Glutathione

Aims

The course aims to ensure you; the student understands the basics of health and safety and anatomy and physiology of the treatment. This manual covers the treatment background, benefits, consultation and contra-indications, contra-actions, aftercare and equipment and products required to perform the treatment. The practical techniques will be covered on the practical session to ensure competency in the procedure.

Objectives

At the end of the course, you will be able to perform a treatment in a professional, safe and hygienic manner in a commercially acceptable time, along with experience in carrying out a thorough consultation with the knowledge of the background, benefits, consultation, contra- indications, contra-actions, aftercare, equipment and the products needed.

Employers must comply with legal requirements, including displaying health and safety information and providing training. It is advised to obtain relevant documents from the local council. Legislation includes the Health and Safety at Work Act 1974, Trade Descriptions Act 2011, Data Protection Act 2018, and others.

Businesses must adhere to health and safety acts monitored by The Health & Safety Executive. Acts such as the Trade Descriptions Act 2011, Data Protection Act 2018, and Sale of Goods Act 2015 protect clients' rights. Control of Substances Hazardous to Health (COSHH) regulations requires assessments and proper handling of hazardous substances.

Local Government (Miscellaneous Provisions) Act 1999 involves registering businesses with invasive treatments. The Management of Health & Safety at Work Regulations 1999 outlines responsibilities. Workplace Regulations 1992 cover various aspects, including hygiene and welfare. Manual Handling Regulations 1999 addresses proper lifting practices.

Regulations like the Personal Protective Equipment at Work Regulations 2022 and Health & Safety (Display Screen Equipment) Regulations 1992 focus on safety equipment and computer use. Electricity at Work Regulations 1992 governs electrical equipment usage, and First Aid Regulations 2018 mandate first aid availability.

Reporting procedures for accidents are outlined in RIDDOR 2013. Fire safety is covered by the Regulatory Reform (Fire Safety) Order 2005, including training and equipment checks. Consumer Protection Act 2015 protects clients from unsafe products. The Provision and Use of Work Equipment Regulations 1998 address equipment use.

Cosmetic Products (Safety) Regulations 2008 ensure safe use of cosmetics. Disability Discrimination Act 1996 prohibits discrimination based on disability, requiring accessible

premises. Businesses must adhere to these regulations for legal compliance, client safety, and overall well-being.

Equality Act 2010:

• Grants disabled people rights for access to services.
• Service providers must make reasonable adjustments based on practicality and available resources.

Accident Reporting:

• Accidents and near misses must be recorded in an Accident Report Book.
• Information includes names, circumstances, date, time, contributing factors, injury details, and witnesses.

Personal Protective Equipment at Work Regulations 1992:

• Covers COSHH regulations.
• Mandates wearing or providing protective clothing or equipment when handling chemicals or bodily fluids.

Salon Hygiene, Health & Safety:

• Daily salon cleaning and client area cleanliness.
• Use fresh, laundered towels and follow proper product handling.
• Sterilise non-disposable tools and maintain fire exits.

Therapist Appearance:

Maintain a professional appearance with clean uniform, shoes, nails, breath, and minimal jewellery.

• Adhere to grooming standards for a positive client experience.

Professional Ethics and Standards of Practice:

• Uphold high professional conduct, courtesy, and respect.
• Maintain confidentiality, avoid gossip, and refrain from controversial conversations.
• Provide special treatment for each client, explain procedures, and respect diversity.

Precautions Taken in the Salon:

• Handwashing before and after each client.
• Disinfect surfaces regularly.
• Proper wound treatment, disposal of sharp instruments, and sterilisation of metal tools.
• Skin preparation precautions, including handling cuts and using protective dressings.
• Proper disposal of items that come into contact with blood.
• Surgical mask usage during colds/flu and general hygiene practices.

These guidelines ensure compliance with legal and safety standards, creating a secure and professional environment for both therapists and clients.

Waste Bins, Gloves, and Instruments:

Bins with liners, lids, and regular emptying.

Surgical gloves for procedures breaking the skin or involving blood.

Instruments must be cleaned, sanitised, sterilised, or disposed of appropriately.

Sterilisation Methods:

Autoclave:

• Functions like a pressure cooker, using moist heat.
• Operates at 121°C, effective for sterilisation.
• Types include dry heat autoclave, vacuum autoclave, and flash instrument autoclave.

Advantages: Economical, non-toxic, easy to operate.

