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Intramuscular Injection Secrets

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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



3

1 Intramuscular Injection Sites



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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


***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



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1.3 Dorso Gluteal Muscle


***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


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



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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)



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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



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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



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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)

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