Art & science clinical skills
How to administer
intramuscular injections
Chadwick A, Withnell N (2015) How to administer intramuscular injections. Nursing Standard. 30, 8, 36-39.
Date of submission: February 19 2015; date of acceptance: June 22 2015.
Rationale and key points
This article aims to help nurses to administer intramuscular
injections in a safe, effective and patient-centred manner. Following
administration of an intramuscular injection, the patient should be
observed for a period of time to reduce any risk of harm.
 Nurses should possess the knowledge, skill, professional judgement
and accountability to administer intramuscular injections safely.
 Nurses should ensure the correct drug is prepared using the correct
method at the correct dose for administration to the correct patient.
 Local and national protocols should be adhered to.
Reflective activity
Clinical skills articles can help update your practice and ensure it
remains evidence based. Apply this article to your practice. Reflect on
and write a short account of:
1. Your most recent experience in injection administration.
2. How reading this article will change your practice.
Subscribers can upload their reflective accounts at: rcni.com/portfolio.
Authors
Angelina Chadwick Lecturer in mental health nursing.
Neil Withnell Associate head, academic enhancement.
Both at School of Nursing, Midwifery, Social Work and Social
Sciences, The University of Salford, Greater Manchester, England.
Correspondence to: A.L.Chadwick@salford.ac.uk
Keywords
administering injections, clinical procedures, clinical skills,
intramuscular injection, medication errors
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36 october 21 :: vol 30 no 8 :: 2015
Preparation and equipment
 A clear prescription chart should be available.
This must be legible, signed and dated.
 All appropriate equipment for administration
of the intramuscular injection should be
available including:
– A clean tray or receiver.
– Two sterile needles (of appropriate size).
– A syringe (2-5mL).
– The drug to be administered.
– An alcohol-impregnated swab.
– Gloves.
– A sharps container.
The nurse should have knowledge of the
intramuscular injection medication, and its normal
dosage range, clinical use, contraindications,
cautions and side effects.
Procedure
1. Undertake infection control measures, such as
handwashing and using sterile equipment.
2. Undertake medication checks: ensure that the
medication is correct against the prescription
chart, including the dose and expiry date.
3. Confirm the identity of the patient and obtain
consent for the procedure, ensuing that the
patient is not allergic to the medication before
administration.
4. Use an ampoule opener or cover the neck of the
ampoule with some gauze to avoid injury when
opening the ampoule.
5. Inspect the injectable solution for inappropriate
appearance (cloudiness, fragments of glass).
Prepare the injection before approaching the
patient, if possible, on the tray or receiver.
6. Aspirate the contents of the ampoule using
the needle and syringe, ensuring any air in the
syringe is expelled.
7. Use a two-needle approach (changing needles
after drawing up the injectable solution and
before administration) to ensure the needle
is clean, sharp and dry to avoid causing
unnecessary pain to the patient during the
procedure (Ağaç and Günes¸ 2010). Dispose of
the first needle directly in the sharps container.
NURSING STANDARD
 8. Resheathe the needle carefully using a Management (NMC 2010) when undertaking
one-handed scooping method (Dougherty and the administration of medicines via intramuscular
Lister 2015), ensuring the contents remain sterile injection. The safe administration of medicines is a
before administration (Hunter 2008). high priority. It is an essential standard of the Care
9. Put on gloves, according to local policy guidelines. Quality Commission (2010) (Outcome 9) and the
10. Select the appropriate intramuscular injection NHS Litigation Authority (2014) (Standard 5.10).
site (deltoid, dorsogluteal, ventrogluteal, rectus The most frequently reported types of medication
femoris, vastus lateralis) depending on the drug errors or incidents involve the wrong dose, omitted
to be administered, the volume to be given, and or delayed medicines and the wrong medicine
the patient’s age and condition. (National Patient Safety Agency (NPSA) 2014).
11. Locate the intramuscular injection site using Therefore, care and attention should be taken when
knowledge of the appropriate anatomical administering intramuscular injections.
landmarks. Nurses are expected to comply with local
12. Ensure the patient is positioned appropriately procedures and policies to safely administer
to avoid unnecessary discomfort during the intramuscular injections. The nine rights of
procedure. Consider using distraction techniques medication administration (Elliott and Liu 2010)
with the patient to reduce their perception of pain. were designed to promote patient safety. It is
13. Ensure the skin is clean. Skin disinfection is not essential to follow these when undertaking the
routinely required (Public Health England (PHE) administration of intramuscular injections; you
2013). However, skin disinfection using an must have the right patient and the right drug, and
alcohol-impregnated swab should be considered administer it via the right route, at the right time,
in accordance with local policy and the patient’s at the right dose, using the right documentation,
condition. Allow 30 seconds to dry. for the right action, in the right form, observing for
14. Insert the needle at 90° stretching the skin, rather the right response.
than bunching it, with a dart-like movement Good communication is essential to inform
using your dominant hand. the patient and to establish their understanding,
15. Use the Z-track technique (Figure 1) to avoid the while also gaining informed consent when
drug tracking back and leaking out.
16. Aspiration is not usually required (PHE 2013), FIGURE 1
with the exception of injection into the vascular Z-track technique
dorsogluteal site, which requires aspiration to
detect inadvertent intravenous administration.
17. Depress the plunger at a recommended rate of
1mL/10 seconds (Dougherty and Lister 2015)
to avoid discomfort for the patient.
18. Dispose of the injection syringe and needle
directly into the sharps container. Do not
resheathe the needle to reduce the risk of avoidable
needlestick injury.
19. Remove gloves and wash your hands.
20. Document the procedure on the prescription
chart. This requires clear, accurate and
immediate documentation. If the medicine has
not been administered, this must be clearly and
accurately indicated on the prescription chart
and a reason stated (Nursing and Midwifery
Council (NMC) 2010).
21. Observe the patient and the injection site and
report any changes, reactions or deterioration to
the medical team immediately.

