Procedure Checklist Chapter 23: Administering Intramuscular Injections

PROCEDURE CHECKLIST
Chapter 23: Administering Intramuscular Injections

Check (9) Yes or No
PROCEDURE STEPS
Yes No
1. Prepares and administers medications according to
Medication Guidelines: Steps to Follow for All
Medications.
2. Selects appropriate syringe and needle, considering
volume and type of medication, and patients muscle
mass.
a. Usual syringe size is 13 mL.
b. Usual needle is 1923 gauge, 1.5 inch in length.
3. Selects a preferred site for injection and locates site
correctly.
4. If patient has received other injections, rotates sites.
5. Positions patient so the injection site is accessible and
the patient is able to relax the appropriate muscles.
a. Deltoid site: Positions patient with arm relaxed at
side or resting on firm surface and completely expose
upper arm.
b. Ventrogluteal site: Position patient on side with
upper hip and knee slightly flexed.
c. Vastus lateralis: Position patient supine or sitting.
d. Rectus femoris (because this site often causes more
discomfort than others, use only if all other sites
inaccessible and no other route feasible): Positions
patient supine.
e. Dorsogluteal (because the sciatic nerve and major
blood vessels are located near this site, use only if all
other sites, including the rectus femoris, are
inaccessible and no other route feasible): Positions
patient prone with toes pointing inward. Does not
attempt to locate this site with the patient side-lying or
standing.
6. Cleanses injection site with alcohol prep pad (or other
antiseptic swab) by circling from the center of the site
outward. Places alcohol wipe on patients skin outside the
injection site, with a corner pointing to the site.
7. Allows the site to dry before administering the
injection.
8. Dons procedure gloves.
9. Removes the needle cap.
Traditional Intramuscular Method
10. With nondominant hand, holds the skin taut by
COMMENTS
Copyright 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing
spreading the skin between the thumb and index finger.

11. Holding the syringe between thumb and fingers of the
dominant hand like a pencil or dart, inserts the needle at a
90 angle to the skin surface.
12. Inserts needle fully.
13. Stabilizes syringe and aspirates by pulling back on the
plunger and waiting for 5 to 10 seconds. If there is a blood
return, removes the needle, discards, and prepares the
medication again.
14. Still stabilizing syringe, uses thumb or index finger of
dominant hand, presses plunger slowly to inject the
medication (5 to 10 seconds per mL).
15. Removes the needle smoothly along the line of
insertion.
16. Engages safety needle device, and disposes in
biohazard container. If there is no safety device, places
uncapped syringe and needle directly in biohazard
puncture-proof container.
17. Gently massages site with a gauze pad and applies
Band-Aid as needed.
Z-Track Administration
18. Follows Steps 1 through 9, above.
19. With the side of the nondominant hand displaces the
skin away from the injection site, about 2.5 to 3.5cm (1 to
1.5 inches).
20. Holding the syringe between thumb and fingers of the
dominant hand like a pencil or dart, inserts the needle at a
90 angle to the skin surface.
21. Stabilizes the syringe with thumb and forefinger of
nondominant hand. Does not release the skin to stabilize
the syringe.
22. Aspirates by pulling back slightly on the plunger for 5
to 10 seconds. If a blood return is obtained, removes the
needle, discards, and prepares the medication again.
23. Using thumb or index finger of dominant hand, presses
plunger slowly to inject the medication (5 to 10 seconds
per mL).
24. Waits for 10 seconds, then removes the needle
smoothly along the line of insertion; then immediately
releases the skin.
25. Engages safety needle device, and disposes in
biohazard container. If there is no safety device, places
uncapped syringe and needle directly in biohazard
puncture-proof container.
26. Does not massage the injection site.
Recommendation: Pass ______ Needs more practice ______

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PROCEDURE CHECKLIST

Chapter 23: Administering Intramuscular Injections

spreading the skin between the thumb and index finger.

Recommendation: Pass Needs more practice

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