Medication Administration – Paediatric Intramuscular Injection

Queensland Paediatric Emergency Care

Skill Sheets

Intramuscular Injection

Infants and children may require an intramuscular injection for a variety of reasons, such as intramuscular antibiotics

or routine vaccinations. Paediatric intramuscular injections must be administered into muscles large enough to

accommodate the medication and avoid major nerves or blood vessels. All injections require consent from the

caregiver. For most medications, verbal consent will suffice. Immunisations must have documented written consent.

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CHQ-NSS-51005 Intramuscular injection v2.0

Developed by the State-wide Emergency Care of Children Working Group, March 2023

pH stripshypax

GATHER EQUIPMENT

syringedrawing up needlealcohol wipe needle for injection

(23 or 25 gauge)

*ensure you don the appropriate PPE prior to undertaking the procedure

dressing

Vastus Lateralis

Muscle Group

Birth to 18

months

18 months

to 3yrs

3 - 6 years 6 - 15 years > 15 years

0.5 mL 1 mL 1.5 mL 1.5 - 2mL 2-2.5 mL

Not

Recommended

0.5 mL 0.5 mL

1 mL

Deltoid

Guide to maximum volume of to be injected into muscular tissue.

0.5ml

(only if vastus lateralis

unavailable)

For information on anatomical markers used to identify the Vastus Lateralis and Deltoid injection sites:

Australian Immunisation Handbook: Vastus Lateralis injection site on the anterolateral thigh

Australian Immunisation Handbook: Deltoid injection site

Clean the skin with an

alcohol wipe. Wait for the

skin to dry.

With the injecting needle,

pierce the skin at an angle

of 90 degrees. Inject the

medication into the muscle.

Remove and discard needle

and syringe into sharps

container.

Apply dressing to injection

site.

PROCEDURE

Position the child to

allow for access to the

appropriate muscle site

(see table from page 1).

Children’s Health Queensland Hospital and Health Service

ALERT

Always check for allergies prior to medication administration.

Seek the prompt advice of a senior clinican if child displaying any adverse effects suggestive of anaphylaxis.

These include but are not limited to: facial swelling, vomiting and rash. Refer to the Allergy and Anaphylaxis

Guideline for management of anaphylaxis.

Prepare medication

according to instructions

in the relevant medication

preperation guide.

PREPARE

It is recommended that filter needles are used to draw

up medications in glass vials.

Lidocaine (lignocaine) may be used as the diluent for

some medications if compatible. It must be ordered by

the medical officer.

It is not recommended to aspirate needle on insertion.

The online version of the RCH Paediatric Injectable

Guideline provides directions for the preparation of

intramuscular medications. The hard copy does not.

• Topical anaesthetics can be used in advance to minimize procedural discomfort.

• To minimise discomfort, consider the use of Sucrose 24% in infants. A medical order and parental consent is required

prior to use. At some sites Sucrose 24% is a nurse initiated medication - check your local policy or procedure. See

the Sucrose 24% Skill Sheet for more information. If the solution amount is greater than the recommended volume

the muscle can take (see table on page 1), the volume may need to be adminstered across two seperate sites in two

seperate needle and syringes.

Tips in Children

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CHQ-NSS-51005 Intramuscular injection v2.0

Developed by the State-wide Emergency Care of Children Working Group, March 2023

Children’s Health Queensland Hospital and Health Service

For further information:

Information on Intramuscular Medication Preparation:

The Australian Immunisation Handbook - Administration of Vaccines

Australian Medicines Handbook: Children’s Dosing Companion (QH only)

CHQ Procedure: Medication Administration (QH only)

RCH: Paediatric Injectable Guidelines (QH only)

Clinical Guidelines, Procedures & Forms:

Queensland Paediatric Emergency Care Guideline: Allergy and Anaphylaxis Guideline

Queensland Paediatric Emergency Care: Adrenaline Skill Sheet (in production)

CHQ Immunisation Consent Form

CHQ Pre-Vaccination Screening Checklist

CHQ Tetanus Prophylaxis in Wound Management Guideline (QH only)

Video:

Paediatric Intramuscular Injection

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CHQ-NSS-51005 Intramuscular injection v2.0

Developed by the State-wide Emergency Care of Children Working Group, March 2023

References:

Australian Technical Advisory Group on Immunisation (ATAGI). (2022) Administration of vaccines. The Australian Immunisation

Handbook. Accessed Febraury 15, 2023 from https://immunisationhandbook.health.gov.au/contents/vaccination-procedures/

administration-of-vaccines.

