Editing Intramuscular injection (section)

===Injection sites===
The deltoid muscle in the outer portion of the upper arm is used for injections of small volume, usually equal to or less than 1&nbsp;mL. This includes most intramuscular vaccinations.<ref name="JBI" /> It is not recommended to use the deltoid for repeated injections due to its small area, which makes it difficult to space out injections from each other.<ref name="JBI">The Joanna Briggs Institute. Recommended Practice. Injection: Intramuscular. The Joanna Briggs Institute EBP Database, from the JBI@Ovid database, published 2019; JBI2138. Accessed on 12 September 2020.</ref> The deltoid site is located by locating the lower edge of the [[acromion process]], and injecting in the area which forms an upside down triangle with its base at the acromion process and its midpoint in line with the [[axilla|armpit]].<ref name="Taylor" /> An injection into the deltoid muscle is commonly administered using a 1-inch long needle, but may use a {{frac|5|8}}-inch long needle for younger people or very frail elderly people.<ref name=Vaccine2017 />

The ventrogluteal site on the hip is used for injections which require a larger volume to be administered, greater than 1&nbsp;mL, and for medications which are known to be irritating, viscous, or oily. It is also used to administer [[narcotic]] medications, [[Antibiotics|antibiotic]]s, [[sedative]]s and [[Antiemetic|anti-emetic]]s.<ref name="JBI" /> The ventrogluteal site is located in a triangle formed by the [[anterior superior iliac spine]] and the [[iliac crest]], and may be located using a hand as a guide.<ref name="Taylor" /> The ventrogluteal site is less painful for injection than other sites such as the deltoid site.<ref name="JAN2019">{{cite journal |last1=Şanlialp Zeyrek |first1=Arife |last2=Takmak |first2=Şenay |last3=Kurban |first3=Nevin Kuzu |last4=Arslan |first4=Sümeyye |title=Systematic review and meta-analysis: Physical-procedural interventions used to reduce pain during intramuscular injections in adults |journal=Journal of Advanced Nursing |date=December 2019 |volume=75 |issue=12 |pages=3346–3361 |doi=10.1111/jan.14183|pmid=31452229 |s2cid=201786789 }}</ref>

The [[vastus lateralis]] site is used for infants less than 7 months old and people who are unable to walk or who have loss of muscular tone.<ref name="JBI" /> The site is located by dividing the front [[thigh]] into thirds vertically and horizontally to form nine squares; the injection is administered in the outer middle square.<ref name=Taylor/> This site is also the usual site of administration for [[epinephrine autoinjector]]s, which are used in the outer thigh, corresponding to the location of the vastus lateralis muscle.<ref>{{cite web|url=https://medlineplus.gov/druginfo/meds/a603002.html|title=Epinephrine Injection|website=[[MedlinePlus]]}} Last revised 03/15/2017</ref>

The dorsogluteal site of the buttock site is not routinely used due to its location near major [[blood vessel]]s and [[nerve]]s, as well as having inconsistent depth of [[adipose tissue]].<ref>{{cite journal |last1=Zimmermann |first1=Polly Gerber |title=Revisiting IM Injections |journal=American Journal of Nursing |date=February 2010 |volume=110 |issue=2 |pages=60–61 |doi=10.1097/01.NAJ.0000368058.72729.c6|pmid=20107407 }}</ref> Many injections in this site do not penetrate deep enough under the skin to be correctly administered in the muscle.<ref name="JBI" /><ref>{{cite journal |last1=Farley |first1=HF |last2=Joyce |first2=N |last3=Long |first3=B |last4=Roberts |first4=R |title=Will that IM needle reach the muscle? |journal=The American Journal of Nursing |date=December 1986 |volume=86 |issue=12 |pages=1327, 1331 |pmid=3641525}}</ref> While current [[evidence-based practice]] recommends against using this site, many healthcare providers still use this site, often due to a lack of knowledge about alternative sites for injection.<ref>{{cite journal |last1=Cocoman |first1=Angela |last2=Murray |first2=John |title=Recognizing the evidence and changing practice on injection sites |journal=British Journal of Nursing |date=October 2010 |volume=19 |issue=18 |pages=1170–1174 |doi=10.12968/bjon.2010.19.18.79050|pmid=20948472 }}</ref> 
This site is located by dividing the buttock into four using a cross shape, and administering the injection in the upper outer quadrant. This is the only intramuscular injection site for which aspiration is recommended of the syringe before injection, due to higher likelihood of accidental [[Intravenous therapy|intravenous administration]] in this area.<ref name="JBI" /> However, aspiration is not recommended by the [[US CDC|Centers for Disease Control and Prevention]], which considers it outdated for any intramuscular injection.<ref name="Lippincott" />

{{multiple image
|header=Sites for administration of intramuscular injections
|direction=horizontal | align=center | total_width = 1000px
|image1=Im-deltoid (cropped).png
|alt1=Deltoid site
|caption1=Diagram showing the [[deltoid muscle|deltoid]] site for intramuscular injection
|image2=Im-ventrogluteal-300x244.png
|alt2=Ventrogluteal site
|caption2=Ventrogluteal and rectus femoris sites for intramuscular injection
|image3=Injection Sites Intramuscular Thigh Adult.png
|alt3=Vastus lateralis site in adult
|caption3=Vastus lateralis site of administration in an adult
|image4=Injection Sites Intramuscular Thigh Child.png
|alt4=Vastus lateralis site in child
|caption4=Vastus lateralis site of administration in an infant or young child
}}