Evidence base
The administration of intramuscular injections
PETER LAMB

is an essential element of professional practice for

nurses registered with the NMC. Nurses in the
UK must adhere to the Standards for Medicines

NURSING STANDARD october 21 :: vol 30 no 8 :: 2015 37

Art & science clinical skills
administering medicines (National Institute for
Health and Care Excellence 2009). It is important
that the patient is educated about the medicine
that they are taking.
It is important that the patient’s allergy status
is clearly documented on the prescription chart,
including the ‘no known medicine allergy’ section,
because this is a requirement before prescribing
and administering medicines. Incidents have
occurred that resulted in harm to patients,
including fatalities, when the allergy status was
omitted (NPSA 2007, NMC 2010).
It is essential to calculate medicine dosage by
weight and age in children and young people,
because of differences in their metabolism and
pharmacokinetics (NPSA 2009, Royal College of
Nursing 2013).
The nurse is required to always check a patient’s
identity before administering intramuscular
injections. Positive identification can be made by
asking the patient, parent or carer or by checking
the identification wristband where the minimum
information will include the patient’s name, date
of birth and hospital number (World Health
Organization (WHO) 2007, NMC 2010). There
are areas where the wearing of identification
wristbands is not the standard procedure, for
example in areas where stigma may be attached,
such as in learning disability or mental health
nursing, or where identification wristbands cannot
be used, for example in neonates and those with
dermatological conditions. Alternative methods
should then be used for patient identification, in
accordance with local healthcare organisation
policies (WHO 2007, NMC 2010).
The choice of injection site should be considered
in relation to the medication being administered
intramuscularly. The deltoid is the smallest muscle
site and the maximum volume of medication that
can be injected is 1-2mL (Cocoman and Murray
2008). The dorsogluteal site can be used for deep
intramuscular injection and up to a maximum
of 4mL of medication may be injected (Hunter
2008). However, this site may result in possible
overdosage, because of its slower absorption rate
(Malkin 2008). The dorsogluteal site also contains
major nerves and blood vessels, and intramuscular
injection might lead to injury (Malkin 2008).
The vastus lateralis and rectus femoris sites in
the thigh may be used for deep intramuscular
injection, with a maximum volume of 5mL being
injected into each site.
The ventrogluteal site may also be used for deep
intramuscular injection. The maximum volume of
medication that may be injected into this muscle
is 3mL. The ventrogluteal is the recommended
site for intramuscular injection, since it has
38 october 21 :: vol 30 no 8 :: 2015
the thickest muscle and is free of major nerves
(Cocoman and Murray 2008).
The Z-track technique should be used to
prevent backtracking of medication (Cocoman
and Murray 2008). This technique involves
displacing the skin over the chosen injection site by
pulling it laterally away from the underlying muscle
with the non-dominant hand up to 1cm and then
inserting the needle and injecting the medicine.
On withdrawal of the needle, the retracted skin
is released at the same time to allow the puncture
tract to be sealed, trapping the medication in the
muscle (Cocoman and Murray 2008).
The appropriate choice of needle depends on
selecting the correct length to ensure penetration
of the muscle. PHE (2013) recommends using
16mm needles in pre-term or very small infants,
with needles of 25-38mm for adults weighing over
90kg. However, an individual assessment should
be made of the person receiving the injection. The
needle width or gauge should also be considered.
A wider bore needle may allow wider dispersion
of the drug, reducing localised swelling and
redness. A 23G (blue) or 25G (orange) needle is
