Learning to give an intramuscular (IM) injection may become necessary if you or a family member suffers from an illness that requires medication to be given by injection. The doctor makes this decision as part of medical care, and the doctor or nurse will explain to the home care provider how to give an intramuscular injection. Be sure to follow their instructions and ask them to show you the technique.
Part 1 of 3: Giving the IM shot
Step 1. Wash your hands before starting the procedure
Good hygiene is important to minimize the risk of infection. Wash your hands with soap and warm water for at least 20 seconds.
Step 2. Reassure the patient and explain how the procedure will go
Indicate where you will give the injection, and describe how it feels once the medication has been injected (if the patient does not already know this).
Some medications may initially be painful or sting after injection. Most do not, but it is important that the patient is aware of this in order to limit any anxiety due to not being familiar with it
Step 3. Clean the spot with an alcohol wipe
Before performing the injection, it is important that the area of skin above the muscle where the injection will take place is sterilized and cleaned. This minimizes the chance of infection after the injection.
Allow the alcohol to air dry for 30 seconds. Do not touch the area until you are about to give the injection, otherwise you will have to clean the area again
Step 4. Encourage the patient to relax
If the muscle you are going to inject into is tense, it will hurt more, so the muscles should be relaxed as much as possible to make the injection as painless as possible.
- It can sometimes be helpful to distract the patient by talking to him or her before the injection. When the patient is distracted, their muscles are also likely to be more relaxed.
- Some people also prefer to sit so that they cannot see the injection. Seeing the needle approach can cause worry and restlessness in some people, resulting in increased anxiety, as well as tensing the muscles. To help the patient relax, you can suggest that they look in a different direction, if they wish.
Step 5. Insert the needle into the specific location
Start by removing the cap, then insert the needle into the skin with a smooth movement at a 90-degree angle. If you're a novice at giving an injection, don't go too fast as you want to make sure you don't push too far and the needle hits the bone. About a third of the needle should remain visible. Be careful not to go so fast that you miss the spot or cause more damage to the skin than necessary.
- As you practice more and get used to giving an injection, you can work a little faster. The faster the needle is inserted, the less pain the patient will feel; however, this should not be at the expense of speed.
- It may help to lift the skin around the injection area with your non-dominant hand (since you are injecting with the dominant hand) before injecting. Lifting the skin can help mark your target and make the injection less painful for the patient once the needle goes into the skin.
Step 6. Pull back the plunger before injecting
After injecting the needle, but before injecting the medication, pull the plunger back slightly. While this may seem counterintuitive, it's important because if blood gets into the syringe when you pull back, it means your needle has entered a blood vessel, not the muscle. You will have to start over with a new needle and syringe if this happens.
- The medication is designed to be injected into a muscle and not into the bloodstream, so if you see a red color when you withdraw, you will have to remove and discard the needle. Prepare a new injection needle and choose a different site for the injection - be careful not to give the next injection in the same place.
- Usually the needle ends up in the muscle itself. Rarely will it get into a blood vessel, but it's always best to err on the side of caution before injecting.
Step 7. Inject the medication slowly
While it is better to quickly insert the needle into the skin to minimize the pain, the opposite is true for the actual injection. This is because the medication takes up space in the muscle, and the surrounding tissue will have to stretch to make room for the injected fluid. Injecting slowly gives the tissues more time to do this and ensures that the patient experiences less pain.
Step 8. Pull the needle out of the skin at the same angle you pricked it
Do this as soon as you are sure that all the medication has been injected.
Gently press the injection site with a gauze (5x5 cm). The patient may find this somewhat uncomfortable, but that is normal. Have the patient hold the gauze in place while you discard the needle
Step 9. Properly dispose of the needle
Needles should never be thrown in the trash. You will receive a hard plastic container specially made for used syringes and needles. You can also use a soda bottle or other plastic bottle with a screw cap. Make sure that both the syringe and needle fit easily into the container and do not protrude past seams.
Ask your carer or pharmacist what the legal requirements are for disposing of used syringes and needles
Part 2 of 3: Gain background knowledge
Step 1. Know the different parts of a syringe
It will be much easier to inject if you understand the mechanics behind what you are doing.
- A syringe has three main parts: the needle, the barrel and the plunger. The needle goes into the muscle; the cylinder has markings, either in cc (cubic centimeters) or ml (millilitres), with numbers next to the markings, and it contains the injection fluid; the plunger is used to get injection fluid in and out of the syringe.
- Medication injected intramuscularly is measured in cubic cm or ml. The amount of medication in one cc is equal to one ml.
Step 2. Know where to give the injection
The human body has a number of places that are most suitable.
