This document provides information on various injection sites and procedures for intramuscular, subcutaneous, and intradermal injections. It identifies best practices for locating injection sites, preparing the skin, inserting the needle at the proper angle, aspirating to check for blood vessels, injecting the medication slowly, and techniques to prevent leaking or tracking. Key injection sites discussed include the dorsogluteal, ventrogulteal, deltoid, vastus lateralis, and rectus femoris muscles. The document emphasizes following standard procedures, rotating injection sites, and displaying confidence during the injection process.

1. Injection -Injection -
SitesSites

2. IMIM
 Intra-Intra-
MuscularMuscular
 DorsalDorsal
glutealgluteal
 VentroVentro
glutealgluteal
SITESSITES
DeltoidDeltoid
 VastusVastus
lateralislateralis
 RectusRectus
femorisfemoris

3. IM SitesIM Sites
 Intradermal andIntradermal and
subcutaneous sitessubcutaneous sites
 Then procedureThen procedure
forfor injections: IM/SQinjections: IM/SQ

4. Nursing School TargetNursing School Target
PracticePractice

5. INTRAMUSCULAR SITESINTRAMUSCULAR SITES
 Give at 90 degree angle
 No more than 3cc/site
Find site by touchFind site by touch
(palpation) and site.(palpation) and site.

6. • **ExceptionException*
 May giveMay give up to 5ccup to 5cc ifif
absolutely necessaryabsolutely necessary
 Muscle absorbs moreMuscle absorbs more
medication than othermedication than other
tissuestissues
 1-1/2”, 21g1-1/2”, 21g needle mostneedle most
commoncommon

7. DORSAL GLUTEALDORSAL GLUTEAL
Buttocks

8. V
VENTROGLUTEAL SITEVENTROGLUTEAL SITE

9. DELTOID----ARMDELTOID----ARM
 No moreNo more
thanthan
1cc1cc

10. DELTOIDDELTOID

11. VASTIS LATERALISVASTIS LATERALIS
 Side ofSide of
infants thighinfants thigh
has manyhas many
nervenerve
endingsendings
 *May be*May be
painful*painful*

12. RECTUS FEMORISRECTUS FEMORIS
 Top of thigh

13. Why IM?Why IM?
 Rapid absorptionRapid absorption
of medication inof medication in
musclemuscle

14. INTRADERMALINTRADERMAL
 Given on innerGiven on inner
forearmforearm
..1-.3cc injection
 TB syringe @ 15
degree angle/or 25
gauge 1-3/8” needle

15. INTRADERMALINTRADERMAL
 Bevel up
 Should form a
bleb or bubble if
properly
administered..

16. SUBCUTANOUS- SITESSUBCUTANOUS- SITES
 Outer, upper arm, thigh or
abdomen.
 Medication absorbs slowly
because SQ tissue is much
less vascular.

17. SUBCUTANEOUSSUBCUTANEOUS
SITESSITES
 No more thanNo more than 2cc2cc ofof
medication given SQ.medication given SQ.
 0.5-1.0 cc0.5-1.0 cc preferred-preferred-
most common needlemost common needle
size issize is 25 gauge, 5/8”25 gauge, 5/8”

18. 45 DEGREE ANGLE INTO45 DEGREE ANGLE INTO
SQ TISSUESQ TISSUE
 May be 90 degree ifMay be 90 degree if
person is obeseperson is obese
 Bevel upBevel up

19. PROCEDUREPROCEDURE
FORFOR
INJECTION:INJECTION:
IM/SQIM/SQ

20. LOCATE/ INSPECT SITELOCATE/ INSPECT SITE
PalpatePalpate
RASH?RASH?
REDNESS?REDNESS?
SWELLING?SWELLING?
PAINPAIN?

21. DISINFECT SKIN USINGDISINFECT SKIN USING
ALCOHOL/ BETADINEALCOHOL/ BETADINE
 UsingUsing
circular-circular-
motionmotion
 FromFrom
center-center-
outwardsoutwards

22. -OR--OR-
 OneOne
swipeswipe
downwarddownward

23.  Let alcohol dry
Avoids stinging!Avoids stinging!
 use alcohol wipe foruse alcohol wipe for
after injectionafter injection

