How To Find The Deltoid Muscle For Injection

Good injection technique can mean the difference betwixt less pain and injury. Angela Cocoman and John Murray explain

The administration of intramuscular injections is a mutual nursing intervention in clinical practice.¹ This article aims to, raise sensation in relation to the injection sites used for intramuscular injection and, to highlight all-time practise in relation to IM injection administration.

The importance of good injection technique cannot be understated. It should not be forgotten that among potential complications of IM injection are abscess, cellulites, tissue necrosis, granuloma, muscle fibrosis, contractures, haematoma and injury to claret vessels, bones and peripheral nerves.² Although IM injection is a commonplace nursing exercise, there is a famine of guidelines for nursing staff in this area.^iii,4 It has been outlined that there are no working policies or procedures on administering injections to which nursing staff can refer.ⁱⁱⁱ Furthermore, the technique and preparation by certain staff may not be substantiated past show.⁴

Sites of the thigh (Rectus femoris and Vastus lateralis)
The uptake of drugs from the thigh region is slower than from the arm only faster than from the buttock, thus facilitating better drug serum concentrations than is possible with the gluteal muscles.⁵

Giving an IM injection into the Vastus lateralis site

To detect the thigh injection site, make an imaginary box on the upper leg. Find the groin. One hand's width below the groin becomes the upper border of the box
Find the summit of articulatio genus. One hand's width higher up the pinnacle of the knee becomes the lower border of the box
Stretch the skin to go far tight
Insert the needle at a right angle to the skin (ninety°) straight in
Up to 2ml of fluid may be given into this site

The thigh may be utilised when other sites are contraindicated or past clients who administer their own medication, as it is readily available in the sitting or lying dorsum position. However, the main disadvantage is that injections in the Rectus femoris site may cause considerable discomfort.⁶

This site can exist used for infants, children and adults. Needle length used is ordinarily 2.5cm or less.

The dorsogluteal site
This site is unremarkably referred to equally the outer upper quadrant and is contraindicated in children.

IM injection into the Gluteus medius site (buttock)

Find the trochanter. Information technology is the knobbly top portion of the long bone in the upper leg (femur). It is the size of a golf ball
Find the posterior iliac crest. Many people have 'dimples' over this bone
Draw an imaginary line between the two basic
After locating the centre of the imaginary line, notice a point one inch toward the caput. This is where (X) to insert the needle
Stretch the skin tight
Hold the syringe like a pencil or sprint. Insert the needle at a correct angle to the skin
Up to 3ml of fluid can be given in this site

The presence of major nerves and claret vessels, the relatively slow uptake of medication from this site compared with others and the thick layer of adipose tissue commonly associated with it, makes this site problematic.⁷ The sciatic nerve and superior gluteal artery lie but a few centimetres distal to the injection site, thus great care needs to be taken to identify landmarks accurately. Palpating the ileum and the trochanter is important; using visual calculations lonely can result in injection being placed too low and injuries to other structures.^eight

Risks associated with an IM injection to the dorsogluteal site

Contact with sciatic nervus
Contact with the superior gluteal artery
Too much fat tissue – poor assimilation rates.

The deltoid site
The ease of access, especially in an outpatient setting, perchance adds to the frequency with which the deltoid site is used for IM injections. This site is used for immunisations/non-irritating medications, hence vaccines which are usually small in volume tend to be administered into the deltoid site.^nine This is a relatively small area and muscle mass, especially in atrophied patients compounded by the close proximity of the radial nerve, brachial artery and bony processes to this site means that more substantial injuries can occur.

Giving an IM injection into the deltoid site

Find the knobbly top of the arm (acromion process)
The top edge of an inverted triangle is two finger widths down from the acromion procedure
Stretch the skin and so bunch upwardly the musculus
Insert the needle at a correct angle to the skin in the centre of the inverted triangle

Caution: This is a small site – give only 1-2ml or less of fluid in this site

It is important to limit volume of medication based upon size of musculus, ie. 0.5-2ml.

The ventrogluteal site
The Ventrogluteal site provides the greatest thickness of gluteal muscle (consisting of both the gluteus medius and gluteus minimus), is free of penetrating nerves and claret vessels, and has a narrower layer of fat of consistent thinness than is nowadays in the dorsogluteal.¹⁰

The ventrogluteal site has come to attract pregnant attention in the nursing literature and there is wide understanding that this site is the preferable site for intramuscular injection.ⁱⁱ There is a famine of research in this surface area in Ireland as to the extent to which the ventrogluteal site is used.

Giving an IM injection into the ventrogluteal site

Find the trochanter. It is the knobbly top portion of the long bone in the upper leg (femur). It is about the size of a golf game ball
Find the anterior iliac crest
Place the palm of your hand over the trochanter. Signal the first or index finger toward the inductive iliac crest. Spread the second or middle finger toward the back, making a 'V'. The thumb should always be pointed toward the front of the leg. E'er use the index finger and middle finger to brand the 'V'
Give the injection between the knuckles on your index and center fingers
Stretch the pare tight
Hold the syringe like a pencil or sprint. Insert the needle at a right angle to the skin (ninety°)
Up to 3ml of fluid may be given in this site7

Administrating an IM injection
There is a big inquiry base for nursing practice to be guided by in relation to the assistants of intramuscular injections and it is the responsibility of nurse educators to ensure that appropriately informed guidelines are devised.^iv

Tracking technique: An intramuscular injection is
designed to deposit medications deep into muscle tissue

It has been suggested^four that the following points should be incorporated into clinical guidelines:

IM injections should exist administered in the Ventrogluteal region whenever possible
The medication should be administered with a needle long plenty to accomplish the muscle without penetrating underlying structures
The patient should be positioned so equally to relax the muscle
The 'Z rail' technique should be used at all times (see diagram).

These measures should ensure optimal nursing care for patients.

Angela Cocoman is mental wellness lecturer at DCU and John Murray is a community mental wellness nurse for Water ford Mental Health Services (HSE South Eastern Expanse)

References

Greenway M. Using the ventral gluteal site for intramuscular injection. Nursing Standard 2004; 18 (29): 39-42
Small-scale SP. Preventing sciatic nerve injury from intramuscular injection: literature review: J Avant-garde Nursing 2004; 47(3): 287-296
MacGabhan L. A comparison of two depot injection techniques. Nursing Standard 1996; xi(52): 33-37
McGarvey MA. Intramuscular injections: a review of nursing practise for adults. All Ireland J Nursing & Midwifery 2001; 1(five): 185-193
Newton M, Newtown DW, Fudin J. Reviewing the large iii injection routes. Nursing 1992; 22: 34-42
Berger KJ, Williams MS. Fundamentals of Nursing: Collaborating for Optimal Health. Appletone Large: Connecticut, 1992
Bolander VR. Sorenson & Luckmann'due south Basic Nursing, A Psychophysiological Approach (tertiary ed.) Saunders: Philadelphia, 1994
Kozier et al. Techniques in Clinical Nursing (4th ed). Sage: California, 1993
Mallett J, Bailey C. The Majestic Marsden NHS Trust Manual of Clinical Procedures (5th ed.) Blackwell Scientific discipline: London, 1996
Zelman S. Notes on the techniques of intramuscular injection. Am J Med Sc 1961; 241: 47-58
Rodger MA, King L. Cartoon upward and administering intramuscular injections: a review of literature. J Advanced Nursing 2000; 31(iii): 574-582