Medication administration in deltoid muscle

[keludtke]

I work at a family practice clinic and have been there for maybe 1.5 years now. I used to work in the hospital on the med-surg floor for almost 4 years. In the hospital setting, pretty much all our meds were delivered IV. Usually, we only gave IM injections when a patient was extremely agitated. Since I have been in the clinic, I have given plenty of IM injections.

I swear that you could only give up to 1 ml in the deltoid muscle. I could be totally wrong, but that is what I remember being told.

I had a situation today. I had a patient who doctor ordered Toradol 60 mg and Solumedrol 40 mg IM. She gets both of these at another doctor's office (Rheumatolgy) at times. She has chronic pain. The nurse there gives both of these meds in the deltoid. I told the patient I wasn't comfortable doing that. I found through our computer system SoluMedrol should not be given in the deltoid because of risk of subcutaneous atrophy.

What about Toradol? I think 60 mg/2 ml is too much in the deltoid because it is 2 mls plus being the type of med that it is. I give plenty of immunizations and B12 in the deltoid.

I talked with the patient and gave them both without difficulty in the ventrogluteal.

I am now doubting myself because I can't find anywhere in my saved notes from school, the hospital, or my clinic nursing skill book on how much you can give in the deltoid. Anybody got any advice on this matter?

[AgentBeast, MSN, RN]

1mL is the generally accepted max for any deltoid injection. You can go up to 3mL in the ventrogluteal or vastus lateralis.

[LegzRN]

I was taught that you can admin 2-3ml in the delt and up to 5ml in the larger muscles. Toradol in the delt hurts like a mother, and solumedrol should only be administered via DEEP IM

[LuxCalidaNP]

I too work in a large FQHC family practice office, and solumedrol and toradol are our mainstays. I had the same questions, and found that by my research, the recommendation for less than 1 ml in the deltoid is due to discomfort and, yes, slight risk of lipodystrophy. Recommendation for 2 ml or more is in the glut, but I found nothing that stated that it affected the rate of absorption at all. One pt who frequents us for toradol pain management swears it hurts less in the delt...

[superdave]

I checked a reference book I have and it states for the deltoid IM injection: 0.5-1ml is the usual amount, while maximum is 2ml.

You also have to take the size of the person into the equation. For an average sized person I would have done the same as you did.

[JerseyBSN]

I've given up to 2cc in the deltoid. It depends on the size of the patient and their arm. Some arms are as big as some patients buttock. There have been some little bitty old ladies who I wouldn't put 1cc in their deltoid.

[Neuro Guy NP, DNP, PhD, APRN]

If they want you to give in the deltoid you could give 1 mL in one deltoid muscle and 1 mL in the other, that's what I was told to do with irritating substances like iron, so perhaps you could try that.

[KellyRPNinOntario]

I would only give 1ml in the deltoid. Question to all....what size/guage needle would you all use for a very obese pt in the deltoid?

[Double-Helix, BSN, RN]

Having just graduated, I can tell you that 1mL is the most you are supposed to give in the deltoid. You could give the Toradol in two divided doses, but that means an extra injection for the patient.

You did the right thing by doing the research, talking to the patient, and administering the med in a way that you felt comfortable.

[MomRN0913]

well, I personally prefer a gluteal IM injection way more than deltoid. Diring my intertility treatments I felt no pain in the gluteal. I get one in the deltoid I am sore for days. no point in giving divided doses times 2 shots. I think you made the right choice.