidermis. This route is commonly used for local anaesthetics prior to an invasive procedure. This guideline includes: Preparation of child and parents for the injection rationale 1 Choosing the site for injection rationale 2 Preparation of the injection rationale 3 Administration of the injection rationale 4 Nursing care rationale 5 Background The use of alternative medication administration routes such as epidural infusions and intravenous patient and nurse controlled analgesia has reduced the number of injections administered by nurses to children.

Preparation of child and family for injection Explain the procedure to the child and parents to reduce anxiety Rationale 8 Schechter et al If the child has not had a wash recently, wash the site with soap and water. Ensure privacy and dignity of the patient Rationale 9. If the child needs to be held this should be in accordance with Restraint and Therapeutic Holding Policy. Parents may find it useful to use distraction techniques as outlined in the parent information sheet on Distraction Therapy. Position the child to allow relaxation of the muscle to be used for the injection to reduce pain and anxiety Ford et al Rationale Lie the infant down or make sure that the child is sitting, if older Rationale 11 Taddeo et al Choosing site for injection The factors that must be considered when selecting a site for injection include, the size and age of the child Rationale 12 , the ability to position the child Rationale 13 , the size of the muscle to tolerate the volume to be injected Rationale 14 and the frequency of the injections required Rationale Intramuscular injection IM : There are two main sites used for the administration of IM injections in children: The deltoid muscle is the preferred site for intramuscular and deep subcutaneous injections in larger children Rationale It is suitable for small volume injections such as immunizations but not for repeated use or large volumes.

It should be used with caution in children under 3 years old Hemsworth, The vastus lateralis is the preferred site for intramuscular and deep subcutaneous injections in infants under one year and children up to 3 years old Rationale 19 World Health Organization , Cook and Murtagh Intradermal injection ID : The most common sites used are the inner surface of the forearm and the upper back, under the scapula. Preparation of the injection for all routes The injection for all routes should be prepared using aseptic non-touch technique.

Medicated solution in a glass vial Wash hands and put on non-sterile gloves Tap the top of the glass vial gently to move any medication into the lower part of the vial.

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Rationale 20 Cover the top of the vial with the inside of a sterile alcohol wipe package e. Inspect the medicated solution for any glass fragments or signs of contamination. Discard if any signs are observed and start the procedure again Rationale Insert either a filter needle or needle size 23 G attached to the syringe into the vial and withdraw the prescribed amount of medication with the vial held tilted upside down keeping the tip of the needle below the level of the medication Rationale After removal from the vial re-sheath the needle with one hand Rationale Hold the syringe in a vertical position and tap the syringe gently to expel the air bubbles Rationale Ensure accurate amount of medicine in syringe — as prescribed.

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  5. Syringes are calibrated to give the correct volume of medication accounting for the medication that remains in the hub of the syringe and needle after administration. Remove the needle and discard in a sharps container. Attach a new appropriate size needle, needle size determined by the route of administration Rationale Do not touch the rubber bung after cleaning it Rationale Draw up the appropriate volume of diluent with a filter needle or needle size 23 G and syringe.

    Insert the needle into the rubber top of the vial and inject the required volume of diluent slowly into the vial. Allow the freeze-dried medication to disperse completely in the solution Rationale Check the dissolved medication for any signs of contamination, e. If any signs of contamination are observed discard and start the procedure again Rationale Using the same syringe and needle as used for diluting, withdraw all of the medication with the vial held tilted upside down keeping the tip of the needle below the level of the medication Rationale Remove the needle from the vial.

    After removal re-sheath the needle with one hand Rationale Discard any additional medication from the syringe into a blue pharmaceutical waste container, leaving the prescribed amount of medication in the syringe. Attach a new appropriate sized needle, needle size determined by the route of administration Rationale For intradermal injections: use a 26G brown length 10mm. Skin Preparation There are many differences of opinion regarding skin cleansing prior to administering injections Pratt et al Administration of the injection Intramuscular Identify an appropriate site for administration according to size and age of child.

    The maximum volume for a intramuscular injection is 2mls Macqueen et al in the thigh and 1ml in the deltoid muscle. Prepare the injection site as above see skin preparation. There is more than one technique for administering IM injections Ogston-Tuck 4. Whichever technique is used, the needle must not be deep enough to touch the bone but must penetrate deeply into the chosen muscle Rationale The needle in all sites is inserted at 90 degree angle Rationale Once the injection has been given, wait 10 seconds following the administration of medicine before removing the needle from the site of administration Rationale