Abstract
During this time of rapid and significant advancements in our knowledge base and practice, it is easy to overlook that which is viewed as fundamental, such as the procedure for administering a deltoid intramuscular (IM) injection. Most fundamental nursing textbooks include a section outlining this procedure; a section which has remained largely unchanged over time. The knowledge base underpinning this procedure warrants re-examination due to increasing use of the deltoid for administration of medications to prevent and manage chronic diseases as well as increasing reports of debilitation and long-lasting physical and functional impairment following injury to underlying anatomical structures (MacKenzie et al., 2025).
Purpose: To summarize how landmarking for deltoid IM injections is described in literature and examine congruence between existing and emerging evidence, a state-of-the-art review was undertaken (Covidence, 2025).
Method: A search was undertaken of nursing textbooks, national Immunization Guidelines, and five bibliographic databases. The search string used for the bibliographic databases was Deltoid AND (Intramuscular OR IM) AND Injection* with a citation limit of English language. Covidence software was used for screening and data extraction. Two reviewers independently screened citations for relevance. Data extraction was completed for 49 articles.
Findings: Within textbooks, landmarking for deltoid IM injections is generally described in finger-widths or centimeters/inches below the acromion process. Details on landmarking for deltoid injections were only found in one Immunization Guideline (Australian, 2019). Nineteen research studies, including 13 anatomical studies, were retrieved. Over half the anatomical studies were published in the 2020s with location of anatomical structures determined by ultrasound, cadaver, MRI or CT scanning, and anthropometric measurements. Notable differences were found among studies in location of anatomical structures and approaches recommended for landmarking (Charmode et al., 2022; Ravi et al., 2024).
Conclusion: Given that nurses and those they care for vary greatly in shape and size, appropriateness of landmarking using fixed metrics such as finger-widths or centimeters is questionable. Although medication administration may be a fundamental nursing skill, the need for discovery to inform our actions and prevent morbidity is required. Recommendations for deltoid landmarking will be shared.
Notes
References:
Australian Government Department of Health, Disability and Ageing. (2019). Avoiding shoulder injury related to vaccine administration. https://immunisationhandbook.health.gov.au/resources/publications/avoiding-shoulder-injury-related-to-vaccine-administration
Charmode, S., Sharma, S., Kushwaha, S.S., Mehra, S., Sangma, S.S., & Mishra, V. (2022). Deltoid intramuscular injections: A systematic review of underlying neurovascular structures to the muscle and proposing a relatively safer site. Cureus, 14(4), Article e24172. doi: 10.7759/cureus.24172
Covidence. (2025). Understanding review types in research. https://www.covidence.org/review-types/
MacKenzie, L.J., Bousie, J.A., Newman, P., Cunningham, J., Woodward, A.P., Silk-Jones, J., Nguyen, C., & Bushell, M.J.A. (2025). What three years of COVID-10 vaccine administration reveals about the incidence of shoulder injury related to vaccine administration (SIRVA). Vaccine, 51, Article e123892. https://doi.org/10.1016/j.vaccine.2025.126892
Ravi, K.S., Basavanna, P.N., Viveka, S., Patra, A., Asghar, A., Pasi, R., & Mahadevappa, M. (2024). Revisiting the safe zone for axillary nerve concerning the deltoid intramuscular injection site: A review. Journal of Morphological Sciences, 41, 142-146. doi: 10.51929/jms.41.142.2024
Sigma Membership
Iota Omicron
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Deltoid Muscles, Intramuscular Injections, Primary Care
Recommended Citation
Batty, Mary Lou; Glazier, Lily; and Hodgins, Marilyn J., "Deltoid Intramuscular Injections: A State-of-the-Art Review of the Evidence on Landmarking" (2026). International Nursing Research Congress (INRC). 173.
https://www.sigmarepository.org/inrc/2026/presentations_2026/173
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-20
Deltoid Intramuscular Injections: A State-of-the-Art Review of the Evidence on Landmarking
Toronto, Ontario, Canada
During this time of rapid and significant advancements in our knowledge base and practice, it is easy to overlook that which is viewed as fundamental, such as the procedure for administering a deltoid intramuscular (IM) injection. Most fundamental nursing textbooks include a section outlining this procedure; a section which has remained largely unchanged over time. The knowledge base underpinning this procedure warrants re-examination due to increasing use of the deltoid for administration of medications to prevent and manage chronic diseases as well as increasing reports of debilitation and long-lasting physical and functional impairment following injury to underlying anatomical structures (MacKenzie et al., 2025).
Purpose: To summarize how landmarking for deltoid IM injections is described in literature and examine congruence between existing and emerging evidence, a state-of-the-art review was undertaken (Covidence, 2025).
Method: A search was undertaken of nursing textbooks, national Immunization Guidelines, and five bibliographic databases. The search string used for the bibliographic databases was Deltoid AND (Intramuscular OR IM) AND Injection* with a citation limit of English language. Covidence software was used for screening and data extraction. Two reviewers independently screened citations for relevance. Data extraction was completed for 49 articles.
Findings: Within textbooks, landmarking for deltoid IM injections is generally described in finger-widths or centimeters/inches below the acromion process. Details on landmarking for deltoid injections were only found in one Immunization Guideline (Australian, 2019). Nineteen research studies, including 13 anatomical studies, were retrieved. Over half the anatomical studies were published in the 2020s with location of anatomical structures determined by ultrasound, cadaver, MRI or CT scanning, and anthropometric measurements. Notable differences were found among studies in location of anatomical structures and approaches recommended for landmarking (Charmode et al., 2022; Ravi et al., 2024).
Conclusion: Given that nurses and those they care for vary greatly in shape and size, appropriateness of landmarking using fixed metrics such as finger-widths or centimeters is questionable. Although medication administration may be a fundamental nursing skill, the need for discovery to inform our actions and prevent morbidity is required. Recommendations for deltoid landmarking will be shared.
Description
Deltoid intramuscular (IM) injections are a fundamental nursing procedure, however they can result in debilitation and long lasting physical and functional impairment if underlying anatomical structures are injured. This state-of-the-art review summarizes how landmarking for deltoid IM injections is described in nursing textbooks, immunization guidelines, and research studies and critically examines congruency between existing and emerging evidence. Recommendations for landmarking are shared.