06.03 Injection Sites and Needle Gauge

Injection Guidelines

Injections can be given in three primary locations; intramuscular (IM), subcutaneous (SubQ), and intradermal (ID).

• Intramuscular: within the muscular tissue
• Subcutaneous: into the subq fatty tissue
• Intradermal: directly underneath the epidermis

Location selection will be based on the medication being given. For example, insulin is given SubQ, TB skin test are preformed intradermal, while vaccines are often given IM.

Absorption and efficacy of the medication will depend directly on route of administration. There are some critical points to remember when administering medications via the various routes.

Intramuscular

Locations:

• Deltiod
• Ventrogluteal
• Dorsogluteal
• Vastus Lateralis

Words of Caution:

• Extreme caution must be used when providing injections in the dorsogluteal area to avoid striking the sciatic nerve.
• The nurse should always aspirate IM injections to insure that the medication is not going into a blood vessel.
• The nurse should always use the clinical landmarks identified in the video to locate injection sites.
• Z-track method can be used to prevent backflow of medication into the subq tissue.

Subcutaneous

Locations:

• Outer aspect of upper thigh
• Outer aspect of upper arm
• Abdomen – avoiding within 2″ of umbilicus
• Upper buttocks

Words of Caution:

• The goal is to inject medication into the fatty tissue. Injecting too deep will put the medication in the muscle.
• Insulin injection sites should be rotated to avoid LIPOHYPERTROPHY which is a build up of fat leading to decrease absorption.

Intradermal

Locations:

• Anterior forearm (preferred site)
• Upper cheat
• Upper back
• Back of arm

Words of Caution:

• DO NOT massage the site
• Insert the needle at a 10° – 15° angle. Medication should be instilled just under the dermis.
• A wheal (blister) SHOULD form. If one does not, the medication is in the subq.

Needle Gauge Selection