Name of Student: ____________________________ Year & Sec: _____________
CHECKLIST ON INTRAMUSCULAR INJECTION
Procedure 5 4 3 2 1
ASSESSMENT
1. Assess that overall condition of your patient
2. Make sure you have the right patient, by asking the patient’s name,
birth date, and also checking the wristlet for the accurate name tag.
Always abide the 5 rights of medication administration to avoid
medication errors.
a. Right Patient
b. Right Medication
c. Right Dose
d. Right Time
e. Right Route
PLANNING
1. Explain the procedure to the patient. Make sure the patient
understands and expects what will happen during the procedure
2. Choose the injection site free of lesions or discolorations. Any
tenderness, soreness, bruising and areas of infection is not a
suitable site for injection. The deltoid muscle is the most common
sites for adults, vastus lateralis for newborn and pediatric patients.
But the ventrogluteal site is the much-preferred route for higher
quantity medications, up to 3 mL
3. Choose the right needle and syringe for the procedure.
a. Ventrogluteal site (administer 1 to 3 mL, 20 to 23-gauge syringe,
1 ¼ to 2 ½ inch needle
b. Deltoid (administer 0.5 to 1 mL, with a 23 to 25 gauge, 5/8 to 1
½ inch needle)
c. Vastus Lateralis (administer in infants max = 0.5 mL, 1 mL in
pediatric patients, and 1 to 1.5 mL in adults maximum 2 mL)
IMPLEMENTATION - PALPATION
1. At the bedside compare the medication with the medication order
and medication ticket, to make sure you are giving the correct
medication, dose and also to the right patient.
2. Inform the patient of the procedure, what medication they are
getting, what it does and what potential side effects to expect. Also
encourage the patient to ask questions. Caution the patient that the
injection might cause a slight burning or stinging sensation.
3. Select an appropriate injection site. The deltoid muscle is the most
common site for adults, vastus lateralis for newborn and pediatric
patients. But the ventrogluteal site is the much-preferred route for
higher quantity medications, up to 3 mL
4. Examine the integrity and amount of patient’s muscle mass. Palpate
the muscle. Areas of tenderness or hardness are not suitable
injection sites. If the patient receives frequent injections, rotate the
injection site selection. Inspect the area for bruising, inflammation
and edema. If the site is bruised or shows signs of infection, use a
different site.
5. Help the patient find a comfortable position that will accommodate
the injection site you have chosen. Expose only that portion of the
body. Always maintain privacy and do not overexposed your patient.
a. Ventrogluteal (supine lateral position) – suited for deep IM or Z-
track injections, free of major nerves. Anatomic landmarks are
also well defined
b. Deltoid (supine, prone, sitting, lateral) – readily accessible, in an
event of hypersensitivity reaction, medication absorption can be
delayed by tourniquet. Ideal also for Z-Track injections
c. Vastus lateralis (sitting, supine) – good site for infants, size
acceptable for multiple injections and free of major nerves
6. Wash hands, wear clean gloves and use anatomical landmarks to
find the site again.
a. Ventrogluteal injection - place the heel of your hand over the
greater trochanter of the patient’s hip with the wrist almost
perpendicular to the femur, point the thumb towards the patient’s
groin. Point the index finger towards the anterior superior iliac
spine and extend the middle finger back along the iliac crest
towards the buttocks. The index finger, the middle finger and the
iliac crest form a “V” shaped triangle. The injection site is the
center of the triangle.
a. For deltoid injection sites. Feel the acromion process with
your index finger. This is the bony prominence in the scapulae.
Then, 2 fingers width down below the acromion process, the
middle or center between the fingers is your site for injection. Z
track method is the ideal choice for this site
7. Once the site is located, you can mark it with an unopen alcohol
wipe.
8. To clean the injection site, begin at the center and move outward at
least 2 inches or 5 cm in a circular pattern. (If available, you may
apply anesthetic cream such as EMLA to the planned injection site
about 1 hour before administering the injection or if you use a vapo
coolant spray such as ethyl chloride, spray it on the site, just before
giving the injection.)
9. Hold a gauze pad, between the third and 4th finger of your
nondominant hand
10. Remove the needle cap by pulling it straight off
11. Hold the syringe with the thumb and forefinger of your dominant
hand as if it were a dart. Remind your patient to try and relax
12. (Preferable for Ventrogluteal site) Place the ulnar site of your
nondominant hand just below the injection site and pull the skin
laterally about 1 to 1 ½ inches or 2 ½ to 3 ½ cm. Hold this position
until you have inserted the needle. You may not do this in sitting
position especially in deltoid site injection.
13. If the patient has little muscle mass, grasp the body of the muscle
between your thumb and forefinger
14. With your dominant hand, quickly pierce the muscle in a 90-degree
angle. So as to reduce the pain of the patient.
15. Continue pulling the skin taut with your nondominant hand, stabilize
the syringe by grasping the lower end of the barrel with the fingers of
the nondominant hand as they are resting on the patient
(Ventrogluteal site injection).
a. For deltoid especially Z-Track, you don’t need to taut the
skin: Use your nondominant hand, place it on the side of the
injection, place just enough pressure to pull the skin on one
side. Hold that position
16. Attempt to aspirate by pulling back on the plunger with your
dominant hand. If blood appears, you are not in the muscle. Remove
and discard the needle and syringe, then start over. If no blood
appears, you are ready to proceed.
17. Inject the medication slowly at a rate of 1 mL every 10 seconds.
Wait 10 seconds and smoothly withdraw the needle. Engage the
needle safety (if you are using a safe syringe). If not, discard
immediately, and do not recap. But if you still need to recap it, you
can use one hand technique to do the recapping, be careful of
needle prick injuries.
18. Release the skin and place a gauze pad over the site. Apply gentle
pressure but do not massage the area.
19. Do aftercare, hand hygiene and dispose of sharps accordingly.
EVALUATION
1. Monitor the patient for 5 to 30 minutes after injecting the medication,
to evaluate for any hypersensitivity reactions or any unexpected and
untoward effects. You can ask the patient to report any unusual
effects that they may feel after the medication administration.
DOCUMENTATION
1. Document the procedure, accurate time, date, dose of the
medication immediately after giving the medication. Also take note
of any untoward effects that the patient may have experienced.
Charting/Documentation:
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Rubrics:
5 – The student performs the procedure outstandingly without correction and assistance
4 – The student performs the procedure very satisfactorily with corrections but no assistance
3 – The student performs the procedure satisfactorily but with minimal corrections and
assistance
2 – The student performs the procedure fairly satisfactory with corrections and assistance
1 – The student performs the procedure unsatisfactorily and needs practice
Highest possible score: 130 points
Total Score Earned: ___________
Equivalent score: _____________
Remarks:
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Clinical Instructor: ___________________
Date Performed: _____________________