Do you pinch the skin when giving an intramuscular injection? Here's the Correct Technique

September 21, 2025 •

5 min read

According to current healthcare best practices, you do not pinch the skin when giving an intramuscular injection, a common point of confusion for many administering medication outside of a professional setting. The correct technique is essential to ensure the medication is delivered safely and effectively into the muscle tissue.

Quick Summary

For an intramuscular (IM) injection, the skin is not pinched; instead, it is stretched taut or displaced using a technique like the Z-track method to ensure the medication is deposited directly into the muscle and to prevent leakage back into the subcutaneous layer. Pinching is reserved for subcutaneous injections, which target the fatty layer above the muscle.

Key Points

Do Not Pinch: Pinching the skin is incorrect for intramuscular (IM) injections and can cause the medication to be delivered into the fatty tissue, leading to improper absorption and potential irritation.
Stretch or Z-track: The correct technique for an IM injection is to stretch the skin taut or use the Z-track method, which displaces the skin to seal the injection site and prevent leakage.
Pinching is for Subcutaneous Injections: The action of pinching the skin is reserved for subcutaneous injections, which deliver medication into the fatty layer, not the muscle.
Use a 90-Degree Angle: IM injections are typically given at a 90-degree angle to ensure the needle reaches deep muscle tissue, unlike subcutaneous injections which use a shallower angle.
Avoid Massaging: After an IM injection, apply gentle pressure with gauze, but do not massage the site, as this can force medication back into the subcutaneous layer or cause bruising.

The Crucial Distinction Between IM and Subcutaneous Injections

One of the most fundamental differences in injection administration is whether to pinch or stretch the skin. This seemingly small detail is critical, as it determines which tissue layer the medication is delivered into. A subcutaneous (sub-q) injection is intended for the fatty tissue just below the skin. To reach this layer while avoiding the underlying muscle, a fold of skin is gently pinched and held throughout the injection. In contrast, an intramuscular (IM) injection is meant for the deep muscle tissue. Pinching the skin for an IM shot can actually push the muscle away, causing the medication to be delivered into the fatty layer instead, which can lead to improper absorption, pain, and tissue damage.

The Correct Intramuscular Injection Technique

The most appropriate method for an IM injection is to stretch the skin taut at the injection site. This action helps to flatten the tissue and stabilize the muscle, allowing for a smooth and quick needle insertion at a 90-degree angle. Holding the skin taut minimizes movement of the needle and helps to ensure the entire dose is administered directly into the muscle. The technique involves:

Preparation: Gather all necessary supplies, wash your hands thoroughly, and prepare the medication as instructed.
Locate the Site: Identify the appropriate IM injection site (deltoid, vastus lateralis, or ventrogluteal) based on the patient's age and weight, and the volume of medication.
Clean the Area: Clean the site with an alcohol swab, using a circular motion from the center outward, and let it air dry completely.
Stretch the Skin: Use your non-dominant hand to stretch the skin tightly over the muscle.
Inject: Hold the syringe like a dart and insert the needle quickly into the muscle at a 90-degree angle.
Administer Medication: Slowly push the plunger to inject the medication at a steady pace.
Withdraw: Pull the needle straight out at the same angle it was inserted.
Apply Pressure: Apply gentle pressure with gauze, but do not massage the area, as this can increase irritation.

The Z-Track Method Explained

The Z-track method is a specific IM injection technique used to prevent medication from leaking into the subcutaneous tissue, which can be irritating or stain the skin. This method is often recommended for medications that are known to cause tissue irritation.

Steps for the Z-Track Method:

Displace the Skin: With your non-dominant hand, pull the skin and subcutaneous tissue to one side, away from the injection site, creating a slight Z-shaped path.
Inject and Hold: Insert the needle at a 90-degree angle and inject the medication slowly, continuing to hold the skin taut.
Wait: After injecting, wait a few seconds before withdrawing the needle. This allows the medication to disperse into the muscle.
Withdraw and Release: Withdraw the needle and then release the skin. The displaced tissue will move back over the injection site, effectively sealing the needle track.

