What is an intramuscular (in-tra-MUS-q-lar) (IM) injection? An intramuscular injection is a "shot" of medicine given into a muscle. A syringe (suh-RINJ) with medicine in it, is attached to a needle. The needle goes through the skin and into a muscle. The medicine is pushed into the muscle by pressing on the syringe plunger. When the medicine has been pushed into the muscle, the needle is removed.

    Where can I give an IM shot? The skin, and the muscles under the skin, cover nerves, blood vessels, and bones. It is important to give a shot where you will not hurt any of these body parts. There are 8 possible areas, 4 on each side of the body, where an IM shot can be given. It is important to choose the correct area. If caregivers showed you what areas are safe, follow their directions. Change the areas where you give shots. If you give a shot in the same place every day or even every week, scar tissue can build up. The scar tissue will affect how the medicine will work. Following is information about the safe areas to give a shot.

    · Vastus Lateralis (VAS-tuss lat-er-AL-iss) Muscle (Thigh): The thigh is used often for children, especially children under 3. It is also a good place for an adult. The thigh area is especially useful if you need to give yourself a shot because it is easy to see.

    Look at the thigh that will get the shot. In your mind, divide the thigh (the area between the knee and the hip) into three equal parts. The middle third is where the shot will go.

    This muscle is called the vastus lateralis. It runs along the top of the thigh (the front) and a little to the outside. Put your thumb in the middle of the top of the thigh, and your fingers along the side. The muscle you feel between them is the vastus lateralis. Ventrogluteal (ven-trow-GLUE-tee-ull) Muscle (Hip): The hip is an area with good bone landmarks and very little danger of hitting blood vessels or nerves. It is a good place for a shot for adults and children over 7 months old. The person getting the shot should be lying in his or her side.
    To find the correct place to give a shot in the hip to another person: Place the heel of your hand on the hip bone at the top of the thigh. Your wrist will be in line with the person's thigh. Point your thumb at the groin, fingers point to the person's head. Form a "V" with your fingers by opening a space between your pointer finger and the other three fingers. Your little finger and ring finger will feel the edge of a bone along the fingertips. The place to give the shot is in the middle of the V-shaped triangle.

    · Deltoid (DEL-toyd) Muscle (Upper arm muscle): The person getting the shot can be sitting, standing or lying down. Start with a completely exposed upper arm. You will give the shot in the center of an upside down triangle. Feel for the bone that goes across the top of the upper arm. This bone is called the acromion process. The bottom of it will form the base of the triangle. The point of the triangle is directly below the middle of the base at about the level of the armpit. The correct area to give a shot is in the center of the triangle, 1 to 2 inches (2.5 to 5 cm) below the bottom of the acromion process.

    · Dorsogluteal (door-so-GLUE-tee-ull) Muscle (rear-end): The upper rear end area is the area where most people have gotten shots. Expose one entire cheek of the rear-end. With an alcohol wipe draw a line from the top of the crack between the cheeks to the side of the body. Starting in the middle of the same side, draw another line across the first one with the alcohol wipe. Start from about 3 inches above the first line to about half way down the middle of the cheek. You should have drawn a cross. In the upper outer square you will feel a curved bone. The shot will go in the upper outer square below the curved bone.

    What items do I need to give a shot?

    •  One alcohol wipe wrapped in foil.
    •  One sterile dry 2x2 in a paper wrapper.
    •  An ampule or vial containing the medicine.
    •  The correct size needle and syringe.
    •  You may want to use gloves for your protection or the protection of the person getting the shot.

    How do I inject medicine into a muscle?

    Please read this entire section before giving the shot. It is important to get a general idea of what you are about to do before beginning.  Read the step-by-step procedure again as you do it.

    1. Wash your hands carefully with soap and dry them completely. Put on gloves if necessary. Open the foil covering the first alcohol wipe.
    2. Take the cover off the needle by holding the syringe with your writing hand and pulling on the cover with your other hand.
    3. It is like taking a cap off a pen.
    4. Hold the syringe in the hand you use to write. Place the syringe under your thumb and first finger.
    5. Let the barrel of the syringe rest on your second finger. Many people hold a pen this way when they write.
    6. Wipe the area where the needle will go with the alcohol wipe. Let the area dry.
    7. Depress and pull the skin a little with your free hand.
    8. Keep holding the skin a little to the side of where you plan to put the needle.
    9. Use your wrist to inject the needle at a 90 degree needle (straight in). The action is like shooting a dart. Do not push the needle in. Do not throw the needle in, either. Throwing the needle will make a bruise. The needle is sharp and it will go through the skin easily when your wrist action is correct.
    10. Let go of the skin. The needle will want to jerk sideways. As you let go of the s3kin, hold the syringe so it stays pointed straight in.
    11. Pull back on the plunger just a little to make sure you aren't in a blood vessel. (If blood comes back, remove the needle immediately. Do not inject the medicine. If this happens, dispose of both the syringe and the medicine. Get more medicine in a new syringe. When you give the second shot give it on the other side.) Pulling back on the plunger is easier said than done. Use your other hand to pull back on the plunger while keeping the syringe in the straight up position. It will feel clumsy at first.
    12. Push down on the plunger and inject the medicine. Do not force the medicine by pushing hard on the plunger. Some medicines hurt. They will hurt more if the medicine goes in quickly.
    13. After all the medicine is injected, pull the needle out quickly at the same angle it went in.
    14. Use the dry sterile gauze 2x2 to press gently on the place where the needle went in.

    Note: Easiest way to ensure you will correctly break the neck of the ampoule is to use a miniature file you can purchase from a hardware store. With your non-writing hand hold your ampule between the thumb, index and middle finger. Carefully saw a circle
    around the neck (saw into the neck partially so you can see the scratch around the neck) and wipe down the ampule with
    alcohol and again holding with three fingers, the bottom portion of the ampule, take a file and gently tap the top of the
    ampoule until it breaks. If you feel that you struggle too much to repeat the above procedure.

    If possible use two different needles, one for transferring medication from the ampoule and one for injecting. This is to keep the injecting needle sharp in case you hit glass when sucking up the medication. We recommend 18 gauge for transferring.

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