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Improve IM Injection Skills to Ace Clinical Demonstration

Nurse Mike (Mike Linares)
By SimpleNursing | Published January 1st, 2018
Published January 1st, 2018
A nurse gives a vaccination to a patient's bare arm

At SimpleNursing.com, we simplify those complicated lessons and demonstrations for you. Today, Mike will be walking you through the proper way of performing an intramuscular (IM) injection to increase your knowledge and skills and pass that clinical demonstration in flying colors.

Let’s begin.

Intramuscular (IM) injection is a method used in the healthcare setting to deliver different kinds of medicines deeply into the muscles. This technique will allow better absorption of the medication into the bloodstream.

IM Sites

When giving an IM injection, there are four main sites namely:

Deltoid muscle – the site preferred for vaccination
Dorsogluteal (buttocks) – no longer recommended due to potential sciatic nerve injury
Dorsal-ventral (side of the hip) or also known as the ventrogluteal muscle – considered as the safest site for children and adults
Vastus lateralis (thigh) – when the other sites are not available due to trauma or other factors, this site is used

Fundamentally, your books will provide instructions on how to administer intramuscularly, saying it should not be more than one or two milliliters in the shoulder; with the legs, it should not be more than 2.5 milliliters. However, there are times when you can actually give 4 milliliters in a person’s leg.

The administration of the drug will entirely depend on the size of your client.

Now here’s a scenario: The doctor ordered 2.5 milligrams of any drug like, Rocephin. How are you going to administer that and what is the proper way to do so?

To answer that, here are the steps in drawing the drug:

1. Do the necessary precaution like washing your hands and gathering the supplies you need.
2. Check if the drug is the right drug; following the five rights of medication administration.
3. Calculate the right dosage.
4. Using the syringe, draw up 2.5 mg of air. Draw the plunger back to fill the syringe with the appropriate dose of air. This is done to regulate pressure inside the vial, making it easier to draw medication.
5. Remove needle cap, insert the needle into the vial, then use the plunger to push all that air inside the vial. Remember not to touch the inside of the syringe for sterility purposes.
6. Turn the syringe and vial upside down, making sure that you have a firm grasp.
7. Draw the appropriate medication dose.
8. Get rid of the air and the bubbles out of your syringe through tapping then depressing.
9. Label your drug. So that if by accident, you dropped the syringe on the floor, whoever will see it will know what kind of drug the syringe contains.
10. Take out the syringe you used for taking the medication and replace it with the appropriate insertion catheter.

Note: The size of the syringe will depend on the size of the client you’re going to administer the drug to. For the arm and leg sites, a 23-gauge syringe which is commonly used for IM injections. That would be an inch to an inch and a half, same with the buttocks.

Administering the drug

Once you’ve prepared your drug and it’s good for administration, you have to follow these steps:

1. Assuming the catheter is already attached to the syringe, the next thing that you would do is to do another round of tapping and depressing the syringe to make sure that no air will be inserted into your client. Make your drug “bleed” to completely get rid of the air from the inside.
2. Identify the appropriate landmark then swab the site with alcohol from the inside out.
3. Use the Z-track method by pulling the skin top. This technique prevents drug leakage from the muscles to the subcutaneous tissues.
4. Hold the syringe like a dart, aiming at the site, then sticking the needle in at a 90-degree angle. Make sure that you don’t push the plunger yet.
5. Once the needle is in, use your index finger and thumb to hold the middle of the syringe for stabilization, then carefully, pull the plunger back a bit to check if blood is present. This method is called aspiration.

Note: If you see a tinge of blood, it means that you have hit a blood vessel. This would call for a repeat of the process with a new syringe and injection site. But this rarely happens.

6. Assuming that there is no blood and everything went out smoothly, the next thing that you have to do is to administer the medication, pushing the plunger slowly.
7. As soon as you’ve administered all of the medication inside the syringe, with the needle from the site then immediately discard into a sharps container.
8. Apply a bit of pressure on the injection site, massaging for effective absorption. Put bandage to get rid of the slight bleeding.

Getting it right

Everything is about mechanics. And with proper practice, you’ll be able to do IM injections smoothly on your next clinical examination. How can you do that? Use an orange. Do the steps at least 10 times before the demonstration. By practicing, you will be able to perform IM injections smoothly. Studies say that during your best days, your dexterity will be about 60% accurate. Make the most out of it and get a hold of your nerves and adrenaline rush through practice.

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Nurse Mike (Mike Linares)
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