Intramuscular Injection Sites?

[Nurse Bethie]

We are having a bit of a debate at the school of nursing where I teach. We are having difficulty getting the students to properly landmark. Although a majority of the texts state that ventrogluteal is the preferred site, but we are wondering if you are using ventrogluteal exclusively in the clinical areas or is dorsogluteal an acceptable alternative. We as the instructors feel that dorsogluteal is a good site for new practitioner students who are nervous enough about an IM and need a littel larger "target" for their injections. Are we wrong? Is this a big no-no in the clinical area?

We would greatly appreciate any feedback, advise or literature/text resources to support one way or another.

Thank you!:)

[JennRN&Mom23]

I always use dorsogluteal, it is what I feel most comfortable with. That is the site that most of the people I work with also use.

[DG5]

I always use the dorso gluteal. I was taught to find the superior iliac crest, go 5 cm diagonally from there into the dorso gluteal muscle and thats the mark. Is that still ok?

[SweetOldWorld, BSN, RN]

6th edition of Potter and Perry's Fundamentals of Nursing states that the dorsogluteal site should not be used because of the danger of hitting the sciatic nerve. I know someone who suffered permanent damage from just this very thing from an injection he received in the ER. I rarely give IMs anymore anyway. Most of our meds are given IV.

[SEOBowhntr]

SweetOldWorld said:

6th edition of Potter and Perry's Fundamentals of Nursing states that the dorsogluteal site should not be used because of the danger of hitting the sciatic nerve. I know someone who suffered permanent damage from just this very thing from an injection he received in the ER. I rarely give IMs anymore anyway. Most of our meds are given IV.

For all of you who use the dorsal glut's, read the bold and read it again if you still desire to use the dorsal glut. The last thing you want to be involved in is a lawsuit over a person who's lost partial use of a leg because you used a site for an injection that is no longer reccommended!!!! I personally used the ventral glut or the Vastus Lateralis, and actually favor the vastus over the glut in most cases. Don't change your practice because of anything I or anyone else said, change it for your patients!!!

[TennNurse]

Wow, I am glad to have seen this thread. Perry & Potter are recommending no longer using dorsogluteal????? Good to know, as another poster pointed out about the potential for lawsuit. Personally I have looked at my P&P book about 6 times since graduating, but we all know how well the "But I didn't know" approach goes over should someone decide to point fingers at you for something.

Aside from that, after reading this post (and watching that awesome streaming video, that was way helpful, thanks!) I did use the VG on a pt who got 50 mg Phenergan IM, her usual dose for migraine-related nausea. Knowing how irritating that med is, I used the VG, and the pt immediately commented on how much more tolerable this injection was than any other she'd had.

So watch the streaming video, know the location of the VG, and go for it! Happy pts AND not going to court for nerve damage, how great is that?

[nursej22, MSN, RN]

I can't remember that last time I gavee an IM, might hveve been a flu shot to a co-worker a couple of years ago. Any way, when my oldest was born I received several dorsalgluteal injections.26 yers later I can still remember the pain that ran down the back of my right leg for several weeks afterwards.

[janetrette]

sometimes its whatever choice you have. like i gave an IM inj of haldol to a pt who was agitated into the vl. normally i would give an IM at vg. so it depends on the situation.

[ebyang]

hi everyone..im looking for theory on the "aaspiration during injection" will you help me find some theories or researches about the topic.. thanks a lot..

[elizabells, BSN, RN]

We were taught (four months ago - still in nrsg school) to avoid dorsogluteal unless there are no other options, such as an emaciated pt. Count me in among those with permanent sciatic damage from dorso injections. It sucks, it hurts, and I have a bit of a limp when it's bad, but I'm not going to go back and sue anyone over it. I believe Depo-Provera is still given dorso, as it's a large volume and I'm not so big.

[lifsavER67]

KRVRN said:

Dorsogluteal is the butt cheek and ventrogluteal is the hip area right???

Are you really an RN? If so you really, really need to pull out your books and review injection sites.

I see many nurses giving IM's intended for the DG way to low. The "butt cheek". No wonder there is damage to the sciatic nerve. If you give dorsogluteal injections in the appropriate area, there is no way you are going to hit the sciatic nerve. Also, until a child has been actively walking for at least 6 months the dorsogluteal is off limits. Vastus lateralis all the way!

I use deltoid for Tetorifice injections only for the most part, never anything irritating, and never over 1 ml.

At my school of nursing, no graduate gets out without being able to properly landmark EVERY injection site. During checkoffs, not being able to precisely describe AND demonstrate the appropriate site is grounds for failure. Repeats are allowed after further study and practice, but I have seen students have to repeat a semester because of this type of thing.

I usually approach nurses who I see not properly landmarking and review with them the appropriate sites. The ones that I have had to approach are NOT people who went to the same school I did. It's scary to me that people are not being properly prepared to function as a nurse.

[1BlessedRN]

mandana said:

At one of our clinical sites Dorsogluteal injections are no longer allowed due to the risk of sciatic nerve damage. Ventrogluteal is preferred at that specific location. At this facility, RN's are also not allowed to give dorsogluteal injections. I guess they had a specific issue.

We are only allowed to give IM shots to infants in the vastus lateralis.

All of our other clinical sites allow us to choose the area based on size of dosage, characteristics of med, size of person.

Amanda

I agree Amanda this is a biggie it is being mentioned in nursing schools and seminars d\t so many people filing legal lawsuits and winning d\t sciatic nerve damage...

[kadokin, ASN, RN]

lifsavER67 said:

Are you really an RN? If so you really, really need to pull out your books and review injection sites.

I see many nurses giving IM's intended for the DG way to low. The "butt cheek". No wonder there is damage to the sciatic nerve. If you give dorsogluteal injections in the appropriate area, there is no way you are going to hit the sciatic nerve. Also, until a child has been actively walking for at least 6 months the dorsogluteal is off limits. Vastus lateralis all the way!

I use deltoid for Tetorifice injections only for the most part, never anything irritating, and never over 1 ml.

At my school of nursing, no graduate gets out without being able to properly landmark EVERY injection site. During checkoffs, not being able to precisely describe AND demonstrate the appropriate site is grounds for failure. Repeats are allowed after further study and practice, but I have seen students have to repeat a semester because of this type of thing.

I usually approach nurses who I see not properly landmarking and review with them the appropriate sites. The ones that I have had to approach are NOT people who went to the same school I did. It's scary to me that people are not being properly prepared to function as a nurse.

Hellloo! Used vg once in nursing school and my instructor was quite impressed that I chose that site. However, have not seen it used by anyone since and have been a little reluctant to use it since b/c of that and the fact that I have to give IM's FAST (psych unit). Scared me to death one time when I saw a new RN try to give an injection in the upper inner quadrant of someone's glut area. Myself and a colleague stopped her before she got too far, but she went on to become a charge RN and DR's wife/medical assisstant. Scary how far mere charm can take one in the nursing profession!