Disadvantages: Blunting of sharp instruments, potential for rust, expense, and maintenance.

Glass Bead Steriliser:

• Operates at approximately 300°C, sterilising metal instruments quickly.
• Requires warming up before sterilisation.
• Follows manufacturers' instructions and local regulations.

Wet Sterilisation (Chemical):

• Involves washing surfaces with antiseptic solutions.
• Effective for maintaining asepsis.

UV Cabinet:

• Used for storage and sanitation, not sterilisation.
• Maintains cleanliness of items.
• Antiseptics and Disinfectants:
• Antiseptics are safe for skin application, slowing microorganism growth.
• Disinfectants destroy or kill microorganisms, suitable for surfaces but toxic for skin.

Examples include soaps, alcohol (antiseptic), Quaternary Ammonium compound (disinfectant).

Ergonomics:

Emphasises the importance of posture during treatments.

Recommends height-adjustable furniture to reduce bending.

Advises against neck twisting and encourages stretching to prevent strain injuries.

Storage:

Highlights the need for training on product and equipment use.

Stresses the importance of accessible training materials.

Recommends proper storage, labelling, and risk assessment for products.

Suggests maintaining flammable products in a safe environment for mobile therapists.

Insurance:

Essential insurances include Professional Indemnity, Public Liability, Employer’s Liability, Product Liability, and Car Insurance.

Each insurance type serves a specific purpose related to business activities.

Aesthetics Health & Safety:

Enforceable guidelines for advertising Prescription-Only-Medication.

Prohibits advertising such medications to the public.

Discusses administration of prescribed products, remote prescribing ban, and storage.

Storage of Medicines:

Dedicated medical fridges are necessary for storing products with specific temperature requirements.

Importance of accurate temperature control and monitoring.

Security features include locking options.

Proper storage practices for optimal performance.

Practitioners should adhere to proper sterilisation methods, hygiene practices, and storage guidelines to maintain a safe and effective aesthetic practice.

Temperature Monitoring for Medical Fridges:

Immediate intervention required if temperature falls outside the safe range.

Considerations for choosing the right medical fridge include space, storage needs, budget, and door type.

Disposal of Medicines:

Clinics must have a policy for safe disposal of surplus or expired medicines.

Disposal reasons include treatment changes, expiry, or reaching 'use by' dates.

Unwanted medicines should not be administered, and proper records must be kept.

Providing Consultations for Aesthetic Procedures:

Emphasises the importance of a full consultation before any procedure.

Clients must be informed about prescription requirements, cosmetic nature of treatments, associated risks, and maintenance needs.

Detailed record-keeping, including client information, prescription details, and before/after images, is essential.

Working with Sharps:

Highlights the Health and Safety Regulations for handling sharps.

Employers must assess and minimise risks, provide training, and have protocols for injury incidents.

Work practice controls include no needle recapping and safe sharps disposal.

Storage of Medicines and Waste Management:

Dedicated medical fridges are necessary for temperature-sensitive products.

Waste management must comply with the Environmental Protection Act 1990.

Hazardous healthcare waste, including clinical waste, requires proper disposal contracts.

Bloodborne Pathogens:

Explains bloodborne pathogens like HIV, Hepatitis B, and Hepatitis C.

Employers must implement exposure control plans, provide protective measures, and offer vaccinations.

Proper procedures for dealing with blood spills using chlorine bleach are detailed.

Anaphylaxis:

Discusses causes, symptoms, and critical symptoms of anaphylaxis.

Urges immediate use of adrenaline auto-injector for critical symptoms.

Antihistamines and steroids are secondary treatments, and clients at risk should be informed.

Managing Complications:

Aesthetics professionals should undergo complications training regularly.

Understanding potential issues from aesthetic procedures is crucial for confident client treatment.

Summary:

The text discusses the importance of glutathione, a powerful antioxidant, in protecting the body against diseases, promoting healing, fighting toxins, and slowing down the aging process. It emphasises glutathione's role in defending against free radicals, detoxifying the body, and supporting various bodily functions.

Invasive Procedures and Emergency Plan:

Invasive salon procedures carry more risk than other treatments.

Regulated independent prescribers are responsible for emergency plans.

Emergency plan includes onsite response, healthcare referral, and access to emergency kit.

Clients should report issues, and prescribers arrange care plans.

Glutathione Overview:

Glutathione is a potent antioxidant and a crucial molecule for various bodily functions.

