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!:)

[florry]

KRVRN said:

Dorsogluteal is the butt cheek and ventrogluteal is the hip area right???

Thank Y for asking...I have also been an instructor for nurses, but maybe I am stupid, or maybe its the language-problem; Would you mind telling me were on the body Y and the students are practicing,- in another language than latin? So I can learn from y!

We describe IM EITHER GIVEN IN THE SEAT: UPPER, OUTERMOST QUADRANT, its very complicated to translate the word in a disent way without using words that can offend people (feks. pt). The part of the body is near the hip.

Or you can prefer to give IM in the thigh; If you look at the thigh, imagine 6 equal parts, then use the part in the middel, and outermost. Sorry I have plenty of books, trying to translate those words, but that was not easy. I wish I could wrote or give y a map, that show y how I used to do when I was an instructor, and what I now do as a RN.

Since its IM, I often prefer the thigh method, because it hurts to move, if Y have a hip problem, or if its emergency. But I know from experience myself that given the IM by my seat, it often doesnt hurt that much. It depence of coruse the amount of fluid that is given. Narcotics for cronic pain patiens are often given true PCA, but if they need more painkillers, they often need IM or IV push. Narcotics in emergency cases often require IV. I am trying to say that it depends on the medication, the pt (fex very thin), the diagnosis, so Your students have to learn that even this is one way we teach you, in practice you'll learn that its many different ways to give IM, because the "case" is that different. Since I have migraine, I often get imitrex, in the mucle, I can confirm that the thigh shoot hurt much more than other places.

If y can try to tell your student that if the patients are relaxing the best they can, it wouldnt hurt that much, even you have to use the thigh. I often choose the needle size, despite its IM, but fex if y have a tiny little old lady, I am very carefull with regullary IM size of the needle.:wink2: :wink2:

[CyndieRN2007]

We learned the dorsogluteal is contraindicated because of the chance of hitting the sciatic nerve from improper landmarking.

[florry]

?

student4life said:

We learned the dorsogluteal is contraindicated because of the chance of hitting the sciatic nerve from improper landmarking.

? All right; now I understand the language:

The dorsogluteal aeria is the same place (upper, quadrant,so far away from the sciatic nerve y can come) we use to give IM, but not allways, it depends on time u have to prepeare for that, the medicament, size of the body, the diagnosis of the pt and many other things.

What you should know, is that its easier to set and easier to get IM in the thigh. As an example of that: To get antibiotics in your thigh, hurts EXTREMELY! Therefore we often use LIDOCAIN/NOVOCAIN before we are giving antibiotics. Mostly you'r md order iv if not per os, if you need antibiotics. But I have seen so many times that MD order IM for antibiotics, that I think its nearly unethical....Do not harm the pt.

I have got dorsogluteal IM medication given by a MD, and unfortunately he hit some tread of the sciatic nerve. It hurts alot, i got numbed, and was told to lay down and dont move. I dont ever blame him, because the same doc has given me the same medication that many times, and in a perfect way; he unfortunally hit some of the sciatic "branches". Nobody is similar. And if you can imagine a tree with branches, he was that unlucky to hit a small branch or section. Its a risk, yes, and you have to learn it. The end of the story was good. I could feel again, I can walk, and after a day I was totally fine.

Bevare of the risk to touch the periost, too. That is extremely hurting, but as a nurse you can easily know when you hit periost. The needle stops.

If you search the net or your literature its esyier to learn and point, and after training you'll gett your own method. Suddently you can "feel" that "I do it correctly and in my own way." Use the little needle ( in size )you have to. Note that B12 and iron is very difficult to give. The substance is that tough, and never push the skin if the medication is heparin-likly. (Heparin is usually given sc, too)

This is what I have learned and also teach my student to do. If you have a medical-doll, practice many times before you give IM. You have to learn all methods. Its one place you can set IM: in the delta mucle, too. I have done that only a fewtimes, just to vaccinate.

[CyndieRN2007]

Quote

florry said:

? ? All right; now I understand the language:

You are from Norway!!!

[florry]

student4life said:

Quote

You are from Norway!!!

:wink2: yes!!! Apology my bad

English, I hope Y do! What beeing from Norway a supprise!

[florry]

:wink2: :wink2: :wink2:

florry said:

student4life said:

:wink2: yes!!! Apology my bad

English, I hope Y do! What beeing from Norway a supprise!

SORRY; WHAS THAT A SUPPRISE? WOULD YOU IF SO TELL ME WHY? HAVE I MISUNDERSTOD?:wink2:

[CyndieRN2007]

florry said:

? ? All right; now I understand the language: quote]

Sorry for the misunderstanding, I didnt understand why you made the above statement in your post. I then looked at your location and realized that you are from Norway a probably speak another language. Thats all, I didnt mean anything bad by that. Im sorry!!