Comparison: Intramuscular vs. Subcutaneous Injection Techniques

To highlight the difference, here is a comparison table of the key administration techniques:


Feature	Intramuscular (IM) Injection	Subcutaneous (Sub-Q) Injection
Target Tissue	Deep muscle tissue	Fatty tissue layer
Skin Manipulation	Stretch skin taut or use Z-track method	Gently pinch a skin fold
Needle Angle	90-degree angle	45- to 90-degree angle (varies with patient)
Needle Length	Longer (typically 1–1.5 inches)	Shorter (typically 5/8 inch)
Purpose of Technique	Ensure medication reaches muscle; prevent leakage	Deliver medication to fat layer; avoid muscle
Typical Medications	Vaccines, certain antibiotics, hormones	Insulin, heparin, some vaccines

Common Intramuscular Injection Sites

Understanding the correct anatomical landmarks is critical for safe IM administration. The most common sites include:

Deltoid Muscle: Located in the upper arm, this site is suitable for small volumes (typically up to 1-2 ml) and is often used for vaccinations. The injection should be administered in the thickest part of the muscle, 2-3 fingerbreadths below the acromion process (the bony point of the shoulder).
Vastus Lateralis Muscle: Located on the outer side of the thigh, this is the preferred site for infants and young children, but is also used in adults. It is a large muscle, making it suitable for larger volumes of medication.
Ventrogluteal Muscle: Found on the hip, this is considered one of the safest sites for adults and children over seven months old, as it is free of major nerves and blood vessels. This site is often underutilized but is an excellent option for large volumes.

What Happens If You Pinch for an IM Injection?

Pinching the skin during an IM injection can have several negative consequences. The primary issue is that the medication may be injected into the subcutaneous tissue rather than the muscle. This can lead to:

Pain and Discomfort: The subcutaneous layer has more nerve endings, making a misplaced injection significantly more painful.
Ineffective Absorption: Medications designed for muscle absorption may be absorbed too slowly or too quickly from the fat, reducing their effectiveness.
Tissue Irritation and Damage: Some medications can cause local irritation, staining, or the formation of sterile abscesses if not delivered to the proper tissue depth.

Conclusion

To answer the question, do you pinch the skin when giving an intramuscular injection? the answer is a definitive no. Proper technique for IM injections involves stretching or displacing the skin, not pinching. This ensures the medication reaches the intended muscle tissue, leading to more effective absorption and minimizing pain and complications. Adhering to these evidence-based best practices, as outlined by authoritative sources like the Centers for Disease Control and Prevention (CDC), is vital for anyone administering injections. Always confirm the correct technique and site with a healthcare professional before administering any injection.

The Proper Intramuscular Injection Technique

Wash and dry your hands thoroughly.
Locate the correct injection site for the patient's age and weight.
Clean the site with an alcohol swab and allow it to dry fully.
Use your non-dominant hand to either stretch the skin taut or perform the Z-track maneuver.
Insert the needle at a 90-degree angle with a quick, firm motion.
Slowly inject the medication.
Remove the needle and apply gentle pressure with gauze.
Dispose of the used needle and syringe in a sharps container.

For more information on vaccine administration best practices, visit the CDC's official guidelines: Vaccine Administration - CDC.

Frequently Asked Questions

This is a common point of confusion because pinching is the correct technique for subcutaneous injections. In the past, or in less formal training, the two methods may have been conflated. It is a misconception that has been clarified with modern, evidence-based practices.

The Z-track method is a technique for IM injections that involves pulling the skin and subcutaneous tissue to the side before injecting. It is used to prevent irritating medications from leaking back into the fatty tissue, and it helps ensure the full dose remains in the muscle. This method is generally recommended for all IM injections but is essential for known irritants.

The key difference is the target tissue. An intramuscular (IM) injection delivers medication into deep muscle tissue, while a subcutaneous injection delivers it into the fatty layer just under the skin. The technique for each is different: IM requires stretching the skin, while subcutaneous requires pinching a skin fold.

Pinching for an IM injection can cause the medication to be delivered too shallowly, into the subcutaneous layer. This can lead to increased pain, poor absorption of the medication, or local tissue irritation. While not usually dangerous in an emergency, it is best to use the correct technique to ensure effectiveness.

No, you should not massage an IM injection site. This can force the medication to leak from the muscle into the subcutaneous tissue, causing pain and irritation. It can also cause bruising. After withdrawing the needle, simply apply gentle pressure with a gauze pad.

Needle size depends on the injection site, the patient's age and weight, and the type of medication. For adults, a 1 to 1.5-inch needle is common, while shorter needles may be used for younger or thinner patients. Always consult a healthcare provider or the CDC guidelines for specific recommendations.

For adults, the safest and most common sites are the ventrogluteal (hip) and deltoid (upper arm). For infants and children under three, the vastus lateralis (thigh) is the preferred site. It is crucial to use proper anatomical landmarks to avoid major nerves and blood vessels.