It protects against free radicals, aids in toxin removal, and is vital for overall health.

Glutathione's ability to rebuild itself and other antioxidants makes it a key player in health.

Declining glutathione levels with age and external stressors can lead to vulnerability to diseases.

Glutathione and Longevity:

Centenarians have higher levels of glutathione reductase, linking it to long-term survival.

Glutathione's role in longevity has been known to the scientific community since 1998.

Glutathione Supplementation:

Challenges in creating efficient glutathione supplements due to its size and instability.

IV or IM injections of glutathione are safe and effective for short-term treatment.

Lack of information on naturally boosting glutathione levels.

Free Radicals and Antioxidants:

Explanation of how free radicals, generated in the body, can cause oxidative damage.

Antioxidants, including glutathione, neutralise free radicals and prevent oxidative stress.

Glutathione's role in recycling other antioxidants and maintaining balance in the body.

Oxidative Stress:

Oxidative stress results from an imbalance between free radicals and antioxidants.

Oxidative stress can damage lipids, proteins, and DNA, contributing to various diseases.

Body Detoxification:

Glutathione plays a key role in the body's detoxification process, especially in the liver.

Collaboration with other antioxidants like vitamins C, E, A, lipoic acid, and CoQ10.

Glutathione Reserves and Aging:

Glutathione levels decline with age, while the body's demand for it increases.

Factors like medication, processed foods, and alcohol consumption affect glutathione demand.

Inflammation:

Inflammation is a normal immune response to injury, but chronic inflammation can lead to various health issues.

Chronic inflammation may result from the body's inability to eliminate harmful substances or regulate the immune response.

Leaky Gut Syndrome:

Leaky gut syndrome, or increased intestinal permeability, while not classified as an autoimmune disease, is associated with autoimmune conditions. This condition involves the small intestine's lining becoming permeable, allowing undigested particles to enter the bloodstream, triggering inflammation, pain, and contributing to autoimmune diseases. Low glutathione levels increase susceptibility to leaky gut, emphasising the importance of supporting GSH levels for prevention and management.

Role of Low Glutathione and Obesity:

Declining glutathione production with age may contribute to weight gain, as GSH is crucial for mitochondrial fat burning. A 2013 Baylor University study revealed that inhibiting glutathione synthesis in mice reduced fat burning, emphasising GSH's role in metabolism. In elderly participants, boosting glutathione levels through supplementation enhanced fat burning and reduced diabetes risk factors, showcasing the potential benefits of maintaining optimal GSH levels for weight management.

Glutathione and Liver Disease:

The liver, a vital detoxification organ, faces challenges from viral infections, drug/alcohol abuse, and inherited diseases. Hepatitis, an inflammatory liver condition, can lead to severe consequences if untreated. Glutathione plays a significant role in mitigating liver damage, as demonstrated by studies in China where glutathione reduced inflammation and improved liver function in hepatitis B patients. Low GSH levels are also linked to non-alcoholic fatty liver disease (NAFLD), and glutathione supplementation shows promise in modifying factors contributing to NAFLD progression.

Macular Degeneration and Cataracts:

Glutathione's antioxidant properties are crucial in protecting the eyes from macular degeneration, where the retina degenerates, leading to vision loss. Age-related conditions like cataracts, caused by oxidative stress, can also benefit from glutathione. Studies suggest that glutathione-boosting compounds and foods may prevent and alleviate these eye disorders.

Slowing Down the Aging Process:

Oxidative stress and inflammation contribute to aging, and glutathione, as a potent antioxidant, helps combat these factors. While aging is influenced by various factors, maintaining optimal glutathione levels may contribute to graceful aging. Glutathione's role in telomere function further connects it to aging, with studies indicating that healthy lifestyle behaviours, including glutathione support, impact telomere length.

Rejuvenating Skin:

Extrinsic and intrinsic aging impact the skin, causing wrinkles, sagging, and reduced cell turnover. Glutathione protects against UV damage, inhibits tyrosinase activity, and contributes to collagen synthesis, making it valuable in skincare. Glutathione-based products, when effectively formulated, show promise in improving skin elasticity, reducing wrinkles, and lightening age spots.

Sunburn, Bruising, and Scars:

Glutathione aids in healing sunburns, bruises, and scars by neutralising free radicals produced during skin damage. It accelerates the healing process, making it beneficial in cosmetic treatments, laser burns, and post-surgical care.

