Episode 326: Intramuscular Injections: The Oncology Nurse’s Role
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“One of the big misconceptions is that this is just a quick shot. And this is a patient’s treatment regimen. So, it is not just a quick shot. It is treatment, and we need to get it where it is supposed to go so that the patient’s, cancer treatment is not impacted,” Caroline Clark, MSN, APRN, OCN®, AG-CNS, EBP-C, director of evidence-based practice and inquiry at ONS, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about administering intramuscular (IM) injections in oncology.

Music Credit: “Fireflies and Stardust)” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org) by August 23, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to the administration of antineoplastic medications by IM injection.

Episode Notes

• Complete this evaluation for free NCPD). 

• Oncology Nursing Podcast™ episodes:

• Episodes on administration topics)

• Episode 324: Pharmacology 101: LHRH Antagonists and Agonists)

• Episode 316: Pharmacology 101: Estrogen-Targeting Therapies)

• *ONS Voice *article:  Oncology Drug Reference Sheet: Asparaginase Erwinia Chrysanthemi (Recombinant)–Rywn)

• ONS books:

• Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice) (second edition)

• Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook) (fourth edition)

• ONS course: Introduction to Evidence-Based Practice)

• ONS Huddle Card: Hormone Therapy)

• American Journal of Therapeutics article: Body Mass Index: A Reliable Predictor of Subcutaneous Fat Thickness and Needle Length for Ventral Gluteal Intramuscular Injections)

• Centers for Disease Control and Prevention resources:

• Administering Vaccines: Dose, Route, Site, and Needle Size)

• Vaccine Administration: General Best Practices for Immunization)

• Concordia University Ann Arbor School of Nursing video:  Ventrogluteal identification)

• Elsevier Clinical Skills: Medication Administration: Intramuscular Injections—Acute Care)

• Healthline article: Z-Track Injections Overview)

• Journal of Advanced Nursing article: Does Obesity Prevent the Needle From Reaching Muscle in Intramuscular Injections?)

• *Journal of Clinical Nursing *article: Dorsogluteal Intramuscular Injection Depth Needed to Reach Muscle Tissue According to Body Mass Index and Gender: A Systematic Review)

• Journal of Nursing Research article: Gluteal Muscle and Subcutaneous Tissue Thicknesses in Adults: A Systematic Review and Meta-Analysis)

• National Institute of Occupational Safety and Health: Hazardous Drug Exposures in Health Care)

• Novartis education sheet: Additional Considerations for Dorsogluteal and Ventrogluteal Intramuscular Injections)

• Oncology Nurse Advisor article: Large-Volume IM Injections: A Review of Best Practices)

To discuss the information in this episode with other oncology nurses, visit the ONS Communities). 

To find resources for creating an Oncology Nursing Podcast Club in your chapter or nursing community, visit the ONS Podcast Library).

To provide feedback or otherwise reach ONS about the podcast, email [email protected]).

Highlights From This Episode

“More frequently oncology nurses are using intramuscular injection techniques when giving certain hormonal therapies for cancer treatment and for cancer symptom management. Some examples of those are fulvestrant for treatment of hormone receptor–positive, HER2-negative breast cancer, leuprolide as androgen deprivation therapy in prostate cancer. This is also used off label for breast cancer management. It’s used for premenopausal ovarian suppression and also in noncancerous conditions like endometriosis and uterine fibroids.” TS 2:04

“Inadvertent injection into the sciatic nerve is one of the most common causes of sciatic injury. It has significant morbidity associated with it. And even for drugs like fulvestrant, the prescribing information notes reports of sciatica, neuropathic pain, neuralgia, peripheral neuropathy—all related to dorsogluteal injection.” TS 6:09

“When administering an IM injection to someone who is cachectic, you don’t want the subcutaneous tissue to bunch up. So you can kind of stretch this over with your nondominant hand, as in the Z-track method, and then grasp the muscle between your thumb and index finger. That’s going to help you ensure that you’re getting that muscular injection.” TS 11:47

 “Z-track is a way that you inject so that there’s no leakage back out into the subcutaneous space. Clean your area as usual. You displace the skin and the subcutaneous tissue that’s over that muscle, and then you inject slowly into the muscle. Once you remove the needle, then you release that tissue. And it kind of seals it over and prevents that leakage back up into the subcutaneous space.” TS 14:19

“I think ventrogluteal injection is less commonly done. There are documented issues with confidence in landmarking and giving it to that site, so practice is necessary. A great way to identify the ventrogluteal site on yourself to start is to stand up and put your hand at your side. You feel for the top of that iliac crest. Place your hand right below the iliac crest and then just start marching in place. You’re going to feel that muscle contraction right away. This also works when you abduct your leg. Abducting the leg is helpful when a patient is at a side-lying position to give a ventrogluteal injection—you feel that muscle contraction.” TS 17:06

“I wish it would be front of mind to encourage adverse event reporting related to any injection you’re giving. These types of reports—they drive improvement measures and monitoring. And then when things are underreported, it leads us to anecdotal reports. So really monitoring any change, trying to get some baseline data on adverse events with injection is really important.” TS 26:32