IM Injection

OBJECTIVE STRUCTURED ASSESSMENTS OF TECHNICAL SKILL (OSAT)
INTRAMUSCULAR INJECTION
(DELTOID MUSCLE)
S.L. CHECK POINTS Y/N

1.
Check materials in the tray
 Drug to be administered in a labeled vial or ampoule
 Medication syringe with sterile 22-25 gauge long & medium thickness
needle
 Nonsterile gloves
 Alcohol swab
 Sterile gauze
 Adhesive tape
2.
Communication with the patient
 Introduce his/herself
 Ask name of the patient
 Describe the procedure to patient in vernacular
 Ask patient about allergies or reactions to specific agents or medications
in the past
 Allay patient’s apprehension
3.
Safety concerns
 Check patient details
 Check prescription & ensure that the drug name, strength and dosage
form match with that on prescription
 Check the drug label for date of expiry
4.
Privacy consideration of the patient
 Draw bedside curtains
5.
Draws up drug to be injected from AMPOULE into syringe:

o Wash hands properly with soap and water
o Take out syringe and needle from disposable pack taking care not to touch
naked end of the syringe
o Put the needle on the syringe

o Remove the liquid from the neck of the ampoule by flicking or tapping it
o File around the neck of the ampoule
o Carefully break off the top of the ampoule (for a plastic ampoule twist the
top). Protect your fingers with gauze (if ampoule is made of glass)
o Remove protective cover of the needle (after removing protective cover, do

not touch anything with unprotected needle)
o Aspirate the fluid from the ampoule

o Remove any air from the syringe
o Cover the needle again with the protective cover
Draws up drug to be injected from VIAL into syringe:

o Wash hands properly with soap and water
o Take out syringe and needle from disposable pack taking care not to touch
naked end of the syringe. Use a syringe with a volume of twice the required
amount of drug or solution.
o Put the needle on the syringe
o Remove protective covering from vial cap. Disinfect the top of the vial with a
cotton swab soaked in disinfectant.
o Remove protective cover of the needle (after removing protective cover, do
not touch anything with unprotected needle)
o Suck up as much air as the amount of solution needed to aspirate
o Insert needle into vial through rubber cap and turn upside down
o Pump air into vial
o Aspirate the required amount of solution and 0.1 mL extra. Make sure the
tip of the needle is below the fluid surface.
o Pull the needle out of the vial
o Remove any air from the syringe
o Cover the needle again with the protective cover
Draws up drug to be injected after dissolving dry powder in vial into syringe:
 Wash hands properly with soap and water
 Take out syringe and needle from disposable pack taking care not to
touch naked end of the syringe.
 Put the needle on the syringe
 Aspirant solvent into syringe from the ampoule
 Remove protective covering from cap of vial. Disinfect the rubber cap
(top) of the vial containing the dry medicine
 Insert the needle into the vial, hold the whole upright
 Suck up as much air as the amount of solvent already in the syringe
 Inject only the fluid into the vial (NOT THE AIR)
 Shake well and turn the vial upside-down
 Inject the AIR into the vial
 Aspirate the total amount of solution (NO AIR)
 Remove any air from the syringe
 Cover the needle again with the protective cover
6. Identification of area for needle insertion
 The patient may be positioned sitting/ standing/ supine

 Uncover lateral upper arm (Deltoid muscle). Avoid atrophied or emaciated
muscle. At the site of injection, there should be no necrosis or abrasions.
 Locate the site about two-three finger breadths below the acromion
process on the lateral midline of the arm
7. Preparation of site of the injection
 Wash hands properly with soap and water

 & wear gloves
 Reassure the patient and explain the procedure.
 Gently tap the site to stimulate nerve endings and minimize pain
 Clean the site using alcohol swab in firm circular motion
 Allow the site to dry
8. Process of Intramuscular injection
 Tell the patient to relax the muscle.

 Take the syringe in your dominant hand, remove the needle cover with
the free fingers of the other hand
 With the thumb and index finger of the non-dominant hand, gently stretch
the skin
 Insert the needle swiftly at an angle of 90 degrees
 Using the non-dominant hand to steady the syringe, pull back slightly on
the plunger to aspirate for blood (If blood appears, withdraw needle, replace it
with a new one and inject at another site). If no blood appears, inject the
medication slowly and steadily using the dominant hand.
 After complete administration, gently but quickly remove the needle at the
same 90-degree angle
 Apply gentle pressure to the site with the used alcohol swab using any one
gloved hand. No need to massage (unless a large volume has been
injected). In case any blood oozes, pat with a dry sterile gauge piece
 Once the injection has been given take care not to prick yourself or
somebody else. Carefully place the cap back on the needle and discard the
syringe in dustbin for sharp waste
 Remove & discard the gloves, perform hand hygiene

 Communicate to the patient about completion of the procedure
 Evaluate the patient for any side-effects
Time to perform procedure in ___________ seconds.
Number of attempts (needle sticks) required to perform _____________
Exceeds expectations Meets expectations Below expectations (NEEDS

(PROFICIENT) (COMPETENT) FURTHER WORK)
COMMENTS
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OBJECTIVE STRUCTURED ASSESSMENTS OF TECHNICAL SKILL (OSAT)

S.L. CHECK POINTS Y/N

Draws up drug to be injected from AMPOULE into syringe:

o Put the needle on the syringe

o File around the neck of the ampoule

o Remove protective cover of the needle (after removing protective cover, do

o Aspirate the fluid from the ampoule

Draws up drug to be injected from VIAL into syringe:

6. Identification of area for needle insertion

 The patient may be positioned sitting/ standing/ supine

7. Preparation of site of the injection

 Wash hands properly with soap and water

8. Process of Intramuscular injection

 Tell the patient to relax the muscle.

 Remove & discard the gloves, perform hand hygiene

 Evaluate the patient for any side-effects

Time to perform procedure in ___________ seconds.

Number of attempts (needle sticks) required to perform _____________

Exceeds expectations Meets expectations Below expectations (NEEDS

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