Skin Diseases:

Low glutathione levels are associated with various skin diseases, including psoriasis. GSH's detoxifying role and its impact on immune cells suggest that supplementation or topical application may alleviate symptoms of skin diseases.

In conclusion, maintaining optimal glutathione levels proves essential for overall health, addressing various conditions, and supporting the body's defence against oxidative stress and inflammation.

Acne:

Acne is a skin condition encompassing blackheads, whiteheads, and pimples, resulting from blocked pores filled with a combination of sebum and dead skin cells. Inflammation, often due to bacterial involvement, leads to the formation of pus-filled bumps. Immune system response generates free radicals, exacerbating inflammation. In papulopustular acne, studies suggest a potential deficiency in the antioxidant defence system, particularly glutathione. Lower glutathione levels have been associated with various types of acne.

Reducing Toxin Exposure

Living with toxins in our system is a reality, as environmental pollutants surround us. Despite the body's natural detoxification abilities, widespread exposure to pollutants poses challenges. Researchers estimate exposure to 129 pollutants on a daily basis. Common sources include household items, personal care products, and environmental factors. Glutathione levels play a crucial role in detoxification, emphasising the importance of maintaining optimal levels.

Chemicals Are Everywhere

Over 80,000 hazardous chemicals are in use, present in everyday items such as furniture, cleaning products, cosmetics, and clothing. Eight common pollutants, including Bisphenol-A and Phthalates, can be harmful, affecting hormones and increasing cancer risks. Being an informed consumer, avoiding specific products, and increasing natural glutathione levels become essential strategies to combat toxin exposure.

Heavy Metals

Heavy metals like arsenic, cadmium, and mercury are omnipresent and non-biodegradable. Industrial activities contribute to their presence in air, water, and soil. Fish, fruit juices, plants, and medicines may contain heavy metals, posing health risks. These metals contribute to oxidative stress, requiring efficient detoxification mechanisms, including optimal glutathione levels.

Toxins Formed by the Body

Metabolic processes in the body produce waste materials, including toxic by-products. Biotransformation determines the creation of safe or harmful metabolites. Glutathione aids in transforming harmful substances into water-soluble molecules for elimination. Cruciferous vegetables support healthy biotransformation.

Medication

While medication is essential, some drugs may have inherent toxicity. Glutathione assists the body in metabolising medicines, reducing the risk of side effects. Maintaining adequate glutathione levels ensures optimal detoxification during medication use.

The Role of the Liver

The liver, a vital organ, serves as the body's primary filter, metabolising and eliminating toxins. Glutathione plays a central role in the liver's detoxification process, neutralising pollutants and facilitating their elimination. Understanding the liver's natural detoxification function emphasises the importance of maintaining glutathione levels.

Glutathione's Other Roles

Beyond liver detoxification, glutathione neutralises carcinogens in the intestines and colon. Depletion of glutathione in the colon is linked to colorectal cancer. Glutathione's multifaceted role highlights its significance in preventing diseases, including cancer.

Glutathione and Alcohol

Alcohol consumption produces toxic by-products, particularly acetaldehyde. Glutathione facilitates the conversion of acetaldehyde into acetate for elimination. Chronic alcohol consumption depletes lung glutathione levels, increasing susceptibility to respiratory infections. Boosting glutathione before alcohol consumption may mitigate hangover symptoms.

Exercise and Glutathione

Exercise induces oxidative stress, generating free radicals. While excessive oxidative stress can be harmful, moderate exercise promotes endogenous antioxidant production, including glutathione. Regular physical activity enhances glutathione synthesis, contributing to overall health and vitality.

Benefits of Increased Glutathione Levels

Elevated glutathione levels offer numerous benefits, including reduced joint inflammation, strengthened immune system, improved energy, enhanced mental clarity, and faster exercise recovery. Glutathione serves as an anti-allergenic, aids in conditions like Parkinson's and Alzheimer's, and contributes to skin health and wound healing.

How to Increase Glutathione Levels

Natural methods, such as a healthy diet rich in sulphur-containing foods, exercise, and avoiding toxin exposure, can enhance glutathione production. Supplementation may be necessary, especially with age, to maintain optimal glutathione levels and support the body's detoxification processes.

