Medication Administration via Intramuscular Injection
Category: Medication Administration
Overview
Administration of medication into muscle tissue using sterile injection technique for systemic absorption when oral route is not suitable.
Indications
Medications requiring systemic absorption with faster onset than oral route, vaccines and immunizations, medications not available in oral form, unconscious or vomiting patients, medications requiring depot effect (long-acting).
Contraindications
Infection or cellulitis at injection site, severe bleeding disorders or anticoagulation, muscle atrophy or contractures, patient refusal, known allergy to medication, thrombocytopenia (platelets <50,000).
Equipment Needed
Appropriate syringe (1-3mL), needle (21-25 gauge, 1-1.5 inch length), alcohol swabs, medication vial or ampule, gloves, sharps disposal container, small adhesive bandage, medication administration record (MAR).
Procedure Steps
1. Verify medication order against MAR using five rights of medication administration
2. Check patient identity using two identifiers (name, DOB, medical record number)
3. Perform hand hygiene and don gloves
4. Prepare medication using aseptic technique, check expiration date
5. Select appropriate injection site based on patient age, muscle mass, and medication volume
6. Position patient appropriately for chosen site
7. Locate anatomical landmarks for safe injection
8. Cleanse injection site with alcohol swab in circular motion, center outward
9. Allow skin to dry completely (15-30 seconds)
10. Remove needle cap, hold syringe like a dart
11. Insert needle at 90-degree angle with quick, confident motion
12. Aspirate briefly if indicated by facility policy (controversial practice)
13. Inject medication slowly and steadily (1mL per 10 seconds)
14. Remove needle quickly at same angle of insertion
15. Apply gentle pressure with gauze, do not massage unless indicated
16. Apply small bandage if needed
17. Dispose of needle and syringe in sharps container immediately
18. Remove gloves and perform hand hygiene
19. Document administration and monitor for adverse reactions
Safety Considerations
Always verify five rights of medication administration. Never recap needles - dispose directly in sharps container. Use appropriate needle length for patient's muscle mass and injection site. Rotate injection sites to prevent tissue damage. Check for medication allergies before administration. Monitor patient for 15-30 minutes for adverse reactions.
Potential Complications
Infection at injection site, nerve damage (especially sciatic nerve), bleeding or hematoma formation, muscle fibrosis, abscess formation, allergic or anaphylactic reaction, inadvertent intravascular injection, pain and tissue irritation.
Documentation
Record medication name, dose, route, injection site, date and time of administration, patient response, any adverse effects, and nurse signature. Document on MAR and in nursing notes if complications occur.
References
Institute for Safe Medication Practices (ISMP). (2019). Medication Safety Self Assessment for Hospitals. World Health Organization. (2010). WHO Best Practices for Injections and Related Procedures Toolkit.