Landmarks for the deltoid muscle are the acromion process and the axillary line. Insert the needle at a point
two to three finger widths (1 to 2 inches) below the acromion process, above the axillary line in the middle of
the triangular-shaped deltoid muscle in the midline of the lateral aspect of the arm.
Ventrogluteal injection
Landmarks for the ventrogluteal muscle are the head of the greater trochanter and the anterior superior iliac
spine. Place the heel or the palm of your hand on the head of the greater trochanter with your thumb pointing
toward the patients abdomen. Extend your index finger up to the anterior superior iliac spine then spread your
other fingers back along the iliac crest. Insert the needle in the V formed between your index and third
fingers.
For the deltoid muscle of an average adult or adolescent, give up to 1 mL of medication with a -inch to 1-inch
needle. Do not use the deltoid site for infants and toddlers younger than 3 years. For preschoolers and older
children, use a -inch needle for giving an IM injection in the deltoid.
For the vastus lateralis muscle in an average adult or adolescent, give up to 3 mL of medication with a 18- to
25- gauge, 1- to 1-inch needle for oil based or viscous solutions. Use a 22- to 27-gauge, 1- to 1-inch needle
for aqueous solutions. For infants, give up to 1 mL with a 1-inch needle; for small infants, give up to 0.5 mL
with a -inch needle. This is one of the preferred sites for infants.
For the ventrogluteal muscle of an average adult, give up to 3 mL of medication with an 18- to 25-gauge, 1- to
1-inch needle for oil-based or viscous solutions. Use a 22- to 27- gauge, 1- to 1-inch needle for aqueous
solutions. For infants, give up to 1 mL with a - to 1-inch, 21- 25-gauge needle; for small infants, give up to
0.5 mL with a ?-inch, 21- 25-gauge needle. For toddlers, give up to 2 mL with a 1-inch, 21- 25-gauge needle.
For children age 3 and older, give up to 2 to 3 mL with a 1-inch, 21- 25-gauge needle. For adolescents, give up
to 3 mL with a 1- to 1-inch, 21- 25-gauge needle. This is the preferred site for administering irritating or oily
solutions to patients of any age.
If you have used a needle to draw up medication for an intramuscular injection, change the needle to a clean,
dry needle for the injection to prevent tissue irritation or damage.
References
Bindler, R. C., & Ball, J. W. (2003). Clinical skills manual for pediatric nursing: Caring for children (3rd ed.).
Upper Saddle River, NJ: Pearson Education, Inc. pp. 55-57.
Perry, A. G., & Potter, P. A. (2006). Clinical nursing skills and techniques (6th ed.). St Louis, MO: Elsevier Mosby.
pp. 697, 699, 723-729.
Smith, S. F., Duell, D. J., & Martin, B. C. (2008). Clinical nursing skills: Basic to advanced skills (7th ed.).Upper
Saddle River, NJ: Pearson Education, Inc. pp. 603-604, 617-621.
Home > Medication Administration Techniques > Injections >
Injections
Subcutaneous (SQ)
Use 1 - 3 cc syringe and 23 - 25 gauge, 1/2 - 5/8 inch needle. Maximum amount of fluid to
administer SQ is 1 cc.
Choose site: abdomen, lateral and anterior aspects of upper arm or thigh, scapular area of
back, or upper ventrodorsal gluteal area.
Note: Avoid areas of bony prominence, major nerves, and blood vessels.
Figure 10: Sites for routine subcutaneous injections. (Avoid umbilicus area.)
Source: Smith et al., 2000, p. 387.
Pinch skin between finger and thumb. Spread taut if client has substantial cutaneous tissue.
Figure 11: Insert needle at 45 or 90 angle into tissue for subcutaneous injection.
Source: Smith et al., 2000, p. 387.
Release the subcutaneous tissue, and aspirate prior to injecting medication (except insulin or
heparin).
Inject medication slowly, remove needle quickly, and gently massage site with alcohol swab. Do
not massage after the administration of heparin.
Intramuscular (IM)
Use 3 cc syringe and 20 - 23 gauge, 1 - 2 inch needle. Maximum amount of fluid should be
determined by client's muscle mass and site to be injected. Use 2 inch needle with obese client
to ensure that medication is injected into a large muscle.
If amount to be injected for adults is > 5 cc or children > 3 cc: divide dose into two syringes to
administer.
Spread skin taut, and insert needle at 90 angle with quick, dartlike action.
Aspirate, and observe for blood. (If blood appears, remove and discard needle).
Inject medication slowly, remove needle quickly, and gently apply pressure to site with dry,
sterile 2 x 2 gauze. Do not massage injection site.
Use if volume is 0.5 - 1 cc, but not more than 3 cc. Use a 23 gauge, 1 inch needle.
Locate site by measuring 2 - 3 fingerbreadths below the acromion process on the lateral midline
of the arm.
Figure 13a: The deltoid muscle of the upper arm, used for intramuscular injections.
Source: Kozier et al., 2000, p. 785.
Figure 13b: The upper arm can be used for both intramuscular (IM) and subcutaneous (Sub Q)
injections.
Source: Smith et al., 2000, p. 387.
Use if volume is 1 - 3 cc, but less than 5 cc. Use a 20 - 23 gauge, 1-1/2 inch needle.
Position client in side-lying or supine position, with knee flexed on injection side, or prone with
toes pointed inward to rotate femur.
Locate site by palpating the posterior iliac spine where the spine and pelvis meet. Imagine a
line from the posterior iliac spine to the greater trochanter. Administer medication above
imaginary line at midpoint.
Figure 14d: Draw imaginary line between trochanter and iliac spine.
Source: Smith et al., 2000, p. 395.
This is the preferred site for adults and children < 7 mo.
Locate site by placing the hand with heel on the greater trochanter and thumb toward umbilicus.
Point to the anterior iliac spine with the index finger (forming a "V"). Injection of medication is
given within the "V" area.
Figure 15c: Place palm on greater trochanter, and point to anterior iliac spine.
Source: Smith et al., 2000, p. 397.
This is the preferred site for infants and children < 7 mo.
Locate by identifying the greater trochanter and lateral femoral condyle. Injection site is the
middle third and anterior lateral aspect of the thigh.
Figure 16a: The vastus lateralis site of the right thigh, used for intramuscular injections.
Source: Kozier et al., 2000, p. 785.
Figure 16d: Select site using middle third and anterior lateral aspect of thigh.
Source: Smith et al., 2000, p. 396.
Discard needle after medication is drawn up, and use new needle for injection to minimize
tissue staining or irritation.
Figure 17: Z-track is used to prevent backflow of medication into subcutaneous tissue.
Source: Smith et al., 2000, p. 398.
Intradermal
Use a tuberculin or 1 cc syringe and 25-27 gauge, 3/8 - 5/8 inch needle. Amount to be injected
is usually 0.01 - 0.1 cc.
Withdraw needle quickly, and pat site gently with sterile 2 x 2 gauze pad. Do not massage area.
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