Highlighted here are the Deltoid and Dorsogluteal muscles as the most common sites for injection.

The choice of site for injection is influenced by the patient’s physical condition, age and possibly preference.

It is highly recommended to alternate between sites to encourage healing and reduce damage. However, some patients may insist on same site.

Deltoid

This is an easily accessible site, generally used for vaccination, but can also be used for second and third generation antipsychotic depot injections (e.g., paliperidone, aripiprazole).

Dorsogluteal

Muscle most frequently used for IM injections. Note that:

• it is in close proximity to a major blood vessel and the sciatic nerve;
• sciatic nerve injury is a known risk;
• drug absorption from this muscle may be slower than other sites, which can lead to a build-up of drugs in the tissues;
• some patients find the use of the dorsogluteal site intrusive.

Before injecting any patient, remember:

• IPC (Infection Prevention Control) procedures → wash your hands and prepare your equipment (👋Hand hygiene)
• check all notes → documentation/secondary care info (🗄️London Care Record (LCR Portal Cerner)) and EMIS records (👶EMIS Web Basics)
• sharps safety → see 🦺Safe use and disposal of sharps
• check you have the necessary/appropriate PPE (😷Personal protective equipment (PPE))

Technique Matters!

The Z-Track Injection Technique is recommended. ⬇️

1. Clean the site with 70% isopropyl swab for 30 seconds and allow the skin to dry.
2. Use your non-dominant hand to pull the skin downward or to the side. The tissue should be displaced by about an inch. This is what will give the Z-track injection the zigzag shape. This seals off the puncture track and reduces leakage of medication through the tissue.
3. Insert the needle with a darting motion at 90 degrees to the skin surface to an adequate depth to allow the needle to penetrate the muscle.
• Keep the graduation markings on the syringe barrel visible at all times.
4. For dorsogluteal injections:

Aspiration Technique should be used → continue to hold the skin taut while you carefully pull back on the syringe with the dominant hand to check for blood.

1. If blood appears in the syringe → discard all equipment and start again.
2. If no blood → continue on to step 6.
5. You do not need to aspirate for deltoid injections.
6. Inject the medication slowly, at about 10 seconds per milliliter of medication.
7. Once you’ve injected all the medication, wait about 10 seconds before smoothly pulling out the needle and, once it has been removed, releasing the skin.
8. If necessary, the injection site may be wiped with a dry gauze swab. Don’t massage the site, as this can cause irritation.
9. A plaster may be applied if this is the patient’s choice and if they have no known allergy to latex or plasters.
10. Properly dispose of the needle and wash your hands.
11. If required, assess the injection site for potential early and late complications.