Intramuscular Injection Secrets
Nursing School Made Simple Guaranteed © 2014 SimpleNursing.com All Rights Reserved.
Page 2 of 9
Table of Contents
1 Intramuscular Injection Sites ................................................................................................................................. 3
1.1 Deltoid Muscle .............................................................................................................................................. 4
1.2 Ventro Gluteal Muscle .................................................................................................................................. 4
1.3 Dorso Gluteal Muscle ................................................................................................................................... 5
1.4 Vastus Lateralis Muscle ............................................................................................................................... 5
2 Before You Give IM Injections .............................................................................................................................. 7
2.1 DICE Your Drugs ......................................................................................................................................... 7
3 Black Box Warnign Drugs ..................................................................................................................................... 8
Intramuscular Injection Secrets
Nursing School Made Simple Guaranteed © 2014 SimpleNursing.com All Rights Reserved.
3
1 Intramuscular Injection Sites
Intramuscular Injection Secrets
Nursing School Made Simple Guaranteed © 2014 SimpleNursing.com All Rights Reserved.
Page 4 of 9
1.1 Deltoid Muscle
Location NEEDLE Amount (ml) Common Meds?
1. LOCATE:
Acromion Process, 2 fingers down Make a “V” with your other hand
2. AIM:
in the middle of the “V” like aiming at a dart board
3. INSERT & ASPIRATE at a 90 degree angle
(Like a throwing Darts at a Dart Board) aspirate to avoid blood stream injection.
20 - 24 gauge
(normal)
LEGNTH:
1.0 - 1.5 inches
Max:
0.5 - 1.0 ml
Vaccines:
- Flu Shot
- Hep B series
1.2 Ventro Gluteal Muscle
Location NEEDLE Amount (ml) Common Meds?
***Please note****
USE RIGHT HAND on patients RIGHT side
Use LEFT HAND on patients LEFT side
To find landmarks…
1. LOCATE:
Palm of hand on greater trochanter (the darn tip of the big bone in your leg… “the femur” )
Index finger, YOUR DARN POINTER FINGER on the front part of the HIP BONE (anterior superior iliac spine)
2. AIM: Once your hand is in position
move your middle finger back along the iliac towards the buttock as far as you are able to go. This forms the triangle with the index and middle finger and the center of that triangle is the injection site for a ventrogluteal injection.
3. INSERT & ASPIRATE at a 90 degree
angle (Like a throwing Darts at a Dart Board) aspirate to avoid blood stream injection.
LEGNTH:
1.0 - 1.5 inches
MAX: 4.0 ml
depends on size
of your patient &
hospital policy
Physciatric
Medications: Haldol
Geodon
Intramuscular Injection Secrets
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5
1.3 Dorso Gluteal Muscle
Location NEEDLE Amount (ml) Common Meds?
***PLEASE NOTE ****
“D” is for Dorso Gluteal, the buttocks makes a
Make sure your thumb always faces toward the buttocks when you are locating your landmarks.
RIGH HAND - LEFT HIP LEFT HAND - RIGHT HIP
1. LOCATE:
The POSTERIOR iliac Spine (THE RIM OF THE HIP BONE) this is the back part of the hip bone leading to you’re Assets
Locate the greater Trochanter ( put your hand on the hip
2. AIM: draw a line between these 2 points, AIM
ABOVE the line
****CAUTION: AVOID SCIATIC NERVE - - AIM HIGH!!!***
3. INSERT & ASPIRATE at a 90 degree angle
(Like a throwing Darts at a Dart Board) aspirate to avoid blood stream injection.
LEGNTH:
1.0 - 1.5
inches
MAX: 4.0ml
5.0ml Drugs are
often broken down
into
2.5ml and 2.5ml
Antibiotics:
- Rocephin
- Levaquin
( Any Thick Viscous
Medications )
1.4 Vastus Lateralis Muscle
Location NEEDLE Amount (ml) Common Meds?
1. LOCATE:
One hand above the knee
One hand belwo the greater tro-chanter (femur neck)
Locate middle of the outter thigh and middle of the side of the thigh.
2. AIM Lateral area of
the thigh
3. INSERT & ASPIRATE at a 90
degree angle (Like a throwing Darts at a Dart Board) aspirate to avoid blood stream injection.
LEGNTH:
1.0 - 1.5 inches
Max 4.0 ml
depends on size of your patient & hospital policy
Antibiotics:
- Rocephin
- Levaquin
Physciatric Medications: Haldol Geodon
Intramuscular Injection Secrets
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Page 6 of 9
Warning!!!
