Editing Nursing Skills and Procedures (section)

=== Intramuscular ===
* '''Ventrogluteal''' is the preferred adult site for volumes above 2 mL and for viscous or irritating medications. It is located by placing the palm on the greater trochanter, the index finger on the anterior superior iliac spine, and the middle finger along the iliac crest, then injecting into the V. It is free of major nerves and vessels.
* '''Deltoid''' holds about 1 mL, up to 2 mL in a well-developed adult, and is located 2.5 to 5 cm below the acromion process. It is the standard adult vaccine site. Injection too high or too deep risks shoulder injury and axillary nerve damage.
* '''Vastus lateralis''' is the preferred site for infants under 12 months and is acceptable at all ages. The dorsogluteal site is no longer recommended because of sciatic nerve injury risk.
* '''Z-track''' technique is now recommended for all intramuscular injections. Pull the skin laterally about 2.5 cm, insert at 90 degrees, inject slowly, wait about 10 seconds, withdraw, then release the skin so the tissue planes seal and medication cannot track back to the subcutaneous tissue. Do not massage.
* Routine aspiration before injection is no longer recommended for vaccines given in the deltoid or vastus lateralis. Facility policy and instructor expectation vary for other intramuscular medications, and aspiration remains a common expected answer for gluteal injections.

Never recap a used needle, activate the safety device immediately, and dispose of sharps at the point of use. Air bubbles are expelled before injection except when the manufacturer directs otherwise, as with prefilled enoxaparin.