Various forms of glutathione

Glutathione has been the most researched supplements online for the past three years in a row, and there are over 800,000 searches on Amazon each month for different glutathione products. Clearly, many people are interested in trying this antioxidant. Not all delivery systems are created equal. The primary reason for this is because GSH is a large, unstable, and reactive molecule. Because it's supposed to seek out all of the nasty guys (free radicals) once it gets inside your body, it's naturally going to be unruly and aggressive. These features, on the other hand, have made producing a stable form of GSH that is readily absorbed by the body one of the greatest challenges in pharmaceutical research. Perhaps it's because there hasn't been a good therapeutic, user-friendly delivery system.

Glutathione is a type of antioxidant that helps the body's cells function properly and ward off damage. Even though it's absorbed, the IV drip, which typically includes a combination of other nutrients delivered via an intravenous line, is completely absorbable. The effects, on the other hand, only last from thirty minutes to three hours. Glutathione is in such high demand that our bodies rapidly consume it. As a result, while IVs' capacity to deliver glutathione directly into the circulation is hard to beat, it isn't an effective method to treat long-term problems. But if a severe condition or overindulgence necessitates an IV or IM treatment to enhance glutathione, it may be a good option.

Oral supplements: The disadvantage of using oral glutathione supplements is that after the active GSH enters the system, digestive enzymes in the stomach break down and absorb most of it. It's difficult to say how much glutathione is absorbed, however some experts believe that only around 15% of the dose reaches the bloodstream. Taking large dosages of oral

supplements is ineffective because you would have to take a huge number of milligrams in order for it to work.

Sublingual GSH drops: These oil-based drops are based on the notion that the glutathione will be absorbed via the mucous membranes and salivary glands in the mouth. There is little evidence of such absorption, so these drops may not be particularly effective.

The majority of topical glutathione skin treatments include liposomes to deliver the antioxidant directly to the epidermis. A liposome is a form of medicine or substance that is incorporated into a tiny spherical (or bubble) container that the oil (lipid) pathways of the skin transport it into the body. However, due to their sluggish and sticky nature, they are ineffective in delivering most molecules, especially glutathione. Remember, glutathione is a large and unpredictable molecule in its unaltered form, making it particularly difficult to transport. To date, there isn't a liposomal glutathione that is highly effective.

S-Acetyl Glutathione: a distinct type of glutathione, is available in tablet and topical forms. It is an acetylated form, altering glutathione's function in the body. Some believe it offers enhanced absorption and stability, with laboratory evidence suggesting improved intracellular glutathione levels and positive effects on oxidative stress biomarkers. It is a lab-made supplement, and research indicates structural changes may enhance its stability in the stomach, allowing higher absorption.

IV and IM glutathione, utilised for various purposes, has limited research but anecdotal usage for over twenty-five years. It addresses overall wellness, fatigue, chronic stress, poor nutrition, injury recovery, and disease treatment. IV nutritional support, including glutathione, has been standard since the 1970s. Conditions like Parkinson’s disease, heavy metal detoxification, high triglycerides, type 2 diabetes, viral infections, tuberculosis, and certain skin conditions respond positively to IV glutathione treatment.

Glutathione upper limits

The issue is not frequently getting too much glutathione, but rather receiving insufficient amounts. GSH is a natural metabolite produced by the body and our bodies know how to utilise it. As a result, although glutathione overload has not been extensively researched, it's improbable.

GSH has a limited quantity of use within a specific period of time. It's like pouring water into an already full glass. The water will simply overflow the sides rather than flowing into the glass. Similarly, if you overindulge in antioxidants by having back-to-back IV or IM treatments, some of that glutathione will go to waste.

Excess application of IV, IM and topical glutathione, on the other hand, is associated with few known harmful side effects. Outside of the occasional detox malaise or rashes - which are not uncommon and are due to the release of toxins, not GSH - glutathione is quite safe.

Client Consultation:

A client consultation is a one-to-one talk with your client. During this time, you will find out very important and confidential information that will allow you to advise and provide the best treatment for the client.

It is important to always introduce yourself to the client as this removes any barriers and relaxes them. Consultations should always be undertaken in a private room or area where you cannot be overheard by others.

A client should first fill out a client consultation which helps identify any contra-indications that may mean you have to alter the treatment or be unable to treat them at all. If their form shows no reason why they cannot proceed with the treatment, then you can move onto verbal questioning.

Verbal questions would be to establish why the client has visited the salon and what their expectations and outcome of the treatment may be. Asking what they want ensures you can provide customer satisfaction as the client should be pleased with the outcome of their treatment. It is good practice to speak to the client in front of a mirror and explain the treatment to them and see if that meets their requirements.

