Blood return on IM injection

[Salley]

I have done quite a few dorsoluteal IM injections and try to be very careful landmarking my patients. Sometimes, however, it can be difficult to palpate landmarks in some patients. I stretch the skin and always make sure I am injecting into the upper outer quadrant and don't go to low. My problem is that I have aspirated blood several times. Since I am doing dorsogluetal injections, I do aspirate for 3 to 5 seconds with gentle pressure. I know I am not hitting the gluteal artery, but I don't know why I keep aspirating blood. I actually aspirated blood twice in a row on a patient once. I have spoken with several of my colleges who said they either don't aspirate or don't do it for longer than one second. I know however, that it is safer in the dorsogluetal site to aspirate, and I prefer to do it for at least 3 to 5 seconds since that is what is recommended. I feel like I am aspirating gently; I am not pulling back hard. Any suggestions would be greatly appreciated. Thank you.

[akulahawkRN, ADN, RN, EMT-P]

If you're easily aspirating blood, you very easily could have punctured a vein. If the dorsogluteal site isn't working for you, consider switching to the ventrogluteal site. Most of my patients prefer this site anyway simply because they feel less exposed. I've also done lateral thigh injections into the Vastus Lateralus but my go-to sites are the Deltoid (small volumes) and the ventrogluteal (Gluteus Minimus) for larger volumes, around 2-3 mL.

[klone, MSN, RN]

Agree with the previous poster. Dorsogluteal is not the preferred site for that very reason - it's far more likely to hit a vessel or nerve. When using that site, you should ALWAYS aspirate, and proper aspiration should be at least 5 seconds.

A better option is to switch to the ventrogluteal site, where aspiration is not necessary, due to the absence of any major vessels (or nerves) if the site is landmarked correctly.