The LSUHSC New Orleans Emergency Medicine Interest Group Presents The Student Procedure Manual

Intramuscular Injection

by Greg Jeansonne

Indications
Prerequisites
Equipment Required
Procedure
-Ventro-Gluteal
-Thigh (Rectus or V. Lateralis)
-Mid-Deltoid
-Dorso-Gluteal
Complications
Related Procedures/Tests

Indications

• Patient requires medication

Prerequisites

• Check patient allergy/contra-indications to medication

Equipment Required

• MedicatioSyringe (smallest possible)
  
• 2 Needles(±18ga for loading syringe, 20ga - 23ga for injection, I"-
• 3" based on fat thickness),
  
• Wipes
  
• Bandaid

Procedure

1. Draw-up medication into syringe (max dose = 5ml except at deltoid = 2ml).
   
2. Eject air & excess medication.
   
3. Change to sharp injection needle.
   
4. Select site (in order of preference):
   
   • Ventro-Gluteal: palm @ trochanter, 2nd digit @ anterior superior iliac spine(ASIS), spread fingers dorsally, inject btwn 2nd & 3rd digit.
   • Thigh (Rectus or V. Lateralis): Mid-way btwn trochanter & patella.
     
   • Mid-Deltoid: Lat. & 2-3 fingers inf to acromion.
     
   • Dorso-Gluteal: 2-3" below iliac crest within superior lateral quadrant. or above line btwn trochanter & PSIS.
     
5. Clean injection site with antiseptic wipe.
   
6. Pull overlying skin for "Z" seal.
   
7. Insert needle @ ±90'
   
8. Pull back on plunger to check for vessel.
   
9. Inject medication slowly.
   
10. Withdraw needle quickly.
    
11. Massage area with antiseptic wipe.

Complications

• Injection into nerve/vessel with result dependent on medication & nerve/vessel involved.
  
• Particular care should be taken to avoid the sciatic nerve with Dorso-Gluteal site.
  
• Tissue damage due to rapid injection =>local necrosis/infection/irritation , soreness, & bruising.

Related Procedures/Tests: subcutaneous injection