Injection in buttocks: 1" vs. 1 1/2" needle

Nurses General Nursing

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I am a new graduate who has yet a lot to learn but I am a bit confused :confused:about giving injections in the buttocks. One of the nurses who trained me told me to use a 1 inch needle when you give Depo-Provera, Phenergan, Kenalog and B12 injections. The only time I use the 1 and 1/2 inch needle is when I give Depo-Testosterone and Rocephin.

Last week I had to give a Phenergan injection to a dehydrated patient who came into our clinic for an office visit (I work in Family Practice). I started her IV and once she was settled I gave her anti-nausea medication in her bottom using a 1" needle. Another nurse (20 year veteran) who was working with me told I should have used a 1 and half inch needle instead of a one inch needle. Then yet another nurse (30+) told me I should have given injection in the arm with 1 inch. Who is right? Please help!

Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.
azilliRN said:
I was told as well in school that injections were not administerd directly into the gluteal muscles. However, in an outpatient clinic we give injections in the U.O.Q (Upper outer quadrant) of the glut.

To administer an IM injection in the gluteus medius muscle, locate the posterior superior iliac crest and the greater trochanter of the femur. Draw an imaginery line connecting the two. The injection is given above this line, i.e., upper outer quadrant of the gluteus medius muscle. :twocents:

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I am a new grad myself and have been working in an LTAC for 2 months. The length of the needle as some of the replies have made clear depends on the client(patient); more cushion will most likely require a longer needle.

As far as giving an IM in the gluteal site, evidence based practice, according to my Nursing Textbook (Potter and Perry) and my last year of Nursing school, shows that you risk damaging the sciatic nerve. You should give the injection ventro-gluteal (you can look that up online), which is a pocket of muscle (gluteus medius) in the hip. To find the landmark you put your palm of the hand on the client's greater trochanter, fan your hand with your thumb pointing toward the client's groin, and the spot is in the triangle made right near (or above) where your middle finger and index finger meet. Click the following link and scroll down and you can actually see a picture at this forum: http://forum.mesomorphosis.com/steroid-forum/ventrogluteal-the-sweet-spot-134274390.html

Hope this helps.

The first time I gave it here it made me nervous. After the first two, it was a piece of cake, and I liked giving it there. Your client only has to turn a bit on the side. Plus, I don't recall anyone saying it hurt. Most of them said "have you gave it already" and I've alread put the safety on the needle.

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Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.
LouisVRN said:
We were told in school NEVER to give gluteal injections, that it wasn't evidence based practice. The only injection I give at work is flu shots/pneumonia shots and one of our docs who always orders IM demerol. I almost always use the deltoid.

What IS the rationale for NOT using the gluteus medius muscle? Having received Demerol (in years gone by) in the deltoid as well as the gluteus medius muscle, I would never again allow anyone to give me IM Demerol in the deltoid muscle. It hurt "like holy hell!" :redlight:

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Specializes in Ante-Intra-Postpartum, Post Gyne.

We were taught not to inject in the glut muscle because of the risk of hitting the sciatic.

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Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.
HeartsOpenWide said:
We were taught not to inject in the glut muscle because of the risk of hitting the sciatic.

Believe it or not, that has been taught in nursing schools from time immemorial. It is not a new concept. Giving an injection is all about knowing anatomy. I have been a nurse for 31 years, and until giving narcotics/Abs, etc.. IV came into being, the gluteus medius muscle was the preferred site for IM injections. Nursing education in the '70s.....

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scoochy said:
What IS the rationale for NOT using the gluteus medius muscle? Having received Demerol (in years gone by) in the deltoid as well as the gluteus medius muscle, I would never again allow anyone to give me IM Demerol in the deltoid muscle. It hurt "like holy hell!" :redlight:

The risk of hitting the sciatic, it is painful, undignified, and unnecessary.

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scoochy said:
Believe it or not, that has been taught in nursing schools from time immemorial. It is not a new concept. Giving an injection is all about knowing anatomy. I have been a nurse for 31 years, and until giving narcotics/Abs, etc.. IV came into being, the gluteus medius muscle was the preferred site for IM injections. Nursing education in the '70s.....

I bet in the 70's they taught that widespread gloving was unnecessary too. Nurses who practiced in the 60's and 70'stell me stories of when they used to smoke at the Nurses station... Used to be acceptable to infuse Vanco peripherally too. Poor outcomes and research have changed Nursing practice over the years.

What was acceptable in the past is not always what is acceptable now, the curse and benefit of evidenced based practice.

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Specializes in critical care, home health.

I'm sure everyone here remembers her/his first IM injection on a real person. Mine was on a horribly cachexic man who'd waited until he was near death to go to the doctor and find out he had cancer. He was skinny, just skin and bones. I had to give him his preop dose of Demerol/Phenergan. My instructor was in the room with me. I looked at that 1 1/2 inch needle and said, "this needle is too long for him". She rolled her eyes and yelled (really yelled at me), "just give it!"

So I did, flawlessly demonstrating the IM injection technique I'd been taught. I hit the bone. It was horrible, just horrible.

When I saw the patient again the next day, he couldn't stop remarking on how the pain from his preop shot was much worse than the pain from his total colectomy. Fortunately he did not remember that I was the one who gave him that shot, but I've felt awful about it for the past 14 years.

The size of the needle should correspond to the size of your patient, and that is a nursing judgement. Lesson learned.

On another note, I miss the days when we gave phenergan freely. It is a great drug, keeping in mind of course the dangers and side effects it can cause. We can still give it PO (which isn't helpful when your patient is too nauseated to keep anything down) or rectally. Phenergan can save the day and I think it's a pity we can't have it anymore.

When I was in nursing school, Zofran was brand spanking new and incredibly expensive. Now we use it like saline, but it doesn't have the "good" side effects of phenergan.

This is not meant to discount the horrible outcomes that others have described here. I'm sure it's better to essentially ban phenergan than to risk those disasters.

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