# How do you landmark the deltoid for IM Injections?



## A.Anaka

I know there are many ways. I am interested in finding out what method works best for you guys.


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## mikeylikesit

i go in at the  lower edge of the acromial process around the
point on the lateral side of the  arm in the same line as the axilla. stick the
needle 2-3(depending on the size of your hands) finger widths below the acromial process, ​​angled slightly toward the process.​


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## Hastings

Hard to explain. I put my thumb on the top of their shoulder, and then my middle finger at the bottom of that muscle, a comfortable distance below the thumb. Then I take my first finger and put that directly in the middle of the thumb and middle finger. And then I move the first finger laterally, directly between the front and the lateral side of the arm. That's where I inject.

Like http://www1.istockphoto.com/file_thumbview_approve/3673985/2/istockphoto_3673985_i_m_injection.jpg
Right there.


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## KEVD18

close my eyes and throw it like a dart. hasnt failed me yet.


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## mycrofft

*After thousands of military immunizations...*

1. Expose the site, warn the pt , then swab with disinfectant. Not proven to make a difference, but can't hurt. 
2. Have the pt drop their arm straight down and open their hand loosely, and droop that shoulder. This relaxes the muscle.
You should already have the shot ready and in your hand ("dart hand"), needle exposed. No teeth, cowboys and girls.
3. With the other "muscle" hand, gently squeeze up the muscle at its meatiest part. With the dart hand, dart the needle straight in from the lateral aspect, in between your "muscle hand" index finger and thumb, and allow the 5th metacarpal "blade" of your needle hand to gently hit the arm the same time as the needle hits. Using the proper needle (we used 1 inch 30 ga; if you use longer needles, don't habitually ram the whole length in), thinking of the length of the needle and the mass of the muscle, put the tip in the center of mass, so to speak.
4. Quicky but smoothly switch the grasp of the needle to your non-dart hand, use the dart hand to gently/quickly draw back on the needle to guarantee no IV (sure). Switch grasp back to the dart hand to depress plunger while your muscle hand steadies the syringe. These shots will be nearly painless if done right. The rythm's easy, it takes about three point five seconds from "Hi there, what's your name?" to "Do you want Scooby Doo or Hello Kitty on that?".

Three extras: use the Z-tack method, it make it less likely much injection material or blood will be expressed; don't be shy about going for the lateral hip if you question the ability of the deltoid to support the injection volume or irritant value; and, control the sharp immediately.


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## mycrofft

*Of course, "military immunization" is SUCH a good recommendation! (hahah)*


..................


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## A.Anaka

KEVD18 said:


> close my eyes and throw it like a dart. hasnt failed me yet.


 lol A thing of beauty.

mycrofft, that is very detailed. It also reminds me of a question. How often does  one see flash with a IM? I don't think it would be that common but I am still so new to all this.


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## Jon

A.Anaka said:


> lol A thing of beauty.
> 
> mycrofft, that is very detailed. It also reminds me of a question. How often does one see flash with a IM? I don't think it would be that common but I am still so new to all this.



It should almost never happen... but that's why you draw back before injecting. If you do get blood coming out, pull it out, control bleeding, and try again (with a fresh syringe).


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## Hastings

Jon said:


> It should almost never happen... but that's why you draw back before injecting. If you do get blood coming out, pull it out, control bleeding, and try again (with a fresh syringe).



I am actually thrilled if I get a flash while doing an IM injection. I just recalculate the dose quickly and inject IV.


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## MasterIntubator

..... and if you hit the bone, just pull the needle back a little and carry on.  It happens, they don't feel it.


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## Hastings

MasterIntubator said:


> ..... and if you hit the bone, just pull the needle back a little and carry on.  It happens, they don't feel it.



Pfft, no way. Hit the bone and you've got an IO! That's a super upgrade!


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