IM injection on underweight pt

Where's the best place to give an IM injection on a very underweight patient?

I work in Home Health and often give B-12 injections. Next week have to give one to a man that's 6'1" and weighs about 125, and I dread it.

Best injection site to use?
I usually would use a tuberculin syringe and put it in their deltoid or buttocks.

I would do either ventral glutteal or vastus lateralis with a shorter needle

In school we're taught vastus lateralis for underweight patients.

I would do the deltoid.

Just use a smaller needle.

With the deltoid, remember that on smaller people you bunch up the muscle by pinching it, rather than pulling to the side to thin out the layer of subcutaneous tissue. While you really can't Z-track using this alternative technique, you're at least sure to be hitting muscle.Also, the few times I've hit bone with these patients, they really didn't notice - it was freakier for me than it was them. People are wired to notice their skin breaking, not needle pokes to their periosteum.

Periosteum can be very sensitive-- bark your shin on the coffee table and tell me that doesn't hurt much. Best ways to check for pain in decreased level of consciousness are all periosteal-- sternal rub, supraorbital pressure, or my favorite because it doesn't look so nasty in front of patient families, the fingers. You put your (closed) scissors or other flat metal piece like the long parts of a Kelly clamp between the pt's first two fingers, hold the fingers snugly over the metal, and rotate the metal so it impacts the inside of the fingers. Try it on yourself. That's periosteum.

That's all blunt, not point like a needlestick.

Quote from TheSquireWith the deltoid, remember that on smaller people you bunch up the muscle by pinching it, rather than pulling to the side to thin out the layer of subcutaneous tissue. While you really can't Z-track using this alternative technique, you're at least sure to be hitting muscle.Also, the few times I've hit bone with these patients, they really didn't notice - it was freakier for me than it was them. People are wired to notice their skin breaking, not needle pokes to their periosteum.