How to Administer an Intramuscular Injection in the Deltoid Muscle

using Z-Track Technique

Before administering any type of medication whether it is an IM injection or

oral medication, always review your facilities protocols on how they require
you to administer that specific medication.

Before giving an injection, ALWAYS make sure you have the:

● Right medication
● Right dose
● Right route/muscle
● Right time
● Right patient

In addition, you will want to make sure you have the right equipment. For an
intramuscular injection, you will need a syringe (many vaccines are pre-filled
already), needle (pick the right gauge and needle length), alcohol prep,
gauze, tape, or a Band-Aid.

Basics you want to know about giving an IM injection in the

deltoid:

1
● Needle size/length:
○ Intramuscular injections in the deltoid muscle will require a
needle length of at least 1-1 ½ inches for adults.
- Most commonly a 1 inch needle length will be used in
adults for an IM injection in the deltoid. However, this is
where you will need to think critically. Look at the patient
and if the patient has a lot of adipose/fatty tissue over the
deltoid muscle a 1 1/2 inch needle length may be best.

● Remember the deltoid in an adult can hold no more than about 2

milliliters of a solution. Hence, this is a great site for the flu, hepatitis B,
and pneumonia vaccines in an adult. If a higher amount of solution is
needed, the solution is thick, or the solution is known to cause irritation,
use another muscle like the ventrogluteal.

How to Give an Intramuscular Injection in the Deltoid Muscle

1. Gather supplies, perform hand hygiene, *don gloves, and explain the
procedure to the patient
● Tip: Ask the patient what arm they prefer for the injection to be
administered in because it can sometimes be sore the next day.
Try to use the non-dominant arm, if not contraindicated.
○ According to CDC.gov: Gloves are not required when
administering vaccines unless the person administering the
vaccine is likely to come into contact with potentially
infectious body fluids or has open lesions on hands
(“Pinkbook | Vaccine Administration | Epidemiology of
VPDs | CDC”, 2015).

2. Have the patient sit or stand (if the patient is afraid of needles have
them sit, in case they pass out)

3. Ensure the deltoid muscle is relaxed. (Note: it will be less painful for the
patient if the muscle is completely relaxed)

2
4. Find the injection site by first locating the acromion process. This forms
the highest part of the outer shoulder and is a bony area (see picture
below). Once you find this area, go about 2 fingers widths below this
area, which will be the injection site for the deltoid muscle.

5. Cleanse the site with the alcohol prep by starting in the center and
working outward. Then let it completely dry.

6. Use the z-track technique to administer the medication. Don’t pinch or

bunch up the skin.

3
 ● The z-track technique is recommended for IM injections. WHY?
This technique decreases pain to the patient, BUT most
importantly it prevents the instilled solution from seeping into the
subcutaneous tissue.
○ WHY? This technique decreases pain to the patient, BUT
most importantly it prevents the instilled solution from
seeping into the subcutaneous tissue.
● To do this technique, take your non-dominant to the side of the
injection site and pull the skin to the side (opposite of the
injection site).

7. Once the z-track technique is in place, take your dominant hand and
quickly insert the needle at a 90’ angle into the skin.

4
8. Steady the needle by using the thumb and forefinger of the
non-dominant hand. This prevents potential damage to the muscle or
surrounding tissues along with accidental displacement of medication.

9. Use the dominant hand to inject the solution at a rate of 10 seconds

per mL (don’t inject too fast because this can cause damage).
Example: if you’re administering 0.5 mL, instill this solution over 5
seconds.

10. Once the solution is injected completely, wait 10 seconds before

removing the needle. Remove the needle at the same angle it was
inserted (90’ degrees).

11. Engage the safety of the needle and promptly discard it in the sharps
container.

5
 12. Don’t massage the injection site (this could force some of the solution
into the subcutaneous tissue). Light pressure can be applied to the site
if bleeding occurs. You may place a Band-Aid over the site if needed.

13. Doff gloves if worn, perform hand hygiene, and document (muscle
used, time administered, right or left side, amount of medication
instilled, and patient’s response).

References:

Notes:https://www.registerednursern.com/administer-intramuscular-injection-
deltoid-muscle-using-z-track-technique/

YT Video:https://www.youtube.com/watch?v=DBHnd3N-5Ns