Intramascular
Injection
PRESENTED BY WARD GROUP F
BATCH: 52ND
DATE: 22/05/2025
Introduction
Definition: Intramascular injection involves administering medication
directly into the muscle tissue
Purpose: Facilitates rapid absorption due to rich vascular supply in
muscle
Common uses:
• Vaccinations
• Hormone Therapies
• Antibiotics
• Emergency Medications
Indications
Therapeutic Uses:
Antibiotics( e.g., Penicillin G benzathine)
Hormonal Agents( e.g., Testosterone, Medroxyprogesterone)
Neuroleptic Drugs( e.g., Sustained release Haloperidol)
Vaccines and Immunoglobulins
Emergency situations:
Epinephrine for anaphylactic shock
Contraindications
Absolute Contraindications:
Muscle atrophy at injection site
Infection or inflammation at injection site
Relative Contraindications:
Bleeding disorder(e.g., Hemophilia)
Anticoagulant therapy
Shock or poor perfusion state
Site of Administration
Deltoid muscle:
Suitable for small volume injections
Gluteal Muscle:
Preferred for larger volumes
Vastus Lateralis:
Commonly used in infants and children
N.B:
i. Injection to the Deltoid must be given at the middle of the muscle, at the
thickest part. The upper part of the muscle should be avoided, due to risk of
Axillary nerve injury.
ii. Upper outer quadrant of the gluteal muscle is preferred for injecting at Gluteal
muscle as injecting at inner quadrant can culminate into sciatic nerve palsy.
Figure: Intramascular Injection sites
Equipment
Appropriate syringe and needle(usually 22-25 gauge,1-1.5
inches)
Alcohol swab
Sterile gloves
Sharp disposal container
Preparations
Verify patient identity and take consent
Check medication for correct drug and expiration
date
Perform hand hygiene and wear gloves
Injection Technique
1) Position of the patient appropriately based on the injection site.
2) Clean the skin with an alcohol swab and allow it to dry.
3) Stretch the skin taut to isolate the muscle.
4) Insert the needle at a 90 degree dart-like motion.
5) Aspirate(pull back the plunger) to check for blood return.
6) Inject the medication steadily.
7) Withdraw the needle and apply gentle pressure with gauze.
Note: Aspiration is not recommended for vaccines and certain
medications.
Figure: Intramascular injection technique
Z-Track Method
Purpose:
Prevents leakage of medication into subcutaneous tissue, reducing
irritation.
Technique:
Displace the skin laterally before needle insertion
Inject the medication.
Withdraw the needle and release the skin, creating a zigzag path
that seals the muscle
Figure: Z-Track method
Pharmacological Perspective
Advantages:
Rapid onset of action
Uniform absorption, so prolonged duration of action
Significant bioavailability(75 to 100%)
Administration of moderate volume of drugs
Disadvantages:
Large volume 0f drugs cannot be given(Not greater than 5ml)
Expensive
Self-medication is not possible
No way of stopping the absorption once given, so mistakes are
unreturnable
Complications and Management
o Common complications:
Pain at injection site
Bleeding and hematoma
Infection or abscess formations
o Serious complications:
Nerve Injury(e.g., Sciatic nerve injury)
Tissue Necrosis
o Management:
Proper site selection and technique
Immediate management of drug averse effects
Figure: Foot Drop(Left) and Hematoma(Right)
Special Considerations
Pediatric patients:
Prefer vastus lateralis muscle for infants.
Use appropriate needle size and length.
Geriatric patients:
Assess for muscle mass and skin integrity.
Consider using ventrogluteal site to minimize risk.
Obese patients:
May require longer needles to reach muscle tissue.
References
[Link]
CDC.(2022) Injection Safety
Wolters Kluwer Journal of Nursing
Katzung and Trevor Basic and Clinical Pharmacology
KD Tripathi Essentials of Pharmacology
Lippincott Illustrated Pharmacology
Thank You