- Vastus Lateralis Musculus (Straight Thigh Muscle): Look at your thigh and divide it into three equal parts. The middle part is where the injection goes. The thigh is a good place to give yourself an injection because it's easy to see. It is also a good place for children under three years old.
- Gluteus medius (Hip) muscle: To find the correct location for ventrogluteal injection, place the bottom of the palm on the upper, outer part of the thigh where it meets the buttocks. Point your thumb at the groin and your fingers at the person's head. Form a V with your fingers by pointing your index finger away from the other three fingers. You can feel the edge of a bone along the tips of your pinky and ring fingers. The injection site is in the center of the V. The hip is a good injection site for adults and children over seven months of age.
- Deltoids (upper arm muscle): Make sure the upper arm is completely exposed. Feel for the bone that goes over the top of the upper arm. This bone is called the acromion. The bottom of it forms the base of the triangle. The point of the triangle is directly below the center of the base at the height of the armpit. The correct area to give an injection is in the center of the triangle, 2.5-5 cm below the acromion. This spot should not be used if the person is very thin or if the muscle is very small.
- Gluteus (buttocks): Make sure one side of the buttocks is exposed. Using an alcohol wipe, draw a line from the top of the gap between the buttocks to the side of the body. Determine finding that line and go up 7.5 cm. From that point on, draw another line down and over the first line, which ends about halfway down the buttock. You should have drawn a cross. In the upper outer quadrant you will feel a curved bone. The injection comes into this upper quadrant below the bent bone. Do not use this place for infants or children under three years of age; their muscles are not yet sufficiently developed.
Step 3. Know who you are going to inject
Each person has a place on the body that is most suitable for an injection. A few things to consider before giving the injection:
Someone's age. For children and babies up to two years old, the thigh muscle is best. For kids three years and older, the thigh or deltoid are both viable options. Use a 22G and 30G needle (this will largely be determined by the thickness of the medication - your doctor will tell you which needle you need).
Note: A smaller needle is required for very small children. A larger needle can also be used for the thigh than for the arm
- Take previous puncture sites into account. If the person has recently had an injection in one area, give the injection in a different area of their body. This helps prevent scarring and damage to the skin.
Step 4. Know how to fill the needle with medication
Some syringes are pre-filled with medication. Other times the medicine is in a vial and must be drawn up with the syringe. Before administering vial medication, make sure you have the correct medication, that it has not expired, is not discolored or has particles floating in the vial (it should not be cloudy). If it is a new bottle, check that the seal is not broken.
- Sterilize the top of the bottle with an alcohol wipe.
- Hold the syringe with the needle up and the cap still on. Pull the plunger back to the line according to the required dose, and fill the syringe with air.
- Push the needle through the rubber top of the bottle and press the plunger, pushing air into the bottle.
- With the bottle upside down and the tip of the needle in the injection, pull the plunger back to the correct dose (or a little further if there are air bubbles). Tap the syringe to move any air bubbles to the top (the needle), and squeeze them into the vial. Make sure you still have the correct dose in the syringe.
- Remove the needle from the vial. If you are not going to give the injection right away, make sure to cover the needle with the cap.
Part 3 of 3: Using the Z-track technique
Step 1. Understand the benefits of the Z-track method
When you give an IM injection, the piercing motion of the needle creates a narrow channel or track in the tissues. It may happen that some of the medication leaks out of the body through this track. By applying the Z-track method, irritation of the skin is reduced and you ensure effective absorption, by retaining the drug in the muscle tissue.
Step 2. Repeat the steps of washing hands, filling the syringe and selecting and cleaning the injection site
Step 3. Pull the skin taut, one inch laterally, to the side with your non-dominant hand
Hold the skin and subcutaneous tissue firmly in place.
Step 4. Insert the needle into the muscle layer at a 90° angle, using your dominant hand
Pull back on the plunger slightly to check for blood coming back, then inject the medication slowly.
Step 5. Hold the needle in place for 10 seconds
This allows the medication to spread evenly in the tissue.
Step 6. Pull the needle out of the skin in one quick motion and release the skin
A zigzag path has been created that closes the trail left by the needle and traps the drug in the muscle tissue. As a result, patients experience less discomfort and injury at the injection site.
Do not massage the area as this can cause medication to leak and cause irritation
- It takes time to get used to giving IM injections. It will feel a bit insecure and awkward at first. Remember, practice makes perfect, and it gets easier over time. You can practice by injecting water into an orange.
- Your doctor or pharmacist can tell you how to dispose of used needles and syringes. It is important to dispose of needles and syringes for safety reasons. Don't just throw them in the trash after use, it's dangerous.