Videos

Intramuscular injection animated demonstration

Demonstration of an intramuscular injection into the ventrogluteal site, using a Z-track technique.

1) Equipment needed

  • Non-sterile gloves

  • Apron

  • Cotton wool or gauze

  • Small sticking plaster (ideal)[77]

  • Disposable tray

  • Sharps bin

  • Medicine for injection

  • Fluid for reconstitution or dilution

  • Filter needle to draw up medication

  • Appropriate needle size for the injection. It should be of sufficient length to penetrate the subcutaneous fat and travel into the muscle layer.[78] A 25 mm (23 gauge) or 38 mm (21 gauge) length needle is recommended for most adults, although individual influencing factors should be considered (e.g., age and sex of patient, degree of subcutaneous fat). There is a difference in depth of fatty tissue between men and women. A needle length of 25 mm is recommended for women weighing between 60 and 90 kg, and a length of of 38mm for women who weigh over 90 kg.[79] [80] [81]

2) Contraindications

  • You should not administer injections through infected or broken skin

  • Take careful note of any previous allergic reactions, hypersensitivity, or other adverse effects by both asking the patient and checking their notes. If the patient is allergic to the medication, do not inject the medication.

Cautions

  • You should always adhere to manufacturer’s guidelines for the route of administration, dilution, dosage, and infusions

  • For immunisations, clean skin with soap and water.[82] For injection of other medications, some organisations have a policy of using isopropyl alcohol wipes to disinfect the skin prior to giving injections. You should follow local policy. If using isopropyl alcohol, allow to dry for 30 seconds.[82]

3) Indications

Some oral medicines undergo extensive first pass metabolism by the liver or are not well absorbed from the gastrointestinal tract, so alternative routes of administration are preferable. In other situations patients may be nil by mouth, or too unwell to take oral medications. For each medicine required, consider the routes of administration available and which is the most appropriate for the clinical setting. The following key issues have been described as important to consider when choosing the most appropriate route:[83]

  • Safety

  • Efficacy

  • Patient preference

  • Pharmacoeconomics.

4) Complications

Complications that may occur as a result of injection include:

  • Bleeding, bruising, or haematoma formation

  • Local infection and formation of an abscess

  • Fainting

  • Allergic reaction

  • Formation of a sterile abscess

  • Overdose (intramuscular opiates in hypovolaemic or shocked patients)

  • Paraesthesia/nerve damage

  • Pain.

5) Aftercare

  • Monitor the patient for the desired responses after medications have been administered. Also be vigilant for potential adverse effects from the injection

  • Observe the injection sites for haematoma formation, bleeding, infection, and hypersensitivity reactions

  • Ensure that you correctly document all medications administered.