Intramuscular injection

Medication administration by intramuscular injection (IM) is a quick way to administer a medication into the bloodstream through the route of muscle tissue and then into the systemic circulation. The most common IM medication to be delivered by EMS is Epinephrine, given for patients experiencing a serious and life-threatening condition called anaphylaxis. Other medications including vaccines can now be administered IM at the EMT level however, currently this is only practiced in some counties and is protocol dependent.

To administer medications by IM we need to identify the target tissue for injection. If injection is too shallow the absorption of medication will be slow. Too deep and we run the risk of hitting the periosteum (tissue surrounding bone) and causing excessive pain. Please reference anatomical illustrations of the skin before proceeding. Note, the musculature we are referring to is skeletal muscle. EMTs do not administer medications into cardiac or smooth muscles.

Follow these steps to administer a medication through the IM route:

1. Ensure the patient is suffering from a condition warranting administration (Anaphylaxis, etc.)
2. Lay out your equipment. For this procedure you will need:
   1. IM needle with 1ml syringe (larger syringes can be used, though it is not recommended as the small volume of drug being given IM makes ensuring dose accuracy difficult).
   2. Alcohol prep pad.
   3. Medication to be administered – ensure it is the proper medication and it is not expired.
   4. Sharps container.
3. Identify your site of injection. Common IM injection sites are:
   1. Deltoid, lateral quadricep, and gluteus maximus muscles.
4. Clean the site using the alcohol prep pad.
   1. Start in the center of your selected site.
   2. Wipe the alcohol pad in small, expanding, concentric circles.
   3. Let the alcohol moisture on the skin evaporate DO NOT WIPE OR TOUCH THE SITE
5. Draw your medication.
   1. While the alcohol is evaporating open the packaging on the syringe.
   2. Uncap your needle and medication vial.
   3. Insert needle into the rubber port on the top of the medication vile.
   4. Invert the medication vial/syringe combo taking care not to withdraw the syringe from the vile.
   5. Draw medication into the syringe to just above desired dose.
6. Remove air bubbles from the syringe.
   1. Pull the syringe/needle out of the vial.
   2. Keep the needle pointed up to facilitate movement of any bubbles to the top.
   3. If necessary, gently flick the syringe to move bubbles to the top.
   4. Eject air and excess medication by pressing the plunger up.
7. Ensure intended dose is what you have drawn up in the syringe.
   1. Sometimes in the process of removing air you accidentally eject more medication than you intend. Repeat steps 5-6 if necessary.
8. Final confirmation of medication “rights”.
   1. Right medication, dose, route, patient condition and timing.
9. Insert needle at 90⁰ into selected site, where you cleaned.
   1. Insert deep enough to access the muscular tissue but not so deep that you strike bone.
   2. Quick insertion is helpful in reducing pain from the procedure.
10. Inject the medication by depressing the plunger on the syringe fully.
11. Remove the needle and place directly into sharps container.
12. Document the time, medication and dose given.