Intramuscular Injection Sites? - page 3

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... Read More

  1. by   SweetOldWorld
    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.
  2. by   SEOBowhntr
    Quote from SweetOldWorld
    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!!!
  3. by   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?
  4. by   nursej22
    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.
  5. by   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.
  6. by   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..
  7. by   elizabells
    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.
  8. by   lifsavER67
    Quote from KRVRN
    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 Tetanus 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.
  9. by   1BlessedRN
    Quote from mandana
    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...
  10. by   kadokin
    Quote from lifsavER67
    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 Tetanus 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!
  11. by   florry
    Quote from KRVRN
    Dorsogluteal is the butt cheek and ventrogluteal is the hip area right???
    Thank Y for asking...I have also been an instructor for nurses, but maybe I am stupid, or maybe its the language-problem; Would you mind telling me were on the body Y and the students are practicing,- in another language than latin? So I can learn from y!

    We describe IM EITHER GIVEN IN THE SEAT: UPPER, OUTERMOST QUADRANT, its very complicated to translate the word in a disent way without using words that can offend people (feks. pt). The part of the body is near the hip.

    Or you can prefer to give IM in the thigh; If you look at the thigh, imagine 6 equal parts, then use the part in the middel, and outermost. Sorry I have plenty of books, trying to translate those words, but that was not easy. I wish I could wrote or give y a map, that show y how I used to do when I was an instructor, and what I now do as a RN.

    Since its IM, I often prefer the thigh method, because it hurts to move, if Y have a hip problem, or if its emergency. But I know from experience myself that given the IM by my seat, it often doesnt hurt that much. It depence of coruse the amount of fluid that is given. Narcotics for cronic pain patiens are often given true PCA, but if they need more painkillers, they often need IM or IV push. Narcotics in emergency cases often require IV. I am trying to say that it depends on the medication, the pt (fex very thin), the diagnosis, so Your students have to learn that even this is one way we teach you, in practice you'll learn that its many different ways to give IM, because the "case" is that different. Since I have migraine, I often get imitrex, in the mucle, I can confirm that the thigh shoot hurt much more than other places.

    If y can try to tell your student that if the patients are relaxing the best they can, it wouldnt hurt that much, even you have to use the thigh. I often choose the needle size, despite its IM, but fex if y have a tiny little old lady, I am very carefull with regullary IM size of the needle.:wink2: :wink2:
  12. by   CyndieRN2007
    We learned the dorsogluteal is contraindicated because of the chance of hitting the sciatic nerve from improper landmarking.
  13. by   florry
    Quote from student4life
    We learned the dorsogluteal is contraindicated because of the chance of hitting the sciatic nerve from improper landmarking.
    All right; now I understand the language:

    The dorsogluteal aeria is the same place (upper, quadrant,so far away from the sciatic nerve y can come) we use to give IM, but not allways, it depends on time u have to prepeare for that, the medicament, size of the body, the diagnosis of the pt and many other things.

    What you should know, is that its easier to set and easier to get IM in the thigh. As an example of that: To get antibiotics in your thigh, hurts EXTREMELY! Therefore we often use LIDOCAIN/NOVOCAIN before we are giving antibiotics. Mostly you'r md order iv if not per os, if you need antibiotics. But I have seen so many times that MD order IM for antibiotics, that I think its nearly unethical....Do not harm the pt.

    I have got dorsogluteal IM medication given by a MD, and unfortunately he hit some tread of the sciatic nerve. It hurts alot, i got numbed, and was told to lay down and dont move. I dont ever blame him, because the same doc has given me the same medication that many times, and in a perfect way; he unfortunally hit some of the sciatic "branches". Nobody is similar. And if you can imagine a tree with branches, he was that unlucky to hit a small branch or section. Its a risk, yes, and you have to learn it. The end of the story was good. I could feel again, I can walk, and after a day I was totally fine.

    Bevare of the risk to touch the periost, too. That is extremely hurting, but as a nurse you can easily know when you hit periost. The needle stops.

    If you search the net or your literature its esyier to learn and point, and after training you'll gett your own method. Suddently you can "feel" that "I do it correctly and in my own way." Use the little needle ( in size )you have to. Note that B12 and iron is very difficult to give. The substance is that tough, and never push the skin if the medication is heparin-likly. (Heparin is usually given sc, too)

    This is what I have learned and also teach my student to do. If you have a medical-doll, practice many times before you give IM. You have to learn all methods. Its one place you can set IM: in the delta mucle, too. I have done that only a fewtimes, just to vaccinate.

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