Australian Technical Advisory Group on Immunisation (ATAGI). (2018) Figure. Figure. Anatomical markers used to identify the

deltoid injection site. The Australian Immunisation Handbook. Accessed Febraury 15, 2023 from https://immunisationhandbook.

health.gov.au/resources/figures/figure-anatomical-markers-used-to-identify-the-deltoid-injection-site.

Australian Technical Advisory Group on Immunisation (ATAGI). (2018) Figure. Vastus lateralis injection site on the anterolateral

thigh. The Australian Immunisation Handbook. Accessed Febraury 15, 2023 from https://immunisationhandbook.health.gov.au/

resources/figures/figure-vastus-lateralis-injection-site-on-the-anterolateral-thigh.

Children’s Health Queensland Hospital and Health Service. (2022, July 25). Medication Administration. Accessed Febraury 15,

2023 from https://qheps.health.qld.gov.au/__data/assets/pdf_file/0015/2122224/proc_01039.pdf.

Children’s Health Queensland Hospital and Health Service. (2021, November 29). Pharmacological Procedural Pain Management.

Accessed Accessed Febraury 15, 2023 from https://qheps.health.qld.gov.au/__data/assets/pdf_file/0031/2372755/proc-00303.

pdf.

Hockenberry, M. & Wilson, D. (2018). Wong’s Nursing Care of Infants and Children. (11th ed.) St Louis: Mosby.

Plover, C. (2021). Paediatric Injectable Guidelines. 2021 Ed. The Royal Children’s Hospital. Accessed February 15, 2023 from

https://pig.rch.org.au/monographs/.

This Queensland Paediatric Emergency Skill Sheet was developed and revised by the Emergency Care

of Children working group Initial work was funded by the Queensland Emergency Department Strategic

Advisory Panel.

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CHQ-NSS-51005 Intramuscular injection v2.0

Developed by the State-wide Emergency Care of Children Working Group, March 2023

The information contained in these Queensland Paediatric Emergency Care

skill sheets is for information purposes only. It was developed to inform

emergency nursing care, but can also be applied by other clinicians acting

within their scope of practice. The information has been prepared using a

multidisciplinary approach with reference to the best information and evidence

available at the time of preparation. No representation, warranty or

assurance is given that the information is entirely complete, current, or accurate

in every respect. The skill sheets are not a substitute for clinical judgement,

knowledge and expertise, or medical advice. Variation from the skill sheets,

taking into account individual circumstances may be appropriate. This

does not address all elements of standard practice and accepts that

individual clinicians are responsible for the following:

• Providing care within the context of locally available resources, expertise,

and scope of practice.

• Supporting consumer rights and informed decision making in partnership

with healthcare practitioners including the right to decline intervention

or ongoing management.

• Advising consumers of their choices in an environment that is culturally

appropriate and which enables comfortable and condential discussion.

This includes the use of interpreter services where necessary.

• Ensuring informed consent is obtained prior to delivering care.

• Meeting all legislative requirements and professional standards.

• Applying standard precautions, and additional precautions as necessary,

when delivering care.

• Documenting all care in accordance with mandatory and local

requirements.

Children’s Health Queensland disclaims, to the maximum extent permitted by

law, all responsibility and all liability (including without limitation, liability in

negligence) for all expenses, losses, damages and costs incurred for any

reason associated with the use of this skill sheet, including the materials within or

referred to throughout this document being in any way inaccurate, out of context,

incomplete or unavailable.

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Children’s Health Queensland Hospital and Health Service