View in context

15.20 Medication: intramuscular injection

Essential equipment

  • Personal protective equipment
  • Recording sheet or book as required by law or hospital policy
  • Patient's prescription chart, to check dose, route, etc.
  • Electronic identity check equipment, where relevant
  • 70% alcohol swab
  • Needle
  • Syringe containing prepared intramuscular medication
  • Clinically clean receiver or tray containing the prepared drug (prepare as described in Procedure guidelines 15.11, 15.12, 15.13, or 15.14)

Pre‐procedure

ActionRationale

  1. 1.
    Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
    To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [257], C).
  2. 2.
    Before administering any prescribed drug, look at the patient's prescription chart and check the following:
    1. the correct patient is being given the drug
    2. drug
    3. dose
    4. date and time of administration
    5. route and method of administration
    6. diluent as appropriate
    7. validity of prescription
    8. signature of prescriber
    9. the prescription is legible.
    To ensure that the correct patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (DH [61], C; RPS [317], C).
    To protect the patient from harm (DH [61], C; NMC [257], C).
    If any of these pieces of information are missing, unclear or illegible, do not proceed with the administration. Consult with the prescriber.
    To prevent any errors occurring. E

Procedure

  1. 3.
    Apply apron, close the curtains or door, and assist the patient into the required position. Wash hands.
    To ensure patient privacy and dignity. E
    To allow access to the injection site and to ensure the designated muscle group is relaxed (Workman [376], E).
  2. 4.
    Take the medication and the prescription chart to the patient. Check the patient's identity by asking them to state their full name and date of birth. If the patient is unable to confirm these details, then check the patient identity band against the prescription chart. If an electronic identity check system for the patient and/or medicine identification is in place, then use it in accordance with hospital policy and procedures. Check the patient's allergy status by asking them or by checking the name band.
    To ensure that the medication is administered to the correct patient and prevent any errors related to drug allergies (NPSA [262], C).
  3. 5.
    Assist the patient to remove the appropriate garment(s) to expose the injection site.
    To gain access for the injection (Workman [376], E).
  4. 6.
    Apply gloves and assess the injection site for signs of inflammation, oedema, infection and skin lesions.
    To promote the effectiveness of the administration (Workman [376], E).
    To reduce the risk of infection (Fraise and Bradley [98], E; Workman [376], E).
    To avoid skin lesions and possible trauma to the patient (Ostendorf [277], E; Workman [376], E).
  5. 7.
    Clean the injection site with a swab saturated with isopropyl alcohol 70% for 30 seconds and allow to dry for 30 seconds (Workman [376]).
    To reduce the number of pathogens introduced into the skin by the needle at the time of insertion and to prevent a stinging sensation if the alcohol is taken into the tissues upon needle entry (Antipuesto [10], E; Hunter [136], E). (For further information on this action see ‘Skin preparation’ above.)
  6. 8.
    With the non‐dominant hand, stretch the skin slightly around the injection site.
    To displace the underlying subcutaneous tissues, facilitate the insertion of the needle and reduce the sensitivity of nerve endings (Antipuesto [10], E; Hunter [136], E).
  7. 9.
    Holding the syringe in the dominant hand like a dart, inform the patient and quickly plunge the needle into the skin at an angle of 90° until about 1 cm of the needle is left showing.
    To ensure that the needle penetrates the muscle (Hunter [136], E; Workman [376], E).
  8. 10.
    Pull back the plunger. If no blood is aspirated, depress the plunger at approximately 1 mL every 10 seconds to slowly inject the drug. If blood appears, withdraw the needle completely, replace it and begin again. Explain to the patient what has occurred.
    The plunger is pulled back to confirm that the needle is in the correct position and not in a vein (Antipuesto [10], E).
    Slow injection allows time for the muscle fibres to expand and absorb the solution (Hunter [136], E; Workman [376], E).
    To prevent pain and ensure even distribution of the drug (Ostendorf [277], E).
  9. 11.
    Wait 10 seconds before withdrawing the needle.
    To allow the medication to diffuse into the tissue (Ostendorf [277], E; Workman [376], E).
  10. 12.
    Withdraw the needle rapidly. Apply gentle pressure to any bleeding point but do not massage the site.
    To ensure that the injected medication is not forced out of the tissues (Antipuesto [10], E).
  11. 13.
    Apply a small plaster over the puncture site.
    To prevent tissue injury and haematoma formation (Ostendorf [277], E).

Post‐procedure

  1. 14.
    Where appropriate, activate any safety device. Ensure that all sharps and non‐sharp waste are disposed of safely and in accordance with locally approved procedures, for example put sharps into sharps bin and syringes into orange clinical waste bag.
    To ensure safe disposal and to avoid laceration or other injury to staff (EASHW [84], C; HWR [137], C; MHRA [201], C).
  2. 15.
    Record the administration on the appropriate charts.
    To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NPSA [268], C; RPS [317], C).
View in context