What is the correct technique for administering an intra-deltoid (in the muscle of the shoulder) injection?

Correct Technique for Administering Intradeltoid Injections

The correct technique for administering an intradeltoid injection requires using the middle third posterior aspect of the upper arm, approximately 4 fingerbreadths (9 cm) below the mid-acromion point, using a 22-25 gauge needle of appropriate length inserted at a 90° angle after proper site preparation. 1, 2

Anatomical Site Selection

Proper Deltoid Site Location

• Identify the deltoid muscle: Located on the lateral aspect of the upper arm
• Locate the proper injection site:
  • Middle third posterior aspect of the upper arm 1, 3
  • 4 fingerbreadths (approximately 9 cm) below the mid-acromion point 2
  • Never inject in the upper half of the deltoid to avoid injury to the axillary nerve and posterior circumflex humeral artery 2, 4
  • Stay at least 2 fingerbreadths away from bony prominences 1

Anatomical Landmarks to Avoid

• Avoid the upper portion of the deltoid where the axillary nerve and posterior circumflex humeral artery are located (typically 8.2-8.7 cm from the mid-acromial point) 2
• Avoid visible veins, lesions, scars, or bruises 3
• Avoid areas with lipohypertrophy (abnormal accumulation of fat) 1

Injection Technique

Preparation

1. Verify the medication to be administered 1
2. Clean hands and prepare equipment
3. Clean injection site with alcohol swab using circular motion from center outward 3
4. Allow alcohol to dry completely

Needle Selection

• For adults: 22-25 gauge needle, 1-1½ inches in length 1
• For toddlers and older children: 22-25 gauge needle, 7/8 to 1¼ inches 1

Administration Procedure

1. Position the patient with exposed upper arm
2. Clean the site with alcohol and allow to dry
3. For most adults, lightly grasp a fold of skin, release the pinch, then inject at a 90° angle 1
4. For thin individuals or children, pinch the skin and inject at a 45° angle to avoid intramuscular injection 1
5. Insert the needle with a quick, dart-like motion
6. Aspiration (pulling back on plunger to check for blood) is optional but not necessary for routine injections 1
7. Inject medication slowly
8. Remove needle and apply light pressure to the site for about 1 minute 3
9. Do not massage the injection site

Special Considerations

Needle Length Selection

• Consider patient's body mass:
  • For average adults: 1-1½ inch needle 1
  • For obese patients: May need longer needle to reach muscle
  • For thin patients: May need shorter needle or 45° angle injection technique 1

Multiple Injections

• If multiple injections are needed in the same limb, space them at least 1 inch apart 1
• Document the location of each injection in the patient's medical record 1

Site Rotation

• When multiple injections are needed over time, rotate injection sites to prevent tissue damage 1, 3
• Systematic rotation within the same anatomical area is preferred over rotating between different areas 1

Common Pitfalls to Avoid

1. Incorrect site selection: Injecting too high on the deltoid risks nerve and artery damage 2, 4
2. Inadequate needle length: Using too short a needle may result in subcutaneous rather than intramuscular administration 1
3. Improper angle: Not inserting at the correct angle based on patient body type 1
4. Failure to rotate sites: Not properly rotating sites for patients requiring multiple injections 1
5. Inadequate cleaning: Not allowing alcohol to dry completely before injection

By following these guidelines, healthcare providers can ensure safe and effective administration of intradeltoid injections while minimizing the risk of complications such as nerve injury, improper medication delivery, or local tissue reactions.