Deltoid Administration of Ondansetron (Zofran) Injection
Yes, Zofran (ondansetron) can be administered intramuscularly in the deltoid muscle, though specific volume and technique considerations must be followed to ensure safe administration.
Volume Limitations for Deltoid Injection
The deltoid muscle has strict volume constraints that must be respected:
- Maximum volume for deltoid injection is 0.5 mL in adults and children ≥3 years of age 1
- Volumes exceeding 0.5 mL risk inadequate muscle penetration, subcutaneous deposition, local pain, reduced absorption, and increased adverse reactions 1
- For volumes >0.5 mL, alternative sites such as the vastus lateralis (anterolateral thigh) should be used instead, as this site accommodates larger volumes and provides more rapid absorption 1
Proper Deltoid Injection Technique
To minimize risk of nerve injury, vascular complications, and musculoskeletal injuries:
- Inject in the middle third of the deltoid muscle to avoid major neurovascular structures 2, 3
- Use a 90-degree angle for proper intramuscular placement 4
- For adults and older children with adequate deltoid mass, use a needle length of 7/8 to 1.25 inches (or >1 inch) to ensure adequate muscle penetration 1
- Clean the injection site with an alcohol swab before administration 4
Critical Safety Considerations
Common pitfalls to avoid:
- Inappropriate injection depth is a significant problem in clinical practice, with studies showing many practitioners use incorrect depths 5
- Nerve palsies and musculoskeletal injuries can occur from inappropriate site selection within the deltoid region 3
- The middle third of the deltoid is safest; avoid the upper or lower portions where neurovascular structures are at higher risk 2, 3
- Poor awareness of at-risk anatomical structures (axillary nerve, posterior circumflex humeral artery) is common among practitioners 5
Alternative Site Recommendation
If the ondansetron volume exceeds 0.5 mL or if the patient has limited deltoid muscle mass, use the vastus lateralis (middle of the anterolateral thigh) instead:
- The vastus lateralis is the preferred site for larger volume IM injections due to minimal risk of vascular or nerve damage 4, 6
- This site provides higher and more rapid peak plasma levels compared to other sites 4
- The middle of the vastus lateralis has been confirmed as anatomically safe with low risk of encountering major blood vessels or nerves 6