Intramuscular Injection Sites?

[Nurse Bethie]

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 is the preferred site, but we are wondering if you are using ventrogluteal exclusively in the clinical areas or is dorsogluteal an acceptable alternative. We as the instructors feel that dorsogluteal is a good site for new practitioner students who are nervous enough about an IM and need a littel larger "target" for their injections. Are we wrong? Is this a big no-no in the clinical area?

We would greatly appreciate any feedback, advise or literature/text resources to support one way or another.

Thank you!:)

[Jolie, BSN]

VickyRN,

Do I understand you correctly that you are giving newborns injections in the hip? I've been out of the nursery for about 5 years, so this may be something new, but that sounds quite difficult to me. How do you restrain the infant to get at the site? Isn't the thigh a much easier target? And safer too, without any major nerves or blood vessels to worry about?

[Huq]

ventrogluteal site is relatively free of major nerves and blood vessels, the muscle is large and well defined, and the landmarks are easy to locate. It is an excellent IM injection site in infants. Simply place the palm of your hand over the greater trochanter, index finger over the anterior superior iliac tubercle, and middle finger along the posterior iliac crest. Inject perpendicular into the center of the V formed by the separated fingers.* It has been my experience that this site is less painful than the vastus lateralis.

[VickyRN, MSN, DNP, RN]

Quote

VickyRN,

Do I understand you correctly that you are giving newborns injections in the hip? I've been out of the nursery for about 5 years, so this may be something new, but that sounds quite difficult to me. How do you restrain the infant to get at the site? Isn't the thigh a much easier target? And safer too, without any major nerves or blood vessels to worry about?

Sorry, MAJOR brain infarct. What I meant to say was vastus lateralis. No, you would never inject newborns in the ventrugluteal, not safe and wouldn't be able to landmark!:imbar Sorry, edited my former post.

[Norma56]

We use dorsalgluteal and ventralglutial, as well as vastus lateralus. My problem is the landmarking teqniques. Have they changed much?

[shammy]

I always give ventro gluteal. I learned it in school and have found in practice that most nurses use dorso gluteal so I continue using ventro d/t site rotation. My pts always comment that it doesn't hurt when I give IM vs my collegues.

I think if you learn how to do it in school you will continue and just because it isn't the common practice on the floor doesnt't mean it shouldn't be taught. Think back not so long ago gloves were encouraged not mandatory. Teach them right!

The other perk for pts is that when I worked on a ortho floor with lots of hips and knees I could admin IM much easier with less positioning to aleviate pain.

[meownsmile, BSN, RN]

I agree with hugs,,thats how i learned the landmarks. I also use the vastus lateralis frequently with pain meds in the hospital. Best to rotate sites anyway avoiding affected leg if it is a hip/knee patient.

[VickyRN, MSN, DNP, RN]

Norma56 said:

We use dorsalgluteal and ventralglutial, as well as vastus lateralus. My problem is the landmarking teqniques. Have they changed much?

The posterior superior iliac spine is the prominence of bone on either side of the pelvis underlying the "bikini dimples" on the lower back/upper buttocks.

[mayzeegrl]

Dorsogluteal always works best for me. I feel more confident using that injection site than any other, although we were taught all injection sites in nursing school.

[sharann, BSN, RN]

OK, help me out. I never heard of Dorsogluteal? I give all my injections in the ventroglut or the deltoid if small and nonirritating.

[deanaRN]

LOVE that streaming media site, THANKS!

VickyRN said:

The posterior superior iliac spine is the prominence of bone on either side of the pelvis underlying the "bikini dimples" on the lower back/upper buttocks.

[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

[Simba&NalasMom, LPN]

I just graduated LPN school this past Feb, and their preferred site was vastus lateralis (yes, on adults)...WTF?!?! I've only seen that site used once and it was because the gentleman was very thin and in end-stage Parkinson's, so turning him was difficult for the nurses and painful for himl; also, he was very thin and had more "meat" on his vastus than his dorsus. The most common site I've seen used in practice (for adults) is the dorso-gluteal.