UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: ADMINISTERING AN INTRAMUSCULAR INJECTION
Effective Date: February, 2002 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed October, 2003 March, 2005 Feb, 2008 April, 2010 January, 2012
November, 2013 June, 2014
PURPOSE: To provide guidelines for the administration of an intramuscular injection at the University of
Wisconsin Medical Foundation (UWMF) and Department of Family Medicine (DFM) clinics.
POLICY: Clinical staff will utilize the following guidelines to administer an intramuscular injection to
UWMF/DFM patients. The preparation and administration of a medication should be completed by the same
Recommendations for maximum quantity of drug that can be injected into one site are listed below, and may
depend upon the drug, size of the patient, and manufacturer’s suggestions.
ξ Large muscles – maximum of 5 mL per site
ξ Deltoid muscle – maximum of 1 mL per site
ξ Small children – maximum of 2 mL per site
ξ Infants (< 1 year old) – maximum of 1 mL
When giving multiple injections in same site, i.e., immunizations, injections should be at least one inch apart.
DEFINITION: The intramuscular route provides faster drug absorption because of a muscle’s vascularity.
SUPPLIES: 3 ml syringe, 1, 1 1/2, or 2 inch needle, or appropriate length for body size
21, 22, 23, or 25 gauge needle, Small gauze pad, Alcohol pads, Gloves, Bandage, Provider’s order, Medication
record (if applicable), medication
1. Check the name and dose of medication against the provider’s order. Clarify any inconsistencies.
2. Wash hands and assemble equipment.
3. Identify the patient and provide privacy for the injection. Verify date of birth and patient’s allergies.
4. Review patient assessment and lab findings relevant to medication.
5. Draw up medication, adhering to the five rights of drug administration.
ξ Right – drug, dose, time, route, patient
ξ Check the expiration date of the medication
NOTE: It is not necessary to change the needle after drug has been
drawn up into the syringe, unless:
ξ The medication requires you to change needles.
ξ The procedure requires a different length needle.
ξ The needle becomes contaminated, broken, etc.
6. Explain procedure and medication to patient.
7. Have patient assume a position for the site selected. (See diagrams).
a. Ventrogluteal - This is a preferred site for deep IM injections for quantities of greater than 1 mL, however,
clinical staff should use their clinical judgment when selecting an injection site. Patient may lie on back or side.
b. Vastus lateralis - Patient may lie on the back or may assume a sitting position. (most common place for
c. Deltoid - Patient may sit or lie with arm relaxed.
d. Dorsogluteal – Patient may lie prone with toes pointing inward or on side with upper leg flexed and
placed in front of lower leg.
8. Locate site of choice and ensure that the area is not tender and is free of lumps or nodules.
9. Put on disposable gloves.
10. Cleanse area thoroughly with alcohol swab, using friction, and then allow alcohol to dry.
11. Remove needle cap by pulling it straight off.
12. Quickly insert (dart) needle into the tissue at a 90° angle.
13. Aspiration may be performed to ensure a blood vessel has not been penetrated. In the event of blood being
aspirated the procedure should be started again with a new needle.
NOTE: CDC does not recommend aspiration when giving immunizations into the vastus lateralis or deltoid,
because there are no large blood vessels in these injection site areas.
14. Move your non-dominant hand to hold lower end of syringe.
15. Slide your dominant hand to tip of barrel.
16. Remove needle slowly and steadily, straight out from the site.
17. Apply gentle pressure at site with a small, dry sponge.
18. Discard needle and syringe in sharps container.
19. Assist patient to a position of comfort.
20. Remove gloves, and dispose of them properly, then wash hands.
21. Documentation (HealthLink)
ξ Manufacture, Lot #, Expiration date (as indicated)
ξ VIS# (if applicable)
ξ Name, dosage, route of medication, site of injection, and time given
Progress Notes utilizing SmartPhrases: .npinjectstart and .npinjectend
ξ Assessment and laboratory results relevant to purpose of the medication
ξ Effects of the medication on patient
ξ Teaching about the drug or injection technique
ξ How patient tolerated procedure, i.e., desired effect, adverse reactions
REVISED BY: LaVay Morrison, RN, BSN, Clinical Staff Educator
REVIEWED BY: Mary Ryan, RN, BSN, Clinical Staff Educator
WRITTEN BY: Ronnie Peterson, RN, MS, Manager of Clinical Support
ξ Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.).
St. Louis, MO: Mosby Elsevier.
ξ Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott
Williams & Wilkins.
ξ Polly Gerber Zimmermann, MS, MBA, RN, CEN; (February 2010). Revisiting IM Injections. The
ventrogluteal site is the safest for intramuscular injections; AJN, Vol. 110, No. 2, pg 60-61.
AUTHORIZED BY: Richard Welnick, MD, Medical Director, Ambulatory Clinic Operations, UWMF
Sandra A. Kamnetz M.D., Vice Chair, Department of Family Medicine
Medical Director, UWMF Date
Vice Chair, Department of Family Medicine Date