Establishing a new appropriate intramuscular injection site in the deltoid muscle

Nakajima, Yukari; Mukai, Kanae; Takaoka, K; Hirose, Toshiharu; Morishita, Katsuyuki; Yamamoto, Takuya; Yoshida, Yuka; Urai, Tamae; Nakatani, Toshio

doi:10.1080/21645515.2017.1334747

Cited by 35 publications

(69 citation statements)

References 16 publications

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“…was previously proposed as a safer site. 6,8 All participants were seated with their arms in the anatomical position before the definition of the examined sites in the deltoid muscle. Site (a) was defined after the acromion on the right arm was identified and the digitus annularis in the left hand was placed on the inferior border of the acromion.…”

Section: Definition Of Examined Sitesmentioning

confidence: 99%

“…Site (b) was defined as described in detail in our previous study. 8 In the ventrogluteal site, two IM injection sites were defined: (c) the point of Clark, which is located at the anterior one-third point between the anterior superior iliac spine and (d) our original IM injection site (a novel point on the gluteus medius), which was previously proposed as a safe site similar to the point of Clark. Site (d) was defined as described in detail in our previous studies.…”

Section: Definition Of Examined Sitesmentioning

confidence: 99%

“…6,7 Therefore, we proposed the intersection between the anteroposterior axillary line (the line between the upper end of the anterior axillary line and upper end of the posterior axillary line) and the perpendicular line from the mid-acromion as the most appropriate site for IM injections with a low risk of axillary nerve and PCHA damage (This site is shown in Figure 1 (A) in reference). 8 A ventrogluteal site is the most commonly used and recommended site for IM injections in adults and children of walking age because of the large muscle mass. This site is located away from the superior and inferior gluteal arteries as well as the sciatic and superior gluteal nerves, 9 and is also the least painful.…”

Section: Introductionmentioning

confidence: 99%

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Anatomically safe sites for intramuscular injections: a cross-sectional study on young adults and cadavers with a focus on the thigh

Nakajima

Fujii

Mukai

et al. 2019

Human Vaccines & Immunotherapeutics

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The anatomical safety of intramuscular injections at the deltoid and ventrogluteal sites has been investigated; however, the anatomical relationship between intramuscular injection sites in the thigh and major blood vessels and nerves remains unclear. We aimed to compare intramuscular injection sites in the rectus femoris and vastus lateralis with those at the deltoid and ventrogluteal sites and identify safe intramuscular injection sites in the thigh. Twenty-seven young adult volunteers were recruited, and the thicknesses of subcutaneous tissue and muscle as well as the number of blood vessels present were evaluated at two sites on the deltoid, ventrogluteal, and thigh using ultrasound equipment. The right thighs of 24 cadavers were used, and the thickness of muscle, number of blood vessels or nerves present, and the distance between each examined site and major blood vessels or nerves were evaluated in the rectus femoris and vastus lateralis. A major blood vessel was observed in the middle of the rectus femoris in young adults. In cadavers, the descending branch of the lateral circumflex femoral artery and muscle branch of the femoral nerves to the vastus lateralis were observed at the middle point, distal two-thirds point, and middle point between the middle and distal two-thirds points of the rectus femoris, but not at the middle of the vastus lateralis. The middle of the vastus lateralis is an appropriate site for intramuscular injections because of the low risk of vascular or nerve damage. The present results support good practices for site selection for intramuscular injections.

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Section: Definition Of Examined Sitesmentioning

confidence: 99%

Section: Definition Of Examined Sitesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anatomically safe sites for intramuscular injections: a cross-sectional study on young adults and cadavers with a focus on the thigh

Nakajima

Fujii

Mukai

et al. 2019

Human Vaccines & Immunotherapeutics

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“…Directly examining latex injectate in dissected deltoid muscle, and determining the correlation to bunching and flattening technique and needle length, has not been previously attempted. Previous studies employing ultrasound to observe and measure intramuscular injections [14,20] are limited by transducer pressure applied during ultrasound, which potentially compresses the tissues, altering the measured depth of the injection and of fat and muscle layers. [9] By physically visualizing and measuring the placement of the injectate in the deltoid, we were able to determine the combination of factors which resulted in successful deltoid IMI or in overpenetration.…”

Section: Discussionmentioning

confidence: 99%

Best practice for deltoid intramuscular injections in older adults: Study in cadavers

Davidson

Bertram

2019

JNEP

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Most injectable vaccines are administered via deltoid intramuscular injection (IMI). Nursing students are taught to perform deltoid IMI in their entry-to-practice education program. However, best practice evidence is lacking regarding specific techniques of deltoid IMI, and students are often taught what their instructor was taught in his/her own entry-to-practice (ETP) program. Nursing textbooks provide instructions and diagrams for how to perform deltoid IMI, but rarely cite underpinning empirical evidence. This study tested the injection techniques of bunching (squeezing) or flattening (stretching) the deltoid muscle before administering IMI using medical school donated cadavers. Flattening technique resulted in over-penetration of deltoid injections more than 85% of the time in these older adults, whereas nearly 80% of deltoid IMI are successful using bunching technique. Body mass index (BMI) and needle length are also crucial considerations when administering deltoid IMI. Nurses, and other health professionals who use deltoid IMI to administer vaccines to older adults, should determine the client’s body mass index to select the appropriate needle length. Based on these results, bunching technique is recommended. Flattening technique is not recommended for older adults with a BMI < 30.

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“…Therefore, it is becoming increasingly important for clinicians to identify a safer IM injection site in the deltoid muscle because of possible complications following the vaccine administration of IM injections [31].…”

Section: Assessment Of Deltoid Muscle Im Injection Sitementioning

confidence: 99%

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

Tanioka¹,

Takase²,

Yasuhara³

et al. 2018

Health

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Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention. The aim of this article was to indicate a safe and effective IM injection technique based on evidenced data derived from ultrasonographic data. Accurate anatomical knowledge is necessary in order to administer IM injections. It is possible to gain an adequate understanding of injection site anatomical structures by using ultrasound diagnostic devices. In particular, ultrasonography offers real-time diagnostic data allowing for observation of injection site, subcutaneous tissues, fat layers, muscle membrane, muscles and bones. To deliver the drug accurately into the muscle is essential, to achieve maximum drug efficacy and prevent injection site reactions. Therefore, when administering IM injections to the buttocks area, a suitable injection needle between 23G 25 mm to 21G or 22G 38 mm must be chosen depending on physique and drug characteristics. Needles determined as safe and effective through ultrasonographic evidence are needed such as in the case of a deltoid injection site, in which a 23G 25 mm injection needle is used in the absence of notable obesity. Not only the needle type is essential, but also the IM procedure itself. It is important to stretch the skin, inserting the needle at 90 degree angle to ensure depth of needle insertion to the muscle. Until new confirmed evidence becomes available, it is necessary to increase the understanding of injection site selection methods, needle insertion depth, needle angle, and established IM injection techniques. The application of ultrasound devices in the development of next-generation techniques for IM injection is promising. Importantly, these techniques provide critical information from a risk management perspective.

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Establishing a new appropriate intramuscular injection site in the deltoid muscle

Cited by 35 publications

References 16 publications

Anatomically safe sites for intramuscular injections: a cross-sectional study on young adults and cadavers with a focus on the thigh

Anatomically safe sites for intramuscular injections: a cross-sectional study on young adults and cadavers with a focus on the thigh

Best practice for deltoid intramuscular injections in older adults: Study in cadavers

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

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