OSCE: Intramuscular Injection (IM Injection)

Intramuscular injection.pdf

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This article is designed to guide medical students in mastering the technique of intramuscular injection (IM), adhering to proper procedures, addressing potential complications, and fulfilling examination requirements for the OSCE.

Key Objectives:

• Perform the IM injection correctly and safely.

• Recognize and address potential complications.

• Adhere to the "Rights of Medication Administration."
  

Steps for Intramuscular Injection:

Preparation and Patient Safety:

1. Verify the Rights of Medication Administration:

   • Right Client: Introduce yourself, verify the patient’s identity (name and date of birth).

   • Right Drug: Confirm the drug name.

   • Right Dose: Verify the correct dosage.

   • Right Route: Confirm the route as IM injection.

   • Right Time: Ensure administration at the prescribed time.

   • Right to Refuse: Respect the patient's decision and explain consequences of refusal.

   • Right Documentation: Record the procedure accurately.

2. Indications for IM Injection:

   • Patient is uncooperative or unable to take drugs via other routes.

   • Patient cannot tolerate oral medication.

3. Contraindications:

   • Local infection at the injection site.

   • Thrombocytopenia or coagulation defects.

   • Myopathy or associated muscle atrophy.

4. Complications:

   • Persistent pain or muscle fibrosis.

   • Infection or abscess formation.

   • Nerve or vascular injury.

   • Osteomyelitis.
     

Procedure for IM Injection:

1. Select the Injection Site:

   • Deltoid Muscle (Upper Arm): 2 fingers below the acromion process.

   • Dorsogluteal Muscle (Buttock): Upper outer quadrant of the buttock, 2–3 inches below the iliac crest (not for children under 3 years).

   • Ventogluteal Muscle (Hip): Place palm over the greater trochanter, index finger on the anterior superior iliac spine (ASIS), middle finger below the iliac crest.

   • Vastus Lateralis Muscle (Thigh): Middle third of the line between the greater trochanter and lateral femoral condyle.

2. Position the Patient:

   • Patient should sit or lie down comfortably.

3. Skin Preparation:

   • Clean the site with alcohol swab in a circular motion outward from the center.

4. Prepare the Syringe:

   • Remove the needle cap and expel air from the syringe.

5. Insert the Needle:

   • Hold the skin taut.

   • Insert the needle at the correct angle and depth for the site:

     • Deltoid Muscle: 45-60° angle, 2/3 inch deep.

     • Dorsogluteal Muscle: 72-90° angle, 1–1.5 inches deep (children: ≤1 inch).

     • Vastus Lateralis Muscle: 72-90° angle, 2/3 inch deep (children: 45°, ¾ inch deep).

6. Aspirate for Blood:

   • Stabilize the syringe and pull back the plunger to check for blood return. If none, proceed.

7. Inject the Medication:

   • Administer the drug slowly and steadily.

8. Withdraw the Needle:

   • Place a dry cotton ball over the site, withdraw the needle at the same angle of insertion.

   • Apply pressure and massage gently.

9. Post-Injection Care:

   • Observe for adverse reactions.

   • If bleeding occurs, apply pressure until it stops.
     

Evaluation Criteria:

Step	Correct	Partially Correct	Not Performed
Patient Identification	✅	⚠️	❌
Drug Verification	✅	⚠️	❌
Skin Preparation	✅	⚠️	❌
Injection Technique	✅	⚠️	❌
Documentation	✅	⚠️	❌