Intramuscular Injection

As the name implies, the goal of intramuscular injections is to deliver medication into a muscle body.

Please read and be familiar with all steps before proceeding with an injection. If you have any questions or concerns, message your provider through the patient portal.

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Collect

Collect all the supplies you will need for the injection:

• Medication vial
• Alcohol wipes (2)
• Syringe
• Drawing needle (larger needle)
• Injection needle (longer needle, to reach muscle)
• Sharps container

Clean

Your syringes and needles should be new and still in sterile factory packaging. Wash your hands with soap and water for at least 20 seconds. Use one alcohol wipe to sanitize the top of the medication vial. Use one alcohol wipe to clean the skin over your chosen site of injection. When cleaning your skin use circular motions several times directly over the site of injection and then moving outward in larger circles until at least a 2-inch diameter area has been cleaned. Make sure to let the medication vial and your skin air dry completely.

Tip: Clean the medication vial first and then move to skin. By the time you are done cleaning your skin the vial will be ready to draw medication out of, and by the time the medication is drawn your skin will be dry.

Fill

1. Take your syringe and drawing needle (larger of the two needles) out of the factory packaging. To avoid contamination, make sure that as you connect them you don't touch near the connection point.
2. Pull back the plunger on the syringe to fill it with air to the prescribed dose.
3. Press the needle tip through the rubber seal of the vial and inject the air completely.
4. Turn the vial upside down, making sure the tip of the needle is within the contained medication. Slowly draw back to fill your syringe with medication.
5. Pull the needle out, draw back a little air to make sure all medication is out of the needle and then recap and remove your draw needle.
6. Put on your longer injection needle, which is long enough to reach muscle. Hold the syringe upside down (with the needle in the air) to ensure any air moves to the tip. Depress your plunger until a drop of oil comes out of the tip of the needle and travels down the shaft.

Tip: When filling, slightly overfill your syringe at first and then inject oil back into the vial to get exactly to your dosage.

Tip: If you have a few bubbles in the oil that don't want to move, flick the barrel of the syringe slightly with your finger.

Inject

The most important part of injecting medication is to find a spot that doesn't have many nerves or blood vessels nearby. Good intramuscular injection sites include the shoulder, outer-glute, upper-outer glute, and outside of the thigh.

Injection Sites

Shoulder (Deltoid)

Find the bony process (acromion) on the top upper shoulder. Measure 2-3 fingers below and inject in the middle of the muscle.

Upper-Outer Glute (Dorsogluteal)

Imagine your glute divided into four quadrants. Inject into the upper-outer quadrant.

Outer Glute (Ventrogluteal)

In an imaginary line from your armpit, move down until you can feel the tip of your hip bone (iliac crest). Move one palm width down into the muscle belly you feel flex when you swing your leg out to the side.

Outside Thigh (Vastus Lateralis)

Divide your thigh into thirds from the hip down to the knee. Identify the middle third and move to the outside of the thigh as you look at your leg from the top (sitting position).

Tip: Experiment with your injection site. Everyone is different and depending on your body, some areas will be easier and less painful than others.

Tip: Vary your injection locations to avoid scar formation: small variations inside of the same muscle, side to side, and in a different muscle altogether.

Injection Procedure

1. With your free hand, spread the skin over the muscle flat and firm between your thumb and fingers. Pulling it taut gives the needle a clean path into the muscle.
2. Take the weight off of whichever muscle you are injecting so it stays relaxed.
3. Holding the barrel of your syringe like you would a dart, push the needle straight in at a 90° angle, all the way to the colored base, in one quick and confident motion. Rest your hand against your body to steady the syringe.
4. Inject the medication into the muscle at a slow, even pace until the syringe is empty.
5. Withdraw the needle quickly at the same angle you went in, then apply light pressure with clean gauze and prepare to dispose.

No need to aspirate: You don't need to pull back to check for blood before injecting at these sites. Current guidance no longer recommends aspiration for routine intramuscular injections. Go straight in, inject at a steady pace, and withdraw.

Tip: The slower and more hesitant you are the more painful inserting the needle will be. If you are fast and confident you probably won't feel it at all.

Tip: Stabilize your syringe once the needle is in by resting your hand on your body.

Tip: If the placement of the needle or the injection of medication is more painful than previous injections, STOP. Withdraw the needle, place a new injection needle on the syringe, and move to a slightly different area. Sometimes a few millimeters will make all the difference.

Dispose

Separate the draw and injection needle from the rest of your waste. You can place the needles in a purchased "Sharps Container," which you can typically get from a local pharmacy or an online retailer. If you don't want to buy one, you can use any old hard plastic container you have at home such as an empty 2L soda bottle or laundry detergent container. If you use a home-made container, label the outside with the words "Sharps Waste". Disposal of full containers varies by county. In Thurston County the sealed sharps container can be placed in your regular trash can. Never place sharps directly into the trash.

For clinical questions, message your provider through the patient portal. This handout is a reference and does not replace direct medical guidance.