The authors and the methods of the investigations were not hidden from the reviewers.
#Im injection sites full#
All of the shortlisted full publications were downloaded and independently examined for relevant data using the data extraction checklist prepared by both authors. Study selectionĪfter applying inclusion and exclusion criteria, two authors (SC and SS) independently assessed all of the titles, abstracts, articles, and guidelines found during the initial search, and relevant publications were shortlisted. Search strategyĪ scoping review was conducted of articles published from 1950 to 2022 on PubMed, Google Scholar, and National Immunization Guidelines using these Medical Subject Headings (MeSH) terms: IMIs, deltoid muscle, safe site for injection, axillary nerve, needle depth, nursing practice, post-injection complications, posterior circumflex humeral artery, and anterior circumflex humeral artery. The citation search was carried out for all the selected articles in the study. There was a restriction for the non-English language of publications. Excluded articles were published before January 1, 1950, and after January 31, 2022, those focusing on topics other than deltoid IMIs, and those accessible through abstracts only. Inclusion criteria were complete articles published between January 1, 1950, and January 31, 2022, authorship by both foreign and Indian authors, immunization guidelines and advisories issued by national public health agencies, and all articles related to deltoid IMIs. The articles which satisfied the inclusion and exclusion criteria were eligible for review.
The review protocol can be accessed from. To reduce the risk of bias in the study, a systematic review protocol was prepared and submitted with PROSPERO at the Centre for Reviews and Dissemination, University of York (ID: 319251). The authors received no specific funding for this study except for the journal publication charges. To avoid injury, a safer site is proposed of 5 fingerbreadths/10 cm below the midpoint of the lateral border of the acromion. The area around the shoulder joint and up to the lower level of the intertubercular sulcus is highly vascularized by the presence of many anomalous arterial patterns.
#Im injection sites free#
Limitations included the unavailability of free access to complete text in many articles resulting in exclusion. A site 1-3 fingerbreadths/5 cm below the mid-acromion point (7 studies) mid-deltoid site/densest part of the deltoid (1 study) a site at the middle third of the deltoid muscle (1 study) triangular injection site (1 study). Twelve deltoid IMI sites and techniques were identified. The remaining 14 articles were the immunization guides issued by the National Public Health Agencies of the Government of India and abroad, whose data was used for comparison. Out of the 39 selected articles, 18 focused on the administration of deltoid IMIs, whereas seven focused on the variations in the underlying neurovascular structures in proximity to the deltoid muscle.
After applying the inclusion and exclusion criteria, 57 articles were shortlisted. The initial search identified 174 articles. Data were depicted by self-generated images. The proposed sites and landmark data were tabulated, and each site was analyzed based on the underlying neurovascular structures. All the authors strictly adhered to a well-developed registered review protocol throughout the study and followed the risk of bias in systematic reviews (ROBIS) guidance tool. PubMed, Google Scholar, and Websites of National Public Health Agencies were searched from 1950 up to 2022 for articles, advisories, and National Immunization Guidelines using Medical Subject Headings (MeSH) terms, including IMIs, deltoid muscle, safe injection sites, to identify recommendations for safer sites and techniques of administering deltoid IMIs. The review protocol was submitted with PROSPERO (ID: 319251). This study analyzes the procedures of administering IMIs in the deltoid related to the neurovascular network underlying the muscle and proposes a preferred site with the least chance of injury. Government immunization advisories, standard anatomy textbooks, and researchers have proposed various injection techniques and sites, but specific guidelines are lacking for the administration of IMIs in the increasingly used deltoid site. The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration.