Appropriate age to stop using vastus in children

[TheOracle]

Hey guys,

I've done a search and can't seem to find a satisfactory answer to a question posed to me. One of the medical assistants in the general clinic I manage approached me with a concern about an LPN's pediatric IM technique. The MA said she observed on 3 separate occasions the LPN administering Rocephin in the dorsogluteal to children whose ages ranged from 4-6 and the MA asked for clarification on IM admin in pediatrics.

I was taught that proper technique is to not use the dorsogluteal on anyone regardless of age d/t chance of damaging the sciatic nerve or nicking the sciatic artery, but that children were especially vulnerable to this possibility. Like most of us, I was taught vastus lateralis for children.

Then the question became what constitutes a child? What is the cut off on using the vastus lateralis? More specifically, when does using the VL stop being first choice IM site? I don't recall that ever being addressed directly in school and in my own experience if I've ever had a doubt I went VL.

I consulted with both NPs I work with and one told me that you could never go wrong with VL on anyone regardless of age and she did not want the dorsogluteal "proper" used on anyone, instead preferring to go more lateral than the traditional DG site. With children she was adamant that VL be used and her definition of "children" capped off around 9 or 10 for the same reason I was taught in school.

The second NP said VL on children 2 and under, then dorsogluteal "proper" on everyone else.

My own personal research indicates they both are right in a manner of speaking. What I've gathered is VL in ages up to 36 months. Then once the DG is "well developed" the site can be utilized; however, now the most appropriate place in terms of avoiding nerves and arteries, etc is the ventrogluteal plus larger amts of meds can be administered.

I may be blind or not as search engine/journal savvy as I thought because I'm having a hard time locating credible documentation that addresses the specificity of age range r/t to selecting IM sites. Or once the child reaches preschool/school age is it the size of the child that dictates site selection? What is standard policy at your facilities?

[checker1981]

I learned in school that the ventrogluteal site is preferred site in children of all ages. A child for med administration is no longer a child when they approach adult sizes (i.e. puberty). The ventrogluteal is pretty much free of major nerves and blood vessels and is less painful than the vastus lateralis.

The dorsogluteal muscle is insufficiently developed to be a safe site for infants and small children. I am not a peds nurse though.