Least painful injection site

  1. 0
    Hi everyone,

    I work in a clinic where I give many intramuscular injections for sexually transmitted diseases. I am mainly giving either Penicillin or Ceftriaxone (Rocephin) IM. My nursing school training (finished 3 years ago!) teaches me to use the ventrogluteal site but I have some reservations...

    From my experience, the ventrogluteal site is FAR more painful than the old dorsogluteal site. I was wondering if this is just my experience or if other people have found this? I find that anything more than 2mL can be very painful for my patients in the ventrogluteal site. I understand the proposed safety advantages of this site but I thing it is far outweighed by the discomfort. I think the muscles under this site are more tense and there is 'less room' for the injection to go causing more pain.

    Several weeks ago a young patient with syphillis found her first IM penicillin shot given ventrogluteally exruciatingly painful and I wondered if she would ever return for her subsequent shots. She did, and I used the dorsogluteal site, which she still found painful but much better.

    I now use both sites but always use the dorsogluteal for the ceftriaxone shots which patients seem to find particuarly painful.

    Doing a literature search I can find many articles arguing that the ventrogluteal site is safer but can't find any research on patient pain.

    What do you other thing?


    -Kate
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  3. 6 Comments so far...

  4. 0
    Quote from kate_osb
    Hi everyone,

    I work in a clinic where I give many intramuscular injections for sexually transmitted diseases. I am mainly giving either Penicillin or Ceftriaxone (Rocephin) IM. My nursing school training (finished 3 years ago!) teaches me to use the ventrogluteal site but I have some reservations...

    From my experience, the ventrogluteal site is FAR more painful than the old dorsogluteal site. I was wondering if this is just my experience or if other people have found this? I find that anything more than 2mL can be very painful for my patients in the ventrogluteal site. I understand the proposed safety advantages of this site but I thing it is far outweighed by the discomfort. I think the muscles under this site are more tense and there is 'less room' for the injection to go causing more pain.

    Several weeks ago a young patient with syphillis found her first IM penicillin shot given ventrogluteally exruciatingly painful and I wondered if she would ever return for her subsequent shots. She did, and I used the dorsogluteal site, which she still found painful but much better.

    I now use both sites but always use the dorsogluteal for the ceftriaxone shots which patients seem to find particuarly painful.

    Doing a literature search I can find many articles arguing that the ventrogluteal site is safer but can't find any research on patient pain.

    What do you other thing?


    -Kate
    I typically use the ventrogluteal as much as possible, because of a couple reasons: 1. It's farther away from the sciatic nerve; 2. I believe there is a greater concentration of muscle in the area, hence better absorption than the dorsogluteal or delt site. As for pain, all of them hurt but I believe I remember that the vastus lateralis hurts the worst, and the delt should only be used for injections <2cc. I haven't had too much complaint of pain (except from the 2 yr old in the ER when I was in clinicals as a student, and he got it in the vastus) and perhaps a reason why is because I hold the skin quite taut at the injection site for injection and removal. In fact I had one pt. thank me for doing this.
  5. 0
    Have you ever tried Rocephin mixed with Lidocaine? Its less painful
  6. 0
    Quote from Charge205
    Have you ever tried Rocephin mixed with Lidocaine? Its less painful
    I think its pretty standard to mix it, but you're right... you NEVER know...
  7. 0
    From a patient perspective I prefer to have all of my shots given in the dorsogluteal location. No way I would want it in the ventrogluteal location. Personal preference.
  8. 0
    Quote from ajtcsx
    From a patient perspective I prefer to have all of my shots given in the dorsogluteal location. No way I would want it in the ventrogluteal location. Personal preference.
    And from this patient's perspective I'd rather have a more painful injection in a safer site. I've experienced nerve irritation from a DG injection, the pain can last for weeks, I'll never go through it again if it can be avoided.

    VG site really should be less painful because it has a lower concentration of nerves.
    To the OP, I realize you've been giving the injections on a regular basis for a while but I'd encourage you to review your landmarks and really think about needle placement.
    I know that in my own practice I've developed habits over time that stray from from the optimal technique and have to take a step back and remember how to do it the 'right' way.

    The antibiotics you're giving on a regular basis can be painful (even using Lido in rocephen). Just because you can inject >2cc in a site doesn't mean you have to, you might consider splitting the injection over two sites to give it more comfortably in the optimal location.
  9. 2
    I don't think it's possible to have a pain free shot of Rocephin, that stuff BURNS!!!
    Hoozdo and ~*Stargazer*~ like this.


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