Name: ________________________________________
Date: _________________________________________
Procedure 54-10:
Administering Parenteral Subcutaneous or Intramuscular Injections
Objective: Administer subcutaneous and intramuscular injections.
Equipment and Supplies: Medication order signed by physician; vial of medication; disposable
gloves; alcohol wipes; sharps container; waste container; biohazard container
subcutaneous injection: 25-gauge, ⅝-inch needle for small arm; 23-gauge, 1-inch needle for
average arm; disposable 3-mL syringe
intramuscular injection: 22-gauge, 1½-inch needle; disposable 3-mL syringe; pen
Affective Behaviors: Affective behaviors provide a professional approach to a skill that enhances
the patient encounter. These behaviors may also display sensitivity to a patient’s rights and
enhance communication. Pay close attention to these skills, which will be in bold, italicized font.
Skills Assessment Requirements
Read and familiarize yourself with the procedure. Complete each procedure within a reasonable
amount of time, with a minimum of 85% accuracy.
Use the area below for any documentation needed to complete the procedure.
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Name: ________________________________________
Date: _________________________________________
= 3–6 points
= 7–9 points
# 1
# 2
1. Perform hand hygiene.
2. Apply gloves and follow standard
blood and body fluid precautions.
Note: As stated in Guidelines
54-2 earlier in this chapter, OSHA
requires that gloves be worn when
there is a reasonable expectation
that you might encounter blood
or body fluids. Employers
disagree about whether giving
injections is a task that creates
this expectation. Follow your
employer’s policies; if you would
prefer to wear gloves and your
employer does not require
donning gloves, you may need to
insist that you want to wear gloves
anyway. Remember, however, that
you may need to wear nonlatex
gloves if the patient is allergic to
3. Select the correct medication as
instructed in the “three befores.
Note: Always double-check the
label to ensure that the strength
is correct, because medications
are manufactured with dierent
strengths (e.g., 250 mg/mL and
500 mg/mL).
4. Gently roll the medication
between your hands to mix any
medication that may have settled.
Refrigerated medication can be
rolled between your hands to
warm it slightly.
5. Prepare the syringe using the
correct technique. Carefully carry
the covered needle and syringe to
the patient.
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Name: ________________________________________
Date: _________________________________________
= 3–6 points
= 7–9 points
# 1
# 2
6. Warmly greet and identify the
patient both by stating his or
her name and examining any
printed identification such as
a wrist name band or medical
record. Ask the patient to state
his or her date of birth. Introduce
yourself to the patient and ask if
the patient has any allergies.
7. Tell the patient the name of the
medication and dosage that
you are administering per the
physician’s order. Ask if the
patient has any questions before
receiving the medication.
8. Position the patient for the site
you are using.
9. Using a circular motion, clean
the patient’s skin with an alcohol
wipe. Wipe the skin with a
sweeping motion from the center
of the area outward.
10. Once again check the medication
dosage against the patient’s order
to determine if this is the correct
time to administer the dose (one of
the “10 rights”).
11. Remove the protective covering
from the needle using care
not to touch the needle. If you
accidentally touch the needle,
excuse yourself to the patient,
then return to the preparation
area and change the needle on
the syringe. If you are using a
self-contained syringe and needle
unit that does not come apart,
discard the entire syringe with the
medication and start the process
over again.
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Name: ________________________________________
Date: _________________________________________
= 3–6 points
= 7–9 points
# 1
# 2
12. When you are prepared to
administer the injection, place
a new alcohol wipe or a cotton
ball between two fingers of your
nondominant hand so that you
can easily grasp it when you are
through with the injection.
13. Firmly grasp the syringe in your
dominant hand like a pencil is
14. a. To administer a subcutaneous
injection: With your
nondominant hand, grasp the
skin at the injection site and
form a small mass of tissue.
b. To administer an intramuscular
injection: With your
nondominant hand, stretch the
skin tightly where you will insert
the needle. (Review Procedure
54-8, Administering a Z-Track
15. Grasping the syringe in a dartlike
fashion, insert the entire needle
with one swift movement.
16. a. For a subcutaneous injection:
Insert into the subcutaneous
tissue at a 45-degree angle
(Figure A).
b. For an intramuscular injection:
Insert directly into the muscle
at a 90-degree angle (Figure B).
17. Do not move the needle once you
have inserted it. If the needle is
pushed in farther, contaminants
are carried into the skin from the
exposed needle.
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Name: ________________________________________
Date: _________________________________________
= 3–6 points
= 7–9 points
# 1
# 2
18. Aspirate to determine if you have
entered a blood vessel. To do this,
pull back slightly on the plunger
with the hand holding the syringe
while holding the needle steady in
the muscle. If blood appears in the
hub area of the syringe, it means
that you are in a blood vessel.
You will then have to withdraw the
needle using correct technique
and discard the syringe containing
the blood and medication. Begin
the procedure again with fresh
Note: Because the CDC no longer
requires this step, some facilities
have eliminated drawing back
for blood return, especially when
injecting insulin or dead viruses
such as with vaccinations. Always
check your facility policy.
19. If you do not see a return of blood
in the syringe when you aspirate,
slowly inject the medication
without moving the needle. Do
not move the needle until you
have completed injecting all the
Note: Insert and withdraw the
needle quickly to minimize pain
but administer the medication
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Name: ________________________________________
Date: _________________________________________
= 3–6 points
= 7–9 points
# 1
# 2
20. Taking the alcohol wipe (or cotton
ball) from between the last two
fingers of your nondominant hand,
place it over the area containing
the needle. Withdraw the needle
at the same angle you used for
insertion, using care not to stick
yourself with the needle.
21. With one hand, place the alcohol
wipe firmly over the injection site.
With the other hand discard the
needle in a sharps container.
22. You may gently massage the
injection site to assist absorption
and ease pain for the patient.
23. Make sure the patient is safe
before leaving him or her
unattended. Observe the patient
for any eects or reactions to the
medication for at least 15 minutes.
24. Correctly dispose of all materials.
25. Remove gloves and discard
into a waste container. If gloves
have come into contact with the
patient’s blood, dispose of the
gloves in a biohazard container.
Perform hand hygiene.
26. Chart the medication
administration on the patient’s
record, noting the time,
medication name, dosage,
injection site, route, lot number on
the medication, and your name.
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Name: ________________________________________
Date: _________________________________________
= 3–6 points
= 7–9 points
# 1
# 2
Points Earned
Points Possible 204 204
Percent Grade (Points Earned/
Points Possible)
Instructor Sign-O
Instructor: ______________________________________________ Date: _________________________
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