24. -OR--OR-
IMPORTANTIMPORTANT
POINT!POINT!
STRETCHSTRETCH The skin forThe skin for
an IM to get closean IM to get close to theto the
musclemuscle

25.  PinchPinch the skin for athe skin for a
SQ.SQ. so you bring theso you bring the
SQ. layer off the muscleSQ. layer off the muscle

26. INSERT NEEDLEINSERT NEEDLE
QUICKLYQUICKLY AT THE PROPERAT THE PROPER
ANGLE-ANGLE- 15, 45, 90 DEGREE15, 45, 90 DEGREE
Bevel up!Bevel up!
Insert all the way to hubInsert all the way to hub

27. HOW DO YOU KNOW IFHOW DO YOU KNOW IF
YOU HIT A BLOODYOU HIT A BLOOD
VESSEL?VESSEL?
 You will see blood inYou will see blood in
the barrel of syringethe barrel of syringe

28. RELEASERELEASE SKIN ANDSKIN AND
SUPPORTSUPPORT SYRINGESYRINGE
 Aspirate by pullingAspirate by pulling
back on plunger to see ifback on plunger to see if
needle has entered bloodneedle has entered blood
vessel

29. Then What?Then What?
 Remove needleRemove needle
and syringe, andand syringe, and
begin again (Newbegin again (New
equipment andequipment and
medication)medication)

30. THERE ARETHERE ARE 22 TIMESTIMES
YOU DON’TYOU DON’T
ASPIRATEASPIRATE
AnotherAnother
exception!exception!

31. INTRADERMALINTRADERMAL
INJECTIONSINJECTIONS
 WHY ??WHY ??
 Needle doesn’t go deepNeedle doesn’t go deep
enough to reach bloodenough to reach blood
vesselsvessels

32. ANTICOAGULANTSANTICOAGULANTS
(i.e. heparin)(i.e. heparin)
 WHY ??WHY ??
 Doing so may causeDoing so may cause
uncontrolled bleedinguncontrolled bleeding

33. INJECT MEDICATIONINJECT MEDICATION
SLOWLYSLOWLY

34. HOLD ALCOHOL PADHOLD ALCOHOL PAD
NEAR NEEDLE ANDNEAR NEEDLE AND
WITHDRAW NEEDLE,WITHDRAW NEEDLE,
BEING CAREFUL NOT TOBEING CAREFUL NOT TO
STICK YOURSELF WITHSTICK YOURSELF WITH
NEEDLE!NEEDLE!

35. MASSAGE SITE TOMASSAGE SITE TO
PROMOTEPROMOTE
ABSORPTIONABSORPTION
 Now, for moreNow, for more
exceptions!exceptions!

36. MASSAGE ISMASSAGE IS
CONTRAINDICATEDCONTRAINDICATED
IN THE FOLLOWING:IN THE FOLLOWING:
MASSAGE ISMASSAGE IS
CONTRAINDICATEDCONTRAINDICATED
IN THE FOLLOWING:IN THE FOLLOWING:

37.  When medicationWhen medication
couldcould stainstain oror irritateirritate
tissuetissue ( i.e. iron )( i.e. iron )
 Slow absorption isSlow absorption is
desireddesired

38.  HeparinHeparin maymay
cause bleedingcause bleeding
and insulin mayand insulin may
absorbabsorb tootoo
rapidlyrapidly

39. SITE ROTATION:SITE ROTATION:
MustMust
rotaterotate
sitessites toto
avoidavoid
tissuetissue
damagedamage
andand
scarringscarring

40. TRACKING:TRACKING:
 The leaking of aThe leaking of a
medication back upmedication back up
the channel afterthe channel after
needle is withdrawnneedle is withdrawn

41. HOW DO YOU PREVENTHOW DO YOU PREVENT
TRACKINGTRACKING
ChangeChange needle p drawingneedle p drawing
up solution if giving ironup solution if giving iron
 Inject medicine slowlyInject medicine slowly
and leave needle in forand leave needle in for 1010
secondsseconds p injectionp injection

42.  USE 2CC AIR BUBBLESUSE 2CC AIR BUBBLES
 It seals off needleIt seals off needle
tracktrack
 Iron- uses .5cc airIron- uses .5cc air,,
leave needle in for 30leave needle in for 30
seconds p giving

43. AvoidAvoid massagingmassaging
injection siteinjection site
Instruct patient-Instruct patient- wearwear
loose clothing,avoidloose clothing,avoid
use of muscle thatuse of muscle that
received injectionreceived injection

44. Z-Track methodZ-Track method
 VistarilVistaril
 ImferonImferon
 changechange
needleneedle after
drawing up,
especially
iron!

45. PULL SKIN TO ONE SIDE-PULL SKIN TO ONE SIDE-
Hold it there for entire
injection
 Hold for at leastHold for at least 10 seconds10 seconds
before withdrawing needlebefore withdrawing needle

46.  REMOVE NEEDLE ANDREMOVE NEEDLE AND
YOUR HANDYOUR HAND WHICH WASWHICH WAS
DISPLACING SKIN AT THEDISPLACING SKIN AT THE
SAME TIME
 THE NEEDLE TRACK ISTHE NEEDLE TRACK IS
SEALED OVERSEALED OVER AS THEAS THE
TISSUE RETURNS TO ITSTISSUE RETURNS TO ITS
NORMAL POSITIONNORMAL POSITION

47. WHAT HAPPENS IFWHAT HAPPENS IF
NEEDLE BREAKS?NEEDLE BREAKS? If visible in skin, don’tIf visible in skin, don’t
move point,move point, pullout withpullout with
sterile tweezerssterile tweezers -OR--OR-
 Mark (circle) site withMark (circle) site with
pen,call physicianpen,call physician FillFill
out incident reportout incident report

48. DORSOGLUTEALDORSOGLUTEAL

49. DORSOGLUTEALDORSOGLUTEAL
 2 Ways to locate2 Ways to locate
sites:sites:
DivideDivide
buttocks intobuttocks into
quarters, usequarters, use
upper outerupper outer
quadrant

50. DRAW AN IMAGINARYDRAW AN IMAGINARY
LINE BETWEENLINE BETWEEN thethe
greater trochanter andgreater trochanter and
the posterior superiorthe posterior superior
iliac spine,iliac spine, injection isinjection is
given above and togiven above and to
outside of lineoutside of line

51. Place patient inPlace patient in
prone positionprone position
with toes pointedwith toes pointed
inward toinward to relaxrelax
musclemuscle

52. VENTROGLUTEALVENTROGLUTEAL

53. VENTROGLUTEALVENTROGLUTEAL
 Place heel of handPlace heel of hand
on greater trochanteron greater trochanter
with fingers pointing upwith fingers pointing up
toward patients headtoward patients head
and thumb pointing upand thumb pointing up
toward ceilingtoward ceiling

54.  With index fingerWith index finger
on patientson patients anterioranterior
superior iliac spinesuperior iliac spine
the 2the 2ndnd finger isfinger is
stretched dorsally tostretched dorsally to
form aform a “V”“V”

55. DELTOIDDELTOID
 1-2” Below1-2” Below AcromionAcromion
process, maximum amountprocess, maximum amount
injected 1cc1cc with 1”1” needle

56. VASTUS LASTERALISVASTUS LASTERALIS

57. • OUTER/UPPER THIGHOUTER/UPPER THIGH
Middle third area between
knee and greater trochanter
 Preferred site forPreferred site for
infantsinfants
 No major blood vesselsNo major blood vessels
or nerves in this areaor nerves in this area

58. RECTUS FEMORISRECTUS FEMORIS

59. ANTERIOR ASPECT OFANTERIOR ASPECT OF
THIGHTHIGH (Quadriceps muscle
group)
Middle third of anteriorMiddle third of anterior
thighthigh
 DisadvantageDisadvantage is site isis site is
painfulpainful

60. A FEW LASTA FEW LAST
MINUTEMINUTE
ITEMSITEMS

61. IV THERAPY:IV THERAPY:
 Most rapid formMost rapid form
of drug therapyof drug therapy
 LPNsLPNs do not givedo not give
IV drugsIV drugs

62. DISPLAY CONFIDENCE!DISPLAY CONFIDENCE!
EXPLAIN WHAT YOUEXPLAIN WHAT YOU
ARE DOING!!ARE DOING!!
Decrease your own fearDecrease your own fear
by-by-
PRACTICE!PRACTICE!
PRACTICE!PRACTICE!
PRACTICE!