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Intramuscular (IM) Injections



Intramuscular injections
are administered

into muscle tissue below the dermis and subcutaneous tissue at a 90

degree angle. Promotes rapid drug absorption

IM Amount injected is

variable. Divide into 2 injections if more than 5ml for adult, 3ml for
child, and 1ml for infant

_________ Injection Site

Preferred site for IM
injection for all clients over
age 7 months


Ventrogluteal good

Safest and least painful site. Free of major blood vessels & nerves.
Less fatty tissue distribution

IM Needle size

can vary. 18 23 gauge. Needle length of 1 1 in

Ventrogluteal locating

Position patient in side-lying or supine position. Place palm at

trochanter & point index finger toward anterior superior iliac spine.
Spread your middle finger to palpate the bony ridge of iliac crest (fan
out your fingers to form a V). The center of the formed triangle (the
V area) is the injection site



Vastus Lateralis Injection Site

Place patient in supine position with thigh exposed. Location- One

handbreadth above the knee, One handbreadth below the great trochanter,
Site is located in the middle 3rd aspect of thigh, anterior-lateral portion

Deltoid Injection Site

Site can be used for children 3 yrs and older. Solution must be nonirritating

Deltoid Injection Site


2 fingerbreadths below acromion process, Inject at 90 degree angle

Deltoid Injection Site

Limited medication volume

0.5 1 ml

Deltoid Injection Site needle


23-25 gauge, 5/8 1 needle

Z-Track Injections Used with

irritating solutions (i.e., Iron), Tissue displaced laterally

Z-track injection is a method


injecting medication into a large muscle. Keeps solution from leaking into
subcutaneous (SQ) tissue and skin.



Subcutaneous (SQ)

Subcutaneous injections are administered into the fatty tissue found

below the dermis and above muscle tissue.

Subq Needle size

25 29 gauge, 3/8 5/8 inch

Sub q Sites

Infants Anterior thigh. Older Children & Adults - Dorsum of the upper

Sub q To avoid reaching

Pinch up the fatty tissue. Insert the needle at a 45 - 90 angle

the muscle.

(depends on needle length). Inject the medication into the tissue.

Insulin can be
administered in the
following sites

Lateral/posterior aspects of upper arm, Fatty tissue of lower abdomen,

Lateral aspect of thigh, Scapular area of back, Flank (upper
ventrodorsal gluteal areas)

If abdomen is used to
inject insulin or heparin,
remember site should be
at least

2 fingerbreadths from umbilicus



Intradermal Injections
Used for

TB skin (PPD) and allergy testing

Intradermal Location

ventral surface of upper third of forearm, away from visible veins or


Intradermal instructions

Gently pull the skin taut on ventral forearm. Insert needle under the
epidermis, with bevel up, at a 10-15 degree angle (advance needle
only about 1/8 inch). Needle point should be visible under skin. Do
NOT aspirate. Inject the PPD solution (0.01-0.1 mL) slowly (you
should feel firm resistance). A wheal (blister) should form. Do NOT
massage site. Mark injection site with pen for future assessment