Preparing and Administering an Injection

Step-by-Step Procedure

1. 1

   Verify the medication order against the "rights" of medication administration: right patient, right drug, right dose, right route, right time, right documentation.

2. 2

   Check the medication vial or ampule for the correct drug, concentration, and expiration date, and inspect for discoloration or particulates.

3. 3

   Draw up the correct dose using proper aseptic technique, expelling air bubbles before administration.

4. 4

   Select the correct needle gauge and length, and the correct site for the ordered route (deltoid or vastus lateralis for IM; outer upper arm or abdomen for subcutaneous; inner forearm for intradermal).

5. 5

   Cleanse the site with antiseptic and allow it to dry before inserting the needle at the correct angle for the route (90 degrees for IM, 45 degrees for subcutaneous, 5-15 degrees for intradermal).

6. 6

   For IM and subcutaneous injections, inject at a steady rate; for intradermal (e.g., a TB skin test), confirm a visible wheal forms, which confirms correct intradermal placement.

7. 7

   Withdraw the needle, apply gentle pressure (not rubbing, which can bruise), and dispose of the needle immediately in a sharps container — never recap a used needle.

8. 8

   Document the medication, dose, route, site, and time immediately, and observe the patient briefly for any immediate reaction.

Quality Checkpoints

• ✓

  All "rights" of medication administration are checked before drawing up or giving the injection, not just before charting it afterward.

• ✓

  Needle gauge, length, angle, and site all match the ordered route — not substituted out of habit.

• ✓

  The needle is disposed of immediately in a sharps container with no recapping.

• ✓

  Documentation (drug, dose, route, site, time) happens immediately, not from memory later in the shift.

Common Mistakes

• ⚠

  Giving an IM injection at the wrong angle or site, increasing the risk of hitting a nerve or blood vessel.

• ⚠

  Not checking for a wheal on an intradermal injection, which means the dose may have gone subcutaneous instead — a false-negative risk for a TB test.

• ⚠

  Recapping a used needle, a leading cause of accidental needlestick injuries.

• ⚠

  Rubbing the injection site immediately afterward, which can push medication out of the muscle or cause bruising.

On-the-Job Tips

• →

  Say the drug name, dose, and route out loud to yourself while drawing up the medication — this simple habit catches more errors than people expect.

• →

  If a patient flinches or the needle doesn't seem to be advancing normally, stop and reassess rather than pushing through — site selection and angle matter more than speed.

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