Intramuscular injection

1.	Goal: The patient receives the medication via the intramuscular route. 1. Gather equipment. Check each medication order against the original physician’s order according to agency policy. Clarify any inconsistencies. Check the patient’s chart for allergies.
2.	Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.
3.	Perform hand hygiene.
4.	Move the medication cart to the outside of the patient’s room or prepare for administration in the medication area.
5.	Unlock the medication cart or drawer.
6.	Prepare medications for one patient at a time.
7.	Read the Medication order and select the proper medication from the patient’s medication drawer or unit stock.
8.	Compare the label with the Medication order. Check expiration dates and perform calculations, if necessary.
9.	If necessary, withdraw medication from an ampule or vial.
10.	When all medications for one patient have been prepared, recheck the label with the Medication order before taking them to the patient.
11.	Lock the medication cart before leaving it.
12.	Transport medications to the patient’s bedside carefully, and keep the medications in sight at all times.
13.	Ensure that the patient receives the medications at the correct time.
14.	Identify the patient. Usually, the patient should be identified using two methods. Compare information with the patient’s chart- a. Check the name and identification number on the patient’s identification band. b. Ask the patient to state his or her name. c. If the patient cannot identify him or herself, verify the patient’s identification with a staff member who knows the patient for the second source.
15.	Close the door to the room or pull the bedside curtain
16.	Complete necessary assessments before administering medications. Check allergy bracelet or ask patient about allergies. Explain the purpose and action of the medication to the patient.
17.	Perform hand hygiene and put on clean gloves.
18.	Select an appropriate administration site.
19.	Assist the patient to the appropriate position for the site chosen. Drape as needed to expose only area of site to be used.
20.	Identify the appropriate landmarks for the site chosen.
21.	Clean the area around the injection site with an antimicrobial swab. Use a firm, circular motion while moving outward from the injection site. Allow area to dry.
22.	Remove the needle cap by pulling it straight off. Hold the syringe in your dominant hand between the thumb and forefinger.
23.	Displace the skin in a Z-track manner by pulling the skin down or to one side about 1″ (2.5 cm) with your non-dominant hand and hold the skin and tissue in this position.
24.	Quickly dart the needle into the tissue so that the needle is perpendicular to the patient’s body. This should ensure that it is given using an angle of injection between 72 and 90 degrees.
25.	As soon as the needle is in place, use your thumb and forefinger of your non-dominant hand to hold the lower end of the syringe. Slide your dominant hand to the end of the plunger.
26.	Aspirate by slowly (for at least 5 seconds) pulling back on the plunger to determine whether the needle is in a blood vessel. Watch for a flash of pink or red in the syringe.
27.	If no blood is aspirated, inject the solution slowly (10 seconds per milliliter of medication).
28.	Once the medication has been instilled, wait 10 seconds before withdrawing the needle.
29.	Withdraw the needle smoothly and steadily at the same angle at which it was inserted, supporting tissue around the injection site with your nondominant hand.
30.	Apply gentle pressure at the site with a dry gauze.
31.	Do not recap the used needle. Engage the safety shield or needle guard, if present. Discard the needle and syringe in the appropriate receptacle.
32.	Assist the patient to a position of comfort.
33.	Remove gloves and dispose of them properly. Perform hand hygiene.
34.	Evaluate patient’s response to medication within an appropriate time frame. Assess site, if possible, within 2 to 4 hours after administration