Sites for Intramuscular Injections
1. Gluteal Site Intramuscular injection
It is ideal due to large muscle mass, & less pain, except in Infants below 2 yrs, when gluteus is not well developed. The site gluteal intramuscular injection is marked by following two methods
- Gluteal area is bounded by iliac crest above, gluteal fold below, midline medially & Anterior superior iliac spine anteriorly. Divide this into 4 quadrants. superior & lateral quadrant is marked for giving injections. This avoids & protects the sciatic nerve.
- Make a ‘V’ between index and middle fingers. Keep one finger on anterior superior iliac spine and the other on iliac crest as wide as possible. Injection may be given anywhere in this triangle, but more near the apex.
2. Deltoid area Intramuscular injection
Very commonly used in General practice but avoid it for painful injections.
- The shirt must be removed. Select a site 2-3 fingerbreadths below the acromion process (to avoid circumflex nerve), and above the groove marking lower border of the Deltoid muscle (to avoid radial nerve).
- Injections in Triceps, in the middle third of the arm, on posterior aspect – are commonly given in General practice (especially in females wearing blouses). But this is not a recommended site. for fear of damage to the radial nerve.
3. Vastus lateralis Intramuscular injection
Most used for infants below 2 yrs age and pediatric patients.
- On lateral aspect of middle third of the thigh, a hand-breadth above the knee & a handbreadth below the greater trochanter.
Technique for Intramuscular Injection
- Clean the chosen site with a spirit swab, rubbing firmly to numb skin sensations.
- With thumb & index finger of the left hand, stretch the skin firmly, to provide counterforce to the needle, to avoid patient movement and to reduce thickness of subcutaneous fat.
- Pierce the needle vertically, with a uniform, firm thrust, till it reaches deep into the muscle mass. Do not go down to the bone.
- Aspirate to confirm that the tip is not lying in a blood vessel.
- Inject the drug slowly. A fast injection is painful.
- Withdraw the needle, and gently massage the site of injection with spirit swab, for 30 seconds.
- Confirm that there is no capillary bleeding from the puncture point before leaving the patient.
Z-Technique for Imferon (Iron-dextran Complex)
- Imferon is always given in gluteal region, deep into the muscle mass. Superficial injection will be painful and will stain the skin black.
- With the thumb of the left hand, stretch the skin firmly to one side, pierce the needle vertically, deep into the muscle mass, aspirate to confirm that the tip is not in a blood vessel, Inject the drug, withdraw the needle in a quick motion, then release the left hand. This technique separates the needle track in subcutaneous plane, from muscle plane, so that drug cannot leak into the subcutaneous tissues.