recommended for infants and children, and a 21G
(green) needle for adults.
Skin disinfection is not routinely required
for intramuscular injection. However, skin
preparation is recommended for older individuals
or those who are immunocompromised (Pratt
et al 2005). The patient’s best interests should be
maintained at all times and is the priority when
administering intramuscular injections.
Nurses have a responsibility to observe patients
following the administration of medicines and
document any changes, reporting immediately
any adverse reactions or deterioration in a
person’s condition to the appropriate healthcare
professional (NMC 2010) NS
Disclaimer: please note that information provided by Nursing
Standard is not sufficient to make the reader competent to
perform the task. All clinical skills should be formally assessed
at the bedside by a nurse educator or mentor. It is the nurse’s
responsibility to ensure their practice remains up to date and
reflects the latest evidence.
USEFUL PRACTICE POINTS
Obtain a copy of the British National Formulary and
access BNF Online (www.bnf.org).
Remember the nine rights of medication
administration when giving intramuscular injections.
Be familiar with your local policies for the
administration of intramuscular injections.
Take your time when administering an intramuscular
injection. You should focus your attention on this task
and avoid distractions from others.
Remember that the patient is your priority.
NURSING STANDARD
References
Ağaç E, Güneş UY (2010) Effect
on pain of changing the needle
prior to administering medicine
intramuscularly: a randomized
controlled trial. Journal of Advanced
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Care Quality Commission (2010)
Guidance about Compliance:
Summary of Regulations, Outcomes
and Judgement Framework.
www.cqc.org.uk/sites/default/
files/documents/guidance_about_
compliance_summary.pdf (Last
accessed: September 17 2015.)
Cocoman A , Murray J (2008)
Intramuscular injections: a review
of best practice for mental health
nurses. Journal of Psychiatric and
Mental Health Nursing.
15, 5, 424-434.
Dougherty L , Lister S (Eds) (2015)
The Royal Marsden Hospital Manual
of Clinical Nursing Procedures. Ninth
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Elliott M, Liu Y (2010) The nine
rights of medication administration:
an overview. British Journal of
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Hunter J (2008) Intramuscular
injection techniques. Nursing
Standard. 22, 24, 35 -40.
Malkin B (2008) Are techniques
used for intramuscular
injection based on research
evidence? Nursing Times. 104,
50–51 , 48-51 .
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Care Excellence (2009) Medicines
Adherence: Involving Patients
in Decisions about Prescribed
Medicines and Supporting
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(2007 ) Safety in Doses: Medication
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(2009) Safety in Doses.
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(2014) Medication Safety.
www.nrls.npsa.nhs.uk/
resources/patient-safety-topics/
medication-safety/ (Last accessed:
September 17 2015.)
NHS Litigation Authority
(2014) NHSLA Risk Management
Standards 2013-14 for NHS Trusts
providing Acute, Community,
or Mental Health & Learning
Disability Services and Non-NHS
Providers of NHS Care.
www.nhsla.com/safety/Documents/
NHS%20LA%20Risk%20
Management%20Standards%20
2013-14.pdf (Last accessed:
September 17 2015.)
Nursing and Midwifery Council
(2010) Standards for Medicines
Management. NMC, London.
Pratt RJ, Hoffman PN, Robb FF
(2005) The need for skin
preparation prior to injection:
point counterpoint. Journal
of Infection Prevention.
6, 4, 18-20.
Public Health England (2013)
Immunisation procedures:
the green book, chapter 4.
Immunisation Against
Infectious Disease. PHE,
London, 25 -34.
Royal College of Nursing
(2013) Standards for the
Weighing of Infants, Children
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PS-Solution2.pdf (Last accessed:
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