hey toad, nice post. if your needle was not too long, jam it in fast, not giving your patient time to move or tense up, make sure the elbow is against the abdomen, pull and push. if you get blood when u aspirate, toss it and start over, hardly ever happens, i have seen many nurses push it anyway, but i dont. thick meds or neulasta and a bunch of other meds hurt like hell, push slow. dont be afraid to push it in the butt if they are real skinny or even the quad. i have hit bone in the deltoid a lot of times, prolly doesnt hurt nothing but its not good practice. you should see what people do to partially ocluded central lines, makes this problem look like childs play. anyway i hope that helps. right needle, hit it fast, elbow against abdomen, pull and push. same for kids. good needle selection is important, i like 23g or 24g sometimes if i can get it for deltoid IM, if your patient has thromoctopenia a 22g can make for good bleeding (not cool). dont forget, right patient, right time, right order, right date, right med, right route, right documentation, right allergy check, right everything. i remember i gave an IM inj to deltoid and this PA saw me, I had blood return, so i tossed it and started over, he freaked out, what an idiot, he doesnt even know how to give a shot and is a PA. hello? i dont want my Tdap IV dude! thanks. Pat.