Charmode Sundip, Sharma Shelja, Kushwaha Sudhir Shyam, Mehra Simmi, Sangma Sarah S, Mishra Vivek
Anatomy, All India Institute of Medical Sciences, Rajkot, IND.
Anatomy, All India Institute of Medical Sciences, Gorakhpur, IND.
Cureus. 2022 Apr 15;14(4):e24172. doi: 10.7759/cureus.24172. eCollection 2022 Apr.
The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. 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. 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. The review protocol was submitted with PROSPERO (ID: 319251). 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. 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. The proposed sites and landmark data were tabulated, and each site was analyzed based on the underlying neurovascular structures. Data were depicted by self-generated images. The initial search identified 174 articles. After applying the inclusion and exclusion criteria, 57 articles were shortlisted. 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. 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. Twelve deltoid IMI sites and techniques were identified. 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). Limitations included the unavailability of free access to complete text in many articles resulting in exclusion. 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. To avoid injury, a safer site is proposed of 5 fingerbreadths/10 cm below the midpoint of the lateral border of the acromion. The authors received no specific funding for this study except for the journal publication charges.
由于三角肌便于进行药物和疫苗注射，因此它是肌内注射（IMI）的首选部位。政府免疫咨询机构、标准解剖学教科书以及研究人员提出了各种注射技术和部位，但对于在日益常用的三角肌部位进行肌内注射，缺乏具体的指导方针。本研究分析了与三角肌下方神经血管网络相关的三角肌肌内注射程序，并提出了一个受伤几率最小的首选部位。该综述方案已提交给国际前瞻性系统评价注册库（ID：319251）。从1950年到2022年，在PubMed、谷歌学术以及国家公共卫生机构网站上，使用医学主题词（MeSH）进行检索，搜索词包括肌内注射、三角肌、安全注射部位等，以确定关于三角肌肌内注射更安全部位和技术的建议。在整个研究过程中，所有作者都严格遵循一个完善的注册综述方案，并遵循系统评价中的偏倚风险（ROBIS）指导工具。将提出的部位和标志性数据制成表格，并根据其下方的神经血管结构对每个部位进行分析。数据通过自行绘制的图像呈现。初步检索共识别出174篇文章。应用纳入和排除标准后，筛选出57篇文章。在选定的39篇文章中，18篇关注三角肌肌内注射的实施，7篇关注三角肌附近神经血管结构的变异。其余14篇文章是印度政府和国外国家公共卫生机构发布的免疫指南，其数据用于比较。确定了12种三角肌肌内注射部位和技术。肩峰中点下方1 - 3指宽/5厘米处（7项研究）；三角肌中点部位/三角肌最厚部分（1项研究）；三角肌中三分之一处的一个部位（1项研究）；三角形注射部位（1项研究）。局限性包括许多文章无法免费获取全文，导致这些文章被排除。由于存在许多异常动脉模式，肩关节周围直至结节间沟较低水平的区域血管高度丰富。为避免受伤，建议在肩峰外侧缘中点下方5指宽/10厘米处选择一个更安全的部位。除了期刊发表费用外，作者未获得本研究的任何特定资金。
