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The ventrogluteal site (Figure 13.23a) is relatively free of major nerves and blood vessels and the muscle is large and well defined, making it easy to locate (Greenway 2004). It is located by placing the palm of the hand on the patient’s opposite greater trochanter (right hand on left hip). The index finger is then extended to the anterior superior iliac spine to make a V. Injection in the centre of the V will ensure the injection is given into the gluteus medius muscle (Hunter 2008). This is the site of choice for intramuscular injections (Rodger and King 2000) and used for antibiotics, antiemetics, deep intramuscular and Z-track injections in oil, narcotics and sedatives. Up to 2.5 mL can be safely injected into the ventrogluteal site (Rodger and King 2000).

The deltoid site (Figure 13.23b) has the advantage of being easily accessible whether the patient is standing, sitting or lying down. It is found by visualizing a triangle where the horizontal line is located 2.5–5 cm below the acromial process and midpoint of the lateral aspect of the arm, in line with the axilla to form the apex (Hunter 2008). The injection is then given 2.5 cm down from the acromial process, avoiding the radial and brachial nerves. Owing to the small area of this site, the number and volume of injections which can be given into it are limited. Drugs such as narcotics, sedatives and vaccines, which are usually small in volume, tend to be administered into the deltoid site (Workman 1999). Rodger and King (2000) state that the maximum volume that should be administered at this site is 1 mL.

The dorsogluteal site (Figure 13.23c) or upper outer quadrant is the traditional site of choice and is used for deep intramuscular and Z-track injections. It is located by using imaginary lines to divide the buttocks into four quarters. However, this site carries the danger of the needle hitting the sciatic nerve and the superior gluteal arteries (Workman 1999). The gluteus muscle has the lowest drug absorption rate and this can result in a build-up in the tissues, increasing the risk of overdose (Malkin 2008). The muscle mass is also likely to have atrophied in elderly, non-ambulant and emaciated patients. Finally, it appears that there is a risk that the medication will not reach the muscle due to the amount of subcutaneous tissue in this area (Greenway 2004) and so it is not recommended for routine immunizations due to the poor absorption and risk of nerve injury (DH 2006, WHO 2004). In adults, up to 4 mL can be safely injected into this site (Rodger and King 2000).

The rectus femoris site (Figure 13.23d) is a well-defined muscle found by measuring a hand’s breadth from the greater trochanter and the knee joint, which identifies the middle third of the quadriceps muscle (Hunter 2008). It is used for antiemetics, narcotics, sedatives, injections in oil, deep intramuscular and Z-track injections. It is rarely used by nurses, but is easily accessed for self-administration of injections or for infants (Workman 1999). 1-5 mL can be injected (1–3 mL in children).

The vastus lateralis site (Figure 13.23d) is used for deep intramuscular and Z-track injections. One of the advantages of this site is its ease of access but more importantly, there are no major blood vessels or significant nerve structures associated with this site. It is the better option in the obese patient (Nisbet 2006). Up to 5 mL can be safely injected (Rodger and King 2000).

Figure 13.23 Intramuscular injection sites.

Reproduced from Rodger and King (2000) with permission.

There is debate over which site to use. The two recommended are the vastus lateralis and the ventrogluteal, but most nurses tend to use the dorsogluteal as it is more familiar (Greenway 2004).

Rate of administration

It is recommended that the plunger is depressed at a rate of 10 seconds per millilitre.

Technique

The Z-track method involves pulling the skin downwards or to one side of the injection site and inserting the needle at a right angle to the skin,