Aspriate: Avoid penetrating & medicating a Blood Vessel!!!
Nerves: Dorsal Gluteal, very common & dangerous mistake
Over 5ml Ordered? Divided into 2 doses and injected into separate sites with a maximum of 2.5 cc per dose.
Needle length: should NOT EXCEED 1 ½ inches
A 1 ¼ inch needle is commonly used.
**** Over View on Syringes & what they are used for! Remember, this is just a guide from personal experience
and should never replace your nursing book! Medicine is constantly changing its rules & guidelines, so keep that
in mind***
Needle SIZE? LENGTH Drug
18g - 21g
gauge BIGGEST OUCH!!
(Big Boy) 1.0 - 1.5 inches
For IM Anibiotics
22 - 23
gauge Normal Avarage Ouch 1.0 - 1.5 inches
For IM Antibiotics or Pain meds (see
below)
24 gauge
25 gauge Small Ouch 1.0 - 1.5 inches
For IM
0.5 inches
For SQ
Heparin
Vaccines: Hep, Flu, Chicken Pox
28 gauge Super Small Ouch
(small smally McSmalls
Less than 0.5 inches Insulin
TB tests (Tuberculosis)
Intramuscular Injection Secrets
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Page 7 of 9
2 Before You Give IM Injections
(1) Allergies to EGGs? Ask the patient about any known allergies before you administer any medication. You
should ask about
specific allergic reactions such as penicillin, eggs, or horse serum to refresh his memory
(2) Pregnant Patients: Ask females about the possibility of current pregnancy. Some medications can cause
severe birth defects if given to the mother during pregnancy. If there is a possibility of pregnancy, do not
administer the injection. Refer the patient to the physician or senior medical person.
(3) Warn the Patient: Tell the patient about the injection procedure. Be sure to wake up a patient if he has
been sleeping. If a patient is unconscious and you think he cannot
understand what you are telling him, tell the patient anyway….. (Especially psychiatric patients)
A patient may be frightened and/or violent. If this is the case, you must seek to contact your instructor & tell
them that you were.
****Remember*****
5 RIGHTS OF MED. ADMIN.
1. Right PATIENT P = Please
2. Right DOSE D = Do
3. Right DRUG D = Da
4. Right ROUTE R = Right
5. Right TIME T = Thing
2.1 DICE Your Drugs
D = Dose
I = Integrity of package ( Is the Vial/ Ampule cracked? Your IV Medication bag torn? )
C = Clarity of medication ( Is it cloudy when it should be clear? Pharmacy could have messed up!)
E = Experiation Date
Intramuscular Injection Secrets
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Page 8 of 9
3 Black Box Warnign Drugs
This section presents the most common black box drugs.
( 2 R.N. verification (two signatures) NEEDED!!!!)
DRUG Route REASON
Insulin Subcutaneous (SQ)
(fat portion of the skin)
Anti-Diabetic
Gets sugar into cells, drops actual
sugar in the blood stream so LOW that patients can DIE & go into a hypoglycemic COMA!! OMG!
Morphine,
Fentanyl, Dilaudid, Demerol
Intravenously (IV)
(inside the vein)
IM (intramuscular) (inside muscle)
NOT SQ (subcutaneous) never!!
Opioid Analgesic
Depresses your CNS (central nervous system)
Blocks pain receptors here. Its All good Right? NO!!!!
CNS is where the breathing and heart rate of your Autonomic Nervous system (automatic system like heart & lungs) are controlled!!!
BLOCK THIS TOO MUCH & HERES WHAT HAPPENS:
1. Breathing Stops
2. Heart Stops
3. DEATH
Potassium Intravenously (IV)
(inside the vein. . .
NOT the artery, get it str8!
Potassium Electrolyte:
LEATHAL INJECTION Anyone? NEVER EVER
IV PUSH !!!
K+ (3.5 - 5.0 blood value)
Is an electrolyte Not made in the human body, comes from diet & food that helps muscle to contract
GIVE TOO MUCH!
1. Heart contracts for good!
2. No more Oxygen to body
3. THIS IS CARDIAC
ARREST…. Aka heart
4. DEAD
Intramuscular Injection Secrets
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Page 9 of 9
Heparin IV
SQ
NEVER IM
ANIT - COAGULANT
Prevents blood from clotting
Stabilizes Clots & prevents future clots from forming.
Diagnosis’s:
DVT (deep vein thrombosis) PE (palmary embolism)
Clot in the Heart
Or just prophylactic for patients in
Bed too long post surgery.
Labs: aPTT or PTT
(just depends on your hospital)