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Many drugs need to be delivered to the muscle layer which underlies skin in certain parts of the body. When giving an intramuscular injection, it is important to ensure that the drug is delivered to the muscle rather than to the subcutaneous tissue or dermis.
Check ID and obtain informed consent
Introduce yourself to the patient by clearly stating your name and role. Ask the patient their name and date of birth and check this information against their hospital wristband or equivalent. Explain why you need to perform the procedure and what the procedure will involve before obtaining verbal consent from the patient.
"Hello, my name is Emma Smith. Can I ask you your name? I am a medical student and I have been asked to give you an injection of medicine to help your condition. You might feel a sharp scratch when I give you the injection. Is that okay with you?"
Check the patient's drug chart
Before administering any drug, you must carefully check the patient's drug chart. Ensure that you check for the following on the drug chart:
Prepare the injection
Before opening any packaging, wash your hands thoroughly using soap and water or alcohol gel. Check the expiry dates of all required items and verify the integrity of all packaging.
Prepare all the equipment required by placing into a clean container. As a minimum, you will need:
A clean tray containing (L-R): drug vial, syringe, 25G ⅝" drawing needle, 23G 1¼" injection needle, gauze dressing & clean nitrile gloves
Once all equipment has been prepared, ask a qualified colleague to double check the patient's prescription against the drug and dose you have selected. Ensure that your colleague pays particular attention to the dose and expiry date of the drug you have selected.
Inspect the vial for any obvious defects, such as cloudiness or floating particles.
Wash your hands using alcohol hand gel.
Put on a pair of clean nitrile gloves and attach the drawing up needle to the syringe. Remove any protective caps from the vial and draw up the required volume of drug into the syringe. Hold the vial upside down and insert the needle just a few millimeters into the vial in order to ensure collection of all of the drug without drawing up air bubbles.
Once all the drug has been drawn, re-cap the needle being careful to avoid a needlestick injury before expelling any residual air bubbles from the syringe. Remove and dispose of the needle in a sharps container.
Attach a fresh needle to the syringe and locate a suitable site for injection, such as the upper arm (deltoid muscle) or upper outer quadrant of the buttock (dorsogluteal muscle). The skin should only be cleaned prior to injection if it is visibly dirty.
Administer the injection
Stretch the patients skin using your thumb and index finger in order to reduce sensitivity and allow the needle to penetrate deep into the muscular layer. Hold the needle like a dart and quickly enter the skin at an angle of 90°. Ensure ¼ of the needle remains visible incase the needle snaps whilst in the patient.
Pull back on the plunger slightly and check to see if any blood fills the syringe. If this occurs, withdraw the needle immediately and discard in a sharps container. Attempt to administer a fresh injection at a different site (e.g. the opposite arm)
Slowly inject the drug. Once all the drug has been administered, rapidly remove the needle and dispose of in a sharps container.
Document the procedure in the patient's notes.