Gluteus non approved IM site???

[nkochrn]

I was talking to my cousin this weekend who is also an RN. I mentioned a doc wanting Solumedrol given in her arm (this was the dr. receiving the injection not another patient.) I said it wasn't supposed to be given in the arm because it is a 2 ml injection. My cousin said the gluteus is no longer an approved injection site and they have signs hanging up all over her hospital about it. Am I missing something???? I've never heard of this and was thinking maybe it's just her hospital doing this.

[applewhitern, BSN, RN]

Someone once hit my son's sciatic nerve and he was miserable. I wasn't with him and do not know if it was a nurse, MA, or who.

[Double-Helix, BSN, RN]

You'd need one hell of a long and strange needle to be able to hit the Vagus nerve through the Gluteal region.

I meant the sciatic nerve. I guess you can tell its been a long day!!

[CrunchRN, ADN, RN]

They have been trying to change this for over a decade! There is plenty of scientific data that show the ventral gluteal site is much safer then dorsal gluteal becuase of this proximity fo the sciatic nerve.

2ml's is too much for the deltiod site so you could give 2 separate 1ml injections in each arm if you really wanted to go deltoid..... or give 2ml in the VG site.

Ok, all that said I haven't given an IM for about 8 years so I haven't kept up on all the latest!

[Medic2RN, BSN, RN, EMT-P]

Solumedrol packs a pretty good punch - I wouldn't give it in the arm even with breaking down into 2 injections. I wouldn't want anyone to have that misery in both arms!

[CrunchRN, ADN, RN]

Medic 2 - good to know. Thanks for mentioning that.

I haven't kept up with all the different meds aggressively, but I store these things away like a squirrel storing nuts because you never know when you may need to use it........

[wooh, BSN, RN]

I meant the sciatic nerve. I guess you can tell its been a long day!!

Hehe, the slip made my night though!

[Sanuk]

Most steroids state explicitly not to inject into the deltoid due to high risk of tissue necrosis and or muscle atrophy. As far as the original question :) I still use the dorsogluteal in addition to ventrogluteal - I just use my best judgement with the patient involved.

[CrunchRN, ADN, RN]

"Most steroids state explicitly not to inject into the deltoid due to high risk of tissue necrosis"

Good to know. Does that apply to the low dose stuff they do in pulmonary clinics? I seem to recall back in the day before I moved out of the clinics we used to give a lot of deltoid injections, but I cannot for the life of me remember what exactly we were giving. It was a decade ago!

[AgentBeast, BSN, RN]

I meant the sciatic nerve. I guess you can tell its been a long day!!

I'd hope so. Otherwise I'd be asking for your money back from your school if I were you.

[AgentBeast, BSN, RN]

Hitting the vagal nerve is bad. That's why it's very important to use your landmarks.

If you are anywhere near the Vagus nerve performing a procedure within the scope of practice of an RN you are doing something seriously wrong.