the risk of pain. Aspiration Aspirating for blood to rule out injecting into a blood vessel is not recommended by the US CDC, Public Health Agency of Canada, or Norway Institute of Public Health, as the injection sites do not contain large blood vessels and aspiration results in greater pain. There is no evidence that aspiration is useful to increase safety of intramuscular injections when injecting in a site other than the dorsogluteal site. However, aspiration is recommended by the Danish Health Authority for COVID-19 vaccines to reduce the potential rare risk of blot clotting and bleeding. Z-track method The Z-track method is a method of administrating an IM injection that prevents the medication being tracked through the subcutaneous tissue, sealing the medication in the muscle, and minimizing irritation from the medication. Using the Z-track technique, the skin is pulled laterally, away from the injection site, before the injection; then the medication is injected, the needle is withdrawn, and the skin is released. This method can be used if the overlying tissue can be displaced. Injection sites The deltoid muscle in the outer portion of the upper arm is used for injections of small volume, usually equal to or less than 2 ml. This includes most intramuscular vaccinations. It is not recommended to use the deltoid for repeated injections due to its small area, which makes it difficult to space out injections from each other. The deltoid site is located by locating the lower edge of the acromion process, and injecting in the area which forms an upside down triangle with its base at the acromion process and its midpoint in line with the armpit. An injection into the deltoid muscle is commonly administered using a 1-inch long needle, but may use a -inch long needle for younger people or very frail elderly people. The ventrogluteal site on the hip is used for injections which require a larger volume to be administered, greater than 1 ml, and for medications which are known to be irritating, viscous, or oily. It is also used to administer narcotic medications, antibiotics, sedatives and anti-emetics. The ventrogluteal site is located in a triangle formed by the anterior superior iliac spine and the iliac crest, and may be located using a hand as a guide. The ventrogluteal site is less painful for injection than other sites such as the deltoid site. The vastus lateralis site is