Intramuscular Injection Procedure
Indications
Medication administration
Contraindications
Injection site presents with any of the following:, irritation, moles, birthmark, scar tissue, lesions,
excessive sensitivity, muscle that twitches or trembles assessment
Precautions
2 allowable locations for IM injection are deltoid & vastus lateralis muscle
Deltoid site for may only be used if patient is ≥ 18 months of age.
Maximum solution volume that may be injected into the deltoid muscle: Adults: 2.0 ml & Infants-Small
Children: 0.5-1 .0 ml
Maximum solution volume that may be injected into the vastus lateralis: Adults: 5.0 ml & Infants-Small
Children: 0.5-2 .0 ml
Equipment
Alcohol Wipes
Syringe (1 cc-3 cc)
Needles 20G-25G,1"- 3"
Bandage/dressing
Medication
Gloves
Procedure
1. Prepare equipment. Explain procedure to patient. Apply gloves.
2. Select the injection site. Gently tap the site to stimulate the nerve endings and minimize pain when
the needle is inserted.
3. Clean the injection site with an alcohol swab. Use a circular motion, moving swab outward to a
circumference of 2 inches from the injection site. Allow the skin to dry.
4. Instruct the patient to relax the muscle. With your thumb and index finger gently stretch and depress
the skin at the injection site (for the deltoid site, or an infant or a poorly muscled site, stretch the skin
and then bunch up the muscle).
5. Hold the syringe as you would a dart or a pencil, positioned at a 90° angle to the skin, with the needle
a couple of inches from the surface.
6. Quickly and firmly thrust the needle through the skin, deep into the muscle. Release the skin and
muscle, while holding onto the syringe.
7. While supporting the syringe, pull back slightly on the plunger to aspirate for blood. If no blood
appears, slowly inject the medication into the muscle.
8. Remove needle. Cover the injection site immediately with an alcohol swab and apply gentle pressure.
Massage the relaxed muscle to distribute the drug.
9. Inspect injection site for active bleeding or bruising. Dress the site.
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Notes:

Choose a needle length that allows for a small portion of the needle to be exposed at the skin in case
the needle should break off from the hub

To estimate needle length, grasp the muscle site using a thumb and index finger, and choose a
needle length that is half the distance between these two digits

For an infant, it is recommended that a 23-27 gauge 5/8" needle be used.

For a small child, it is recommended that a 23-27 gauge 1 inch needle be used.

For a large child or adult, it is recommended that a 21-25 gauge 1.5 inch needle be used

Deltoid Site: find the lower edge of the acromial process (bone that goes across the top of the upper
arm). The bottom of this bone will form the base of an inverted triangle. The point of the triangle is
directly below the middle of the triangle's base, at the level of the armpit. The injection site is in the
middle of the triangle (1" to 2", or 2-3 fingerbreadths below the acromial process).
Alternate landmarking technique in an adult patient: starting at the elbow, the upper arm can be
divided into thirds, using your hand breadth. Inject medication into the centre of the middle third.
o
If insertion cannot be performed at 90°, then angle the syringe slightly towards the acromial
process.
Vastus Lateralis Site: put your thumb in the middle of the top of the thigh, and your fingers along the
side. The muscle you feel between them is the vastus lateralis. Draw an imaginary box, with the
upper margin a hand breadth below the greater trochanter and the lower margin hand breadth above
the knee. Inject the needle into the middle third of the box.
Deltoid muscle
Vastus Lateralis

When multiple injections are required, rotate sites as far as possible (at least 1 inch) from the
previous site. Report the sites used to the receiving staff in the emergency room.

If blood is aspirated into the syringe, stop the injection. Withdrawal the needle and prepare another
injection with new equipment. Do not inject the bloody solution.

A relaxed muscle at the injection site will reduce pain and the potential for bleeding.
D:\533560336.docCreated on 10/8/2008 10:46:00 AM
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