Intramuscular Injection (OSCE)
Introduction
- Greet patient and introduce yourself
- Confirm patient details ✍
- Briefly explain the procedure in a patient friendly manner
- Check what the patient understands about the medication
- Get patient consent ✅
- Identify contraindications (bleeding disorders or anticoagulant use)
- Check if the patient has any relevant allergies
- Ask if the patient has any preference about the injection site
- Expose injection site
- Ask patient to sit comfortably
- Check the patient is not in any pain
- Wash hands ✋
Equipment
- Disposable gloves ✋
- Apron
- Alcohol wipe
- Gauze/cotton wool
- Drawing up needle 💉
- Injecting needle (21 to 23 gauge, 25mm) 💉
- Small syringe 💉
- Sharps bin 🚮
- Patient’s follow up medication/prescription 💊
- Clean procedure tray
Seven rights of medication administration
- Right patient: confirm details verbally and on wristband
- Right drug: compare prescription to drug label
- Right dose: compare prescription to dose 💊
- Right time: check paperwork and speak to patient about last dose administration ⏱
- Right route: check route planned is appropriate ✅
- Right reason: check you have gained valid consent ✍
- Right documentation: check validity of prescription and check notes for allergies
Procedure
- Wash hands ✋
- Put gloves and apron on ✋
- Using the drawing up needle, collect the medication in the syringe
- Remove the drawing-up needle and immediately dispose of it into a sharps bin
- Dispose of drawing up needle in sharps bin 🚮
- Attach injecting needle to syringe 💉
- Identify most appropriate injection site (ventrogluteal/deltoid/vastus lateralis/avoid any area where skin is not intact) 💉
- Ensure you can adequately access the injection site(s)
- Clean the site only if soiled, using soap and water, and with an alcohol wipe if your hospital guidelines advise it
- Pull the skin away from your chosen injection site (Z-track technique) with your non-dominant hand ✋
- Inform the patient that you are ready to insert the needle and that they may feel a sharp scratch
- Insert the needle at a 75 to 90° angle 📐
- Aspirate and observe for blood, if blood appears you have pierced a blood vessel and must find a new injection site
- When you have an injection site which is not within a blood vessel, inject the contents of the syringe (1ml per 10 seconds) ⌛
- You can now release the skin your dominant hand has been holding ✋
- Using the gauze or cotton wool, apply pressure to the injection site
- Put a plaster over the injection site
- Appropriately dispose of any waste 🚮
Completion
- Tell the patient the procedure is complete ✅
- Thank patient
- Wash hands ✋
- Tell patient they may experience pain around the injection site for 48 hours, beyond this medical care should be sought, reminding them of potential complications they should be aware of
- Record the details of the procedure ✍
Summary:
- Greet the patient and explain the procedure
- Check the Seven Rights of medication administration
- Prepare by collecting equipment, putting on PPE and washing hands
- Identify the most appropriate injection site and clean it
- Insert the needle and aspirate to make sure you have not pierced a blood vessel
- Inject the contents of the syringe into a location that it is not within a blood vessel
- Remove needle and apply cotton wool/plaster
- Complete procedure by thanking patient and disposing of waste appropriately
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