Theoretical Principles of Intramuscular Injections

Situation of the patient:

In contrast with other injections, this injection is associated with more anxiety in patients.The intention with this injection

The administration of analgesics achieves a depot effect that leaves the patient pain-free for a longer period of time. Maximum effect occurs after 20-> 40 minutes.

Theoretical principles:

Def: The i.m. Injection is an injection technique in which smaller amounts of medication (max. 1ml) are injected into a muscle. It should always be checked whether an i.m. injection is necessary at all, as most drugs can be taken orally. If parenteral administration is essential, i.v. injections should be considered first.

Injection sites:

Typical area for i.m. Injections

The injection into the “upper outer quadrant” of the glutaeal region into the glutaeus maximus maxedmuscle or into the glutaeus medius muscle is more or less frequent. However, there is the danger of either remaining too superficial, i.e. subcutaneous, or of getting too deep and injuring nerves. Note! The method “upper outer quadrant of the gluteal muscle” is dangerous and must be rejected! Since patients are at risk with this technique, a safe execution is necessary in addition to the clear medical order.

Every injection represents a bodily injury within the meaning of the penal code; it is only justified if the patient has agreed to the intervention, the nurse has mastered the technique through training and the injection is carried out for healing purposes.
This also requires information about the effect of the medication.

Ventroglutaeal injection according to A. von Hochstetter

Relatively safe method for the gluteal muscles.

To be performed on adults only.

It occurs in the glutaeus medius muscle or in the glutaeus minimus muscle below.

Here the injection takes place from the side into a clearly defined triangular field (between Crista iliaca, Spina iliaca and Trochanter major), which can be found by means of orientation points with little variation possibilities.

The injection site has a sufficient distance to the large vascular > and nerve strands.

The skin fold is firmly grasped and lifted for the injection.

Injection into the gluteal muscle is performed in the lying patient.

In a flat lateral position, the upper knee is slightly tightened (muscle relaxation):

Seriously ill patients can receive the injection in supine position from experienced, certified nursing staff.

Searching for the injection site after von Hochstetter


Crista iliaca= iliac crest

Eminentia cristae iliacae= protrusion of the iliac crest, iliac hill

Spina iliaca anterior superior= anterior, upper iliac spine

Trochanter major= large rolling mound

Injection site= triangle between index-> and middle finger

Putting on the non-injecting hand on the left hip

The middle finger palpates the anterior, upper iliac spine.

The index finger moves along the iliac crest until it reaches the highest point, the iliac crest.
The palm of the hand is now moved by approx. 2 cm until it lies on the large rolling mound; the middle finger remains on the iliac spine, the index finger is moved by approx. 2 transverse fingers.

Applying the non-injecting hand to the right hip

The index finger feels the anterior, upper iliac spine

The middle finger moves along the iliac crest until it reaches the highest point, the iliac crest;
The palm of the hand is moved by approx. 2cm until it lies on the large rolling mound; the index finger remains on the iliac spine, the middle finger is moved by approx. 2 transverse fingers.

Stitch guide

The skin is stretched between the index finger and the middle finger;

The cannula is inserted at an angle of 90 degrees to the body surface (i.e. vertically) towards the abdomen.

Intramuscular injection according to Sachtleben

Crista Method

Injection site is the Musculus glutaeus medius the patient is lying on his side, his head to the right of the caregiver;  the left hand is placed in the patient’s flank, the index finger lies on the bone ridge of the iliac crest to the left of the index finger, approx. 3 fingers wide below the iliac crest and the large rolling mound is the injection site.

With the Crista method, the patient can take the prone position in addition to the lateral position.
Note! For children up to 75cm body height the injection site is one transverse finger, for children up to 125cm body height two transverse fingers wide below the iliac crest.

Stitch guide

The cannula is inserted perpendicular (90 degree angle) to the body surface;

The cannula is directed upwards outwards (cranial lateral, towards the navel).

Intramuscular injection into the thigh see Standard

Injection site

Is the middle third of the front side of the thigh, lateral of the crease (= musculus vastus lateralis);
In the lying patient, the front of the thigh is divided into three areas: a) groin to one hand below the groin, b) knee to one hand above the knee, c) middle third of the thigh.

Lengthwise the thigh is divided into the anterior crease and the lateral trouser suture; between these lines in the middle third of the thigh the injection area = middle of the lateral thigh region.
The injection site is gripped with gentle pressure and lifted slightly.

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