Giving an IM (intramuscular) injection

You will need:

• One alcohol wipe
• One sterile 2 x 2 gauze pad
• A new needle and syringe -- the needle needs to be long enough to get deep into the muscle
• A cotton ball

Where you give the injection is very important. The medicine needs to go into muscle. You do not want to hit a nerve or a blood vessel. So show your health care provider how you will choose where you will put the needle, to make sure you can find a safe spot.

Thigh:

• The thigh is a good place to give an injection to yourself or a child less than 3 years old.
• Look at the thigh, and imagine it in 3 equal parts.
• Put the injection in the middle of the thigh.

Hip:

• The hip is a good place to give an injection to adults and children older than 7 months.
• Have the person lie on the side. Put the heel of your hand where the thigh meets the buttocks. Your thumb should point to the person's groin and your fingers point to the person's head.
• Pull your first (index) finger away from the other fingers, forming a V. You may feel the edge of a bone at the tips of your first finger.
• Put the injection in the middle of the V between your first and middle finger.

Upper arm:

• You can use the upper arm muscle if you can feel the muscle there. If the person is very thin or the muscle is very small, do not use this site.
• Uncover the upper arm. This muscle forms an upside down triangle that starts at the bone going across the upper arm.
• The point of the triangle is at the level of the armpit.
• Put the injection in the center of the triangle of the muscle. This should be 1 to 2 inches (2.5 to 5 centimeters) below that bone.

Buttocks:

• DO NOT use this site for a child under 3 years old, because there is not enough muscle here yet. Measure this site carefully, because an injection given in the wrong place could hit a nerve or blood vessel.
• Uncover one buttock. Imagine a line from the bottom of the buttocks to the top of the hip bone. Imagine another line from the top of the crack of the buttock to the side of the hip. These two lines form a box divided into 4 parts.
• Put the injection in the upper outer part of the buttocks, below the curved bone.

To give an IM injection:

1. Make sure you have the right amount of the right medicine in the syringe.
2. Wash your hands well with soap and water. Dry them.
3. Carefully find the spot where you will give the injection.
4. Clean the skin at that spot with an alcohol wipe. Let it dry.
5. Take the cap off the needle.
6. Hold the muscle around the spot with your thumb and index finger.
7. With a quick firm thrust, put the needle into the muscle straight up and down, at a 90 degree angle.
8. Push the medicine into the muscle.
9. Pull the needle straight out.
10. Press the spot with the cotton ball.

If you have to give more than one injection, DO NOT put it in the same spot. Use the other side of the body or another site.

To get rid of the used syringes and needles:

• DO NOT put the cap back on the needle. Put the syringe in the sharps container right away.
• It is not safe to put needles or syringes into the trash. If you do not get a hard plastic container for used syringes and needles, you may use a milk jug or coffee can with a lid. The opening has to fit the syringe, and the container needs to be strong enough so a needle cannot break through. Ask your provider or pharmacist how to get rid of this container safely.

Call 911 or the local emergency number right away if:

After getting the injection the person:

• Gets a rash.
• Feels very itchy.
• Has trouble breathing (shortness of breath).
• Has swelling of the mouth, lips, or face.

Call the provider if:

• You have questions about how to give the injection.
• After getting the injection, the person gets a fever or gets sick.
• A lump, bruise, or swelling at the injection site does not go away.

American Academy of Pediatrics website. Vaccine administration. www.aap.org/en/patient-care/immunizations/implementing-immunization-administration-in-your-practice/vaccine-administration/. Updated May 20, 2024. Accessed August 14, 2024.

Ogston-Tuck S. Intramuscular injection technique: an evidence-based approach. Nurs Stand. 2014;29(4):52-59. PMID: 25249123 pubmed.ncbi.nlm.nih.gov/25249123/.

Valentin VL. Injections. In: Dehn R, Asprey D, eds. Essential Clinical Procedures. 4th ed. Philadelphia, PA: Elsevier; 2021:chap 13.

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.