Injection routes, sites and angles
Three routes, three angles, three needle specifications — and the CCMA builds most of its items by giving you one of the nine and asking for another. The reliable way through is to memorize each route as a complete package rather than as an angle on its own.
| Intradermal | 10 to 15 degrees, bevel up, into the dermis — used for TB skin testing and allergy testing |
| Subcutaneous | 45 degrees into a pinched fold, 5/8-inch needle, 23 to 25 gauge (CDC) |
| Intramuscular | 90 degrees, 1-inch needle, about 22 gauge — the pairing that makes a 22-gauge 1-inch at 90 degrees an IM description rather than a SubQ one |
| Deltoid landmark | Find the acromion process, the bony point at the end of the shoulder, and inject approximately 2 inches below it and above the axilla (CDC adult IM job aid) |
| Preferred adult IM site when the deltoid is unsuitable | Ventrogluteal, not dorsogluteal — the dorsogluteal risks the sciatic nerve |
| Infants and toddlers under 3 | Vastus lateralis, not the deltoid |
| The six rights | Right patient, drug, dose, route, time and documentation — and the charting happens immediately AFTER administration, never before |
| Never abbreviate the dose unit | 'Units' is spelled out. U and IU are on The Joint Commission Do Not Use list because U reads as a zero, a four or 'cc', turning 10 units into 100 |
| One needle, one syringe, one entry | CDC safe injection practices require a new sterile needle AND a new sterile syringe for each patient and for each entry into a vial |
| Recapping | 29 CFR 1910.1030 forbids bending, recapping or removing contaminated needles unless no alternative is feasible, and then only by a one-handed technique or a mechanical device |
| Injecting a patient who refused | That is battery — intentional offensive contact without consent. A competent adult may refuse any treatment |
Where the point is lost: If an item gives you a gauge and a length, it has already told you the route. 25 gauge and 5/8 inch is subcutaneous; 22 gauge and 1 inch is intramuscular. You rarely need the angle to answer.
Injection routes, sites and angles
12 questions on injection angles gauge medical assistant CCMA, each with an explanation and statute citation.
12 questions
Pass line: 78%, same as the real exam
Other topics
- Autoclave monitoring: proving a load was sterile
- Correcting an error in the medical record
- HIPAA disclosures and minimum necessary
- Informed vs implied consent, and who obtains it
- Medical vs surgical asepsis and Spaulding
- Order of draw and tube additives
- OSHA Bloodborne Pathogens Standard duties
- PPE donning and doffing: the CDC order
- Medical assistant scope of practice
- Sharps, regulated waste and the red bag
- Standard vs transmission-based precautions
- Vital sign normal ranges and technique errors
- Blood pressure categories and measurement errors
- Venipuncture vein selection and what to avoid
- Vaccine cold chain and storage
- Specimen labeling and patient identification