Intramuscular (IM) Injections

May 31, 2022
| Created by Greg Jones, RPh, MBA

Copy for this article was written by Kimberly Wilson, RN, BSN, PharmD

Medication is injected into the muscle

  1. Wash hands with soap and water.
  2. Clean and inspect injection site. Inspect injection site for bruising, swelling, hardness or irritation. Clean skin with an alcohol swab. Let dry.
  3. Prepare syringe with medication. If not using a prefilled syringe, draw up medication from the correct medication vial using a new needle and syringe.
    1. Remove cap from vial and wipe rubber stopper with an alcohol swab. Let dry.
    2. Draw back plunger to fill syringe with air up to the dose to be injected.
    3. Inject air into the vial, turn vial upside down and draw the correct amount of medication into the syringe. 
      TIP: Make sure the needle tip is in the vial liquid before drawing up medication.
    4. Tap syringe with a finger or on counter edge to bring bubbles to the top. Gently press the plunger to push the excess bubbles out.
      TIP:       Leave the needle in the vial while doing this. If needed, the plunger can be used to pull more medication into the syringe or to push air bubbles and extra medication into the vial.
      TIP:       A new needle can be attached to the syringe for injection.
  4. With your free hand, gently press on and pull the skin so that it is slightly tight.
  5. Insert the needle into the muscle. Hold the syringe barrel tightly and use the wrist to inject the needle through the skin and into the muscle at a 90-degree angle.
  6. Check needle placement. Let go of the skin and use that hand to hold the base of the syringe so it stays pointed straight in.
  7. Inject the medicine. Gently push down on the plunger to inject the medicine.
  8. After the medication is delivered, release the skin, and take the needle out at the same angle as it went in.
  9. Place the needle into a puncture-resistant container.
  10. Place gauze over the area and apply pressure until bleeding stops. A band-aid can be applied to cover the injection site.

Possible injection sites: side of the thigh, upper outer side of buttocks, upper hip, and upper outer arm/deltoid.

Needle and syringe sizes for IM injections: 22 to 25 gauge, 1” or 1½” length needle. 1 to 3 mL syringe.