MVJ MEDICAL COLLEGE & RESEARCH HOSPITAL

Dandupalya, Kolathur Post, Hoskote-562114

Department of Medicine
Skill lab

Topic : Intramuscular injection

Objective : To administer intramuscular injections.

 Materials required : Alcohol swab(70% isopropyl), Cotton gauze, Syringe, Drawing up

needle(18 gauge), Injecting needle(21-25 gauge).

Sl no. Procedure steps 1st 2nd 3rd

attempt attempt attempt
1 Introduce yourself to the patient including your name and role

2 Briefly explain what the procedure will involve using patient-friendly language and gain
consent for the same.
3 Gather Equipment (refer appendix I below)

4 Wash/Sanitize your hands and don gloves.

5 Draw-up the appropriate medication into the syringe using a drawing-up needle

6 Remove the drawing-up needle and immediately dispose of it into a sharps bin, then attach
the needle to be used for performing the injection.
7 Choose an appropriate site for the injection (refer appendix II)

8 Position the patient to provide optimal access to your chosen site

9 Clean the site with alcohol swab.

10 Gently place traction on the skin with your non-dominant hand away from the injection
site, continuing the traction until the needle has been removed from the skin.

If the patient is elderly with reduced muscle mass or is emaciated, do not apply traction,
instead, bunch the muscle up to ensure adequate bulk before injecting.
11 Warn the patient of a sharp scratch

12 Holding the syringe like a dart in your dominant hand, pierce the skin at a 75 - 90° angle.
Insert the needle quickly and firmly, with the bevel facing upwards, leaving approximately
one-third of the shaft exposed.
13 Aspirate to check the location of the needle

14 Discard the glove, cotton used and the needle to their respective bins

15 If aspiration does not reveal evidence of intravascular needle placement, inject the contents
of the syringe whilst holding the barrel firmly. Inject the medication slowly at a rate of
 approximately 1ml every 10 second.
16 Remove the needle and immediately dispose of it into a sharps container

17 Release the traction you were applying to the skin

and apply gentle pressure over the injection site with a cotton swab or gauze. Do not rub
the site.
18 Replace the gauze with a plaster.

19. Dispose of your clinical equipment and gloves into an appropriate clinical waste bin.

20. Explain to the patient that the procedure is now complete

Appendix I

 Equipment required.

Appendix II

 Injection sites

Below is a brief overview of the common sites used for intramuscular injections.

 Deltoid site
The deltoid muscle is relatively easy to locate and access, making it an ideal site for intramuscular injections. The
deltoid site is most commonly used for the administration of small volume intramuscular injections such as vaccines.

Procedure
1. Position the patient sitting on a chair with their arm relaxed.

2. Expose the patient’s upper arm and shoulder.

3. Palpate the lower edge of the acromial process and administer the intramuscular injection approximately 2.5cm
below this.

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 Ventrogluteal site

The ventrogluteal site provides access to the gluteus medius and minimus muscles whilst avoiding nerves and blood
vessels, making it an ideal candidate for most intramuscular injections including those involving higher volumes of
medication.

Procedure
1. The patient can be positioned prone, semi-prone or supine for this procedure, so choose whichever is most
comfortable for the patient.

2. Place the palm of your hand over the greater trochanter of the patient’s hip, with your thumb pointing anteriorly.

3. Extend your index finger to touch the anterior superior iliac crest and point your middle finger towards the iliac
crest to form a V-shape.

4. Insert the needle between your index and middle fingers (i.e. within the V-shape).
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 Vastus lateralis site

The vastus lateralis muscle is relatively easy to locate and access making it an ideal site for intramuscular injections.
The vastus lateralis site is most commonly used for immunisations in infants up to the age of 7 months. Patient’s at
risk of anaphylaxis are also often taught to use this site for administering adrenaline intramuscular injections (i.e.
Epipen).

Procedure
1. To locate the site, divide the front thigh into thirds vertically and horizontally to make nine squares and inject into
the outer middle square.

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References-

 World Health Organisation. WHO Best Practices for Injections and Related Procedures Toolkit.
 Sacha Wynter. Intramuscular Injection Interactive OSCE guide. Geekymedics.com