Intramuscular, subcutaneous, and intradermal
Specifications: A model or skin pad in lieu of a patient.
• Introduce yourself to the patient.
• Confirm his name and date of birth.
• Discuss the procedure and obtain consent.
• Ask the patient if he has any allergies and what happens when he develops a reaction.
• Gather the appropriate equipment.
• Patient’s drug chart • Non-sterile gloves
• British National Formulary (BNF) • Alcohol steret
• Diluent (usually sterile water or saline) • Plaster
• Appropriately sized syringe (e.g. 1 or 2 ml) • Sharps box
• 21G (green) needle and 23G (blue) or 25G (orange) needle*
*Note that the colour scheme for needles is not the same as that for cannulae (see Station 4)
• Consult the prescription chart and check:
– the prescription: validity, drug, dose, diluent (if appropriate), route of administration, date
– drug allergies, anticoagulation
• Consult the BNF and check the form of the drug, whether it needs reconstituting, the type and
volume of diluent required, and the speed of administration.
• Check the name, dose and expiry date of the drug on the vial, and ask another member of the
healthcare team to countercheck them.
• Wash your hands and don the gloves.
• Attach a 21G needle to the syringe and draw up the correct volume of the drug, making sure to
tap out and expel any air. For a powder, inject the appropriate type and volume of diluent into
the ampoule and shake until the powder has dissolved.
• Dispose of the needle and attach a new 23G needle to the syringe for IM/SC administration or
a 25G needle for ID administration.
• Ask the patient to expose his upper arm or leg and ensure that the target muscle is completely
• Identify landmarks in an attempt to avoid injuring nerves and vessels.
• Clean the exposed site with an alcohol steret and allow it to dry.
• Warn the patient to expect a ‘sharp scratch’.
Intramuscular (IM) injection technique
• For older children and adults, the densest portion of the deltoid muscle (above the armpit and
below the acromion) is the preferred IM injection site. The gluteal muscle is best avoided as the
Station 7 Intramuscular, subcutaneous, and intradermal drug injection 15
needle may not reach the muscle and there is a risk of damage to the sciatic nerve, not to mention
the general embarrassment of the thing. In infants and toddlers, the vastus lateralis muscle in the
anterolateral aspect of the middle or upper thigh is the preferred IM injection site.
• With your free hand, slightly stretch the skin at the site of injection.
• Introduce the needle at a 90 degree angle to the patient’s skin in a quick, firm motion.
• Pull on the syringe’s plunger to ensure that you have not entered a blood vessel. If you aspirate
blood, you need to start again with a new needle, and at a different site.
• Slowly inject the drug and quickly remove the needle.
Subcutaneous (SC) injection technique
• Bunch the skin between thumb and forefinger, thereby lifting the adipose tissue from the
underlying muscle (‘tenting’).
• Insert the needle, bevel uppermost, at a 45 degree angle in a quick, firm motion. You are aiming
for the tip of the needle to be in the ‘tent’.
• Pull on the syringe’s plunger to ensure that you have not entered a blood vessel.
Intradermal (ID) injection technique
• Stretch the skin taut between thumb and forefinger.
• Hold the needle so that the bevel is uppermost.
• Insert the needle at a 15 degree angle, almost parallel to the skin.
• Ensure that the needle is visible beneath the surface of the epidermis.
• A visible (and uncomfortable) bleb should form. If not, immediately withdraw the needle and
start again – you may have inserted the needle too deeply.
• Immediately dispose of the needle in the sharps box.
• Apply gentle pressure over the injection site with some cotton wool (the patient may assist
• Ensure that the patient is comfortable.
• Ask him if he has any questions or concerns.
Figure 2. Intramuscular, subcutaneous, and intradermal injection techniques.
Intramuscular Subcutaneous Intradermal
be a cannula in situ, enabling the drug to be administered through the cannula.
• Introduce yourself to the patient.
• Confirm his name and date of birth.
• Discuss the procedure and obtain consent.
• Ask the patient whether he has any allergies and what happens when he develops a reaction.
• Gather the appropriate equipment.
• Patient’s drug chart • Non-sterile gloves
• British National Formulary (BNF) • Tourniquet
• Diluent (usually sterile water) • Cotton wool
• Appropriately sized syringes • Sharps box
• Consult the prescription chart and check:
– the prescription: validity, drug, dose, diluent (if appropriate), route of administration, date
• Consult the BNF and check the form of the drug, whether it needs reconstituting, the type and
volume of diluent required, and the speed of administration.
• Check the name, dose and expiry date of the drug on the vial and the name and expiry date of
the diluent. Ask another member of the healthcare team to countercheck them.
• Wash your hands and don the gloves.
• Attach a 21G (green) needle to a syringe and draw up the correct volume of the diluent.
• Draw up the reconstituted drug into the same syringe, making sure to tap out and expel any air.
• Remove the needle and attach a new 21G needle to the syringe.
• Apply a tourniquet to the model arm and select a suitable vein.
• Clean the venepuncture site with an alcohol steret.
• Retract the skin with your non-dominant hand to stabilise the vein, tell the patient to expect a
‘sharp scratch’, and insert the needle into the vein until a flashback is seen.
• Administer the drug at the correct speed (too fast may cause adverse reactions such as emesis).
• Withdraw the needle and immediately dispose of it in the sharps box.
• Apply gentle pressure over the injection site using a piece of cotton wool.
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