Intramuscular Injection Instructions Using a Syringe and Vial

Intramuscular Injection Instructions Using a Syringe and Vial

An intramuscular (IM) injection is a shot of medicine that is given into a muscle. An IM injection may be given when medicine needs to start working right away, or when medicine cannot be given any other way. An IM injection is given with a single-use syringe and needle. The medicine comes in a bottle (vial). You will fill the syringe with medicine from the vial.

Use only the syringe, needle, and medicine that your health care provider prescribes. Use each syringe and needle only one time.

Supplies needed:

  • Syringe.
  • Needle. Use the needle length and size (gauge) that your health care provider or pharmacist gives to you.
  • Medicine prescribed by your health care provider.
  • Alcohol wipes.
  • Bandage.
  • A container for syringe disposal. This may be a puncture-proof sharps container or a hard-sided plastic container that has a secure lid, such as an empty laundry detergent bottle.

How to choose a site for injection

Follow instructions from your health care provider about where to give an injection. The best injection site depends on a person’s age, weight, and the amount of medicine in the injection.

Only give an injection in a site that is safe for a certain age as told by your health care provider. For general recommendations about where to give an injection, refer to the instructions for the appropriate age group:

Babies who are younger than 7 months old

  • The outer thigh is the preferred injection site.
  • Do not give injections in your baby’s hip or buttocks.
  • If your baby’s health care provider approves, you may give an injection in your baby’s upper arm. However, your baby’s health care provider must approve this based on your baby’s muscle mass.

Babies and children who are 7–23 months old

  • The outer thigh is the preferred injection site. The injection may also be given in the hip.
  • If your baby is younger than 1 year, do not give the injection in the buttocks. If your baby is older than 1 year, the injection may be given in the buttocks.
  • If your baby’s health care provider approves, you may give an injection in your baby’s upper arm. However, your baby’s health care provider must approve this based on your baby’s muscle mass.

Children who are 2–18 years old, and adults

  • The upper arm is the preferred injection site.
  • The injection may also be given in the outer thigh, the hip, or the buttocks, depending on the amount of medicine in the injection.

There is a maximum amount of medicine that can be injected into each site. Do not inject more than the maximum amount of medicine into an injection site. The maximum amount is listed here for each site:

  • Outer thigh: 5 mL
  • Upper arm: 2 mL
  • Hip: 5 mL
  • Buttocks: 4 mL

How to locate an injection site

Write down the date, time, and location of each injection that you give. If more than one injection is needed, give an injection at least 1 inch (2.5 cm) away from the previous injection site. Refer to the following instructions to find the exact location of each injection site.

Outer thigh

Imagine that the thigh is divided into three equal sections (thirds) between the knee and the hip. The injection site area is in the middle third, on the outer side of the thigh.

Upper arm

Place the palm of your hand on the top of the shoulder. Your thumb should point away from the neck. Your fingers should point toward the floor. Your thumb should be on one side of the shoulder, and your fingers should be on the other side, so that they make an upside-down V shape.

The injection site area is in the middle of the V shape, on the top of the arm.

Hip

Place the palm of your hand on the outside of the hip so your wrist is at the top of the upper leg. Your thumb should point toward the groin. Use your ring finger and little finger to feel the upper edge of the pelvic bone. Spread your index finger and middle finger apart from each other into a V shape. The injection site is the area between those fingers.

Buttocks

Imagine that the buttock is divided into four equal sections (quarters), and imagine those quarters as four squares:

  • An inner square and an outer square on the upper half of the buttock.
  • An inner square and an outer square on the lower half of the buttock.

The injection should be given in the upper, outer quarter. There is a high risk of hitting a nerve, blood vessel, or bone when you give an injection in this site.

How to give an IM injection using medicine from a vial

  1. Wash your hands with soap and water. If soap and water are not available, use hand sanitizer.
  2. Gently roll the medicine vial between your hands to mix it. Do not shake the vial.
  3. If there is a plastic covering on the vial, remove it. Clean the top rubber part of the vial with an alcohol wipe.
  4. Remove the plastic cover from the needle on the syringe. Do not let the needle touch anything.
  5. Pull the plunger back to draw air into the syringe. Stop the plunger when the dose indicator gets to the line that is the same as your medicine dose.
  6. Push the needle through the rubber on the top of the vial. Do not turn the vial over.
  7. Push the plunger in all the way. This pushes air into the vial.
  8. While the needle is still in the vial, turn the vial upside down and hold it at eye level.
  9. Pull back slowly on the plunger to draw medicine into the syringe. Stop when the dose indicator is at the correct amount of medicine needed.
  10. Remove the needle from the vial. Do not let the needle touch anything.
  11. Hold the syringe with the needle pointing up. Check the syringe for any remaining air bubbles. If there are air bubbles, flick the syringe with your finger until the air bubbles rise to the top. Then, gently push on the plunger until you can see a drop of medicine appear at the tip of the needle. This will clear any remaining air bubbles from the syringe.
  12. Use an alcohol wipe to clean the site where you will be injecting the needle. Let the site air-dry.
  13. Hold the syringe in your writing hand like a pencil.
  14. Gently but quickly, put the needle straight into the skin. The needle should be at a 90-degree angle (perpendicular) to the skin. Push the needle all the way against the skin. Continue to hold the syringe with your writing hand.
    1. If instructed, use your other hand to pull back slightly on the plunger (aspirate) to see if any blood enters the syringe. If there is blood, do not inject the medicine. Remove the needle and start over with a new needle and syringe. Most medicines will not require that you do this step.
  15. Use the thumb of your writing hand to push the plunger all the way into the syringe to inject the medicine. If the medicine is a gel, you may need to push harder on the plunger to press the medicine out of the syringe.
  16. Pull the needle straight out of the skin.
  17. Press and hold the alcohol wipe over the injection site until bleeding stops. Do not rub the area.
  18. Cover the injection site with a bandage, if needed.

How to safely throw away the supplies

If you are using a syringe that does not have a safety system for shielding the needle after injection:

  • Do not recap the needle. Place the syringe and needle in the disposal container.

If your syringe has a safety system for shielding the needle after injection:

  • Firmly push down on the plunger after you complete the injection. The protective sleeve will automatically cover the needle, and you will hear a click. The click means that the needle is safely covered.

Follow the disposal regulations for the area where you live. Do not use any syringe or needle more than one time. You may throw the empty medicine vial in the trash.

Contact a health care provider if:

  • You have difficulty giving the injection.
  • You think that the injection was not given correctly.
  • You have difficulty with any of the supplies.
  • The medicine causes side effects.
  • Rashes develop on the skin.
  • A fever develops.
  • The condition that is being treated gets worse.

Get help right away if:

  • Any of these symptoms develop after the injection is given:
    • Difficulty breathing.
    • Chest pain.
    • A rash over most or all of the body.
    • Swelling of the lips or tongue.
    • Difficulty swallowing.

Summary

  • An intramuscular (IM) injection is a shot of medicine that is given into a muscle.
  • Use only the syringe, needle, and medicine that your health care provider prescribes. Use each syringe and needle only one time.
  • Follow instructions from your health care provider about where to give an injection.
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