Once you have established what the client is after, then a physical examination should be undertaken. This allows you to further check for any undeclared contra-indications and get a better overview of any issues that you may face during the procedure.

Allow around 15 minutes for the client's first salon visit. Ideally, you should sit face to face or next to the client to create an open atmosphere. Avoid barriers such as a couch or table between you.

Use open questions to tactfully encourage the client to give you information that you may need rather than using interrogating questioning techniques. Use the consultation form to work from and record anything you may discuss.

Record Keeping:

• Records must be maintained and updated for a number of reasons.
• They provide contact details in case you need to alter or cancel an upcoming appointment.
• So that you can track client’s progression.
• To record the products used and timings so you can use these at further visits and adjust the treatment plan if required.
• Tracks any aftercare you provide the client.
• Records patch test history.
• As a backup in case, the client has an adverse reaction to treatment.
• For legal reasons if the client brings a claim against you.

Client records can be stored electronically or filed away manually and should be updated at every visit. If consultation forms are not updated and do not contain a history of services and dates, then you may find your insurance invalid.

Forms should be kept for the timeframe suggested by your insurance company. This may be for up to six years. If a client is under 21 at the time of service, then it is recommended to keep the forms for six years past their 21st birthday.

Client confidentiality must be protected at all times. Forms need to be locked away in a secure cabinet, and electronic records should be held on a password-protected computer. You may also need to register with the ICO as a data controller.

All information must be accurate and necessary for the service or treatment being performed.

Individual client records must be available for the clients to view if requested.

Data should not be passed on or sold without the client’s prior written permission.

• The following details should be recorded on the client consultation form:
• Personal details – name, address, contact details
• Results of any patch tests
• Contra-indications
• Contra-actions
• Reasons for the treatment
• Any reactions to treatments/previous treatments
• Home care advice/suggested retail items.
• Any sales
• Treatment timings/products used etc.
• Next appointment or recommendations

Special Warnings & Side Effects

Side effects:

Generally considered to be free of side effects. No untoward side effects nor interactions with oral administration reported even in prolonged use. It is SAFE. Classified as a food supplement not herbal. Made from genetically synthesised molecules. The only reported side- effect is SKIN WHITENING when taken in increased doses.

Toxicity: No toxicities have been reported or suspected as being associated with glutathione.

Drug and dosage

Tationil 600mg/4ml Powder and Saline for Solution (10)

• Always recommend a course of treatments to your clients to get maximum results.
• Administer one injection (IV or IM) every 3 days or twice weekly (1 box every month).
• Reconstitute the saline solution into the glutathione powder just before injecting (4ml injection)
• The reconstituted solution can be stored for up to 8 hours only
• Prescription only medication
• The first month of use only internal results are obtained as it inhibits extra melanin secretion in the first month, external results can be seen starting from the second month (second Box of Tationil) according to skin type and individual differences and commitment to the treatment
• Do not mix Tationil with any other vitamin or product in the same syringe.

Contraindications

• During some forms of chemotherapy and radiation where antioxidants are contraindicated due to their inhibition of the free radical formation which is an integral part of the therapeutic mechanism.
• Pregnancy or breastfeeding

INJECTION METHODS:

Intramuscular Injections

Intramuscular (IM) injections deposit medications into the muscle fascia, which has a rich blood supply, allowing medications to be absorbed faster through muscle fibres than they are through the subcutaneous route.

The IM site is used for medications that require a quick absorption rate but also a reasonably prolonged action. Due to their rich blood supply, IM injection sites can absorb larger volumes of solution. In addition, muscle tissue is less sensitive than subcutaneous tissue to irritating solutions and concentrated and viscous medications.

The deltoid site

The ease of access, especially in an outpatient setting, possibly adds to the frequency with which the deltoid site is used for IM injections. This site is used for immunisations/non-irritating medications; hence vaccines that are usually small in volume tend to be administered into the deltoid site. This is a relatively small area and muscle mass, especially in atrophied clients compounded by the close proximity of the radial nerve, brachial artery and bony processes to this site, means that more substantial injuries can occur.

• Find the knobbly top of the arm (acromion process)
• The top border of an inverted triangle is two finger widths down from the acromion process
• Stretch the skin and then bunch up the muscle
• Insert the needle at a right angle to the skin in the centre of the inverted triangle
• Caution: This is a small site – give only 1-2ml or less of fluid in this site