[pvjerrys]

SweetOldWorld said:

6th edition of Potter and Perry's Fundamentals of Nursing states that the dorsogluteal site should not be used because of the danger of hitting the sciatic nerve. I know someone who suffered permanent damage from just this very thing from an injection he received in the ER. I rarely give IMs anymore anyway. Most of our meds are given IV.

We also use Perry & Potter as basis for practice. Students learn to give IM injections in the ventrogluteal site. They practice locating the site repeatedly in the lab prior to clinical.

There are advantages to the VG site: large muscle site, lack of nerves or vessels, and, last but not least, the patient can be in supine position during administration. We also teach students to inject with Z-track technique for all injections. Meds are beter absorbed and students get to perfect a technique that they might otherwise not be able to use. I have observed students having minimal problems locating the VG site using Z-track for injections.

Community practice usually lags behind current theoretical practices, so it is no surprise that nurses still use the dorsogluteal site.

One last response: Always aspirate for IM. It s not necessary to aspirate for subcutaneous injections as there are minimal blood vessels in this area.

[DCJ3]

i'm in nursing school now and they are discouraging the use of dorsogluteal site because of the high chances of hitting the sciatic nerve and the preferred site is now the vg. my clinical instructor also taught me that a better way to give all ims is via z track - less pain, better absorption.

b.

------------------------------

i hear and i forget

i see and i remember

i do and i understand~ old proverb

[florry]

dcj3 said:

i'm in nursing school now and they are discouraging the use of dorsogluteal site because of the high chances of hitting the sciatic nerve and the preferred site is now the vg. my clinical instructor also taught me that a better way to give all ims is via z track - less pain, better absorption.

b.

------------------------------

i hear and i forget

i see and i remember

i do and i understand~ old proverb

? in your country or us, would you telling me what a z-track is! i cant find the word translated, and i apressiate if you can explain it! thank you very much!:)

[pvjerrys]

florry said:

? In your country or us, would you telling me what a Z-track is! I cant find the word translated, and I apressiate if you can explain it! Thank you very much!:)

FLORRY - THIS MIGHT HELP.

Could you please provide a list of drugs that should be administered via the Z-track method.

18th January 2001

We are not able to specify a list of drugs - application of the Z-track injection technique differs from hospital to hospital and country to country. As a general observation, though, the Z-track method is used for intramuscular injections of substances which are known to cause pain to the patient if they seep into the subcutaneous tissues or cause permanent staining of the skin. To reduce the risk of causing irritation along the injection pathway, the needle used to draw up the substance is normally changed before the injection is given. The Z-track technique involves displacing the skin and subcutaneous layer in relation to the underlying muscle so that the needle track is sealed off when the needle is withdrawn, thus minimizing reflux (see diagram above). It is most commonly employed in the administration of parenteral iron solutions such as Iron Dextran (Imferon) and Iron Sorbitex (Jectofer). A drug which is highly coloured in solution may be administered by this method. It is sometimes used in the administration of Heparin into the abdominal subcutaneous tissues. Several studies have been carried out to compare the effectiveness of different injection techniques (eg: Keen, 1986; Quartermaine and Taylor, 1995).

References

Johns, M.P. (1989) Drug therapy and nursing care. London: Macmillan Press.

Keen, M.F. (1986) Comparison of intramuscular injection techniques to reduce site discomfort and lesions. Nursing Research, 35(4), 207-210 (Jul-Aug).

Potter, P.A., and Perry, A.G. (1993) Fundamentals of nursing: concepts, process & practice (3rd edition). St. Louis: Mosby-Year Book, Inc (pp 662-663).

Quartermaine, S., and Taylor, R. (1995) A comparative study of depot injection techniques. Nursing Times, 91(30), 36-39 (Jul 26-Aug 1).

[florry]

pvjerrys said:

FLORRY - THIS MIGHT HELP.

Could you please provide a list of drugs that should be administered via the Z-track method.

18th January 2001

We are not able to specify a list of drugs - application of the Z-track injection technique differs from hospital to hospital and country to country. As a general observation, though, the Z-track method is used for intramuscular injections of substances which are known to cause pain to the patient if they seep into the subcutaneous tissues or cause permanent staining of the skin. To reduce the risk of causing irritation along the injection pathway, the needle used to draw up the substance is normally changed before the injection is given. The Z-track technique involves displacing the skin and subcutaneous layer in relation to the underlying muscle so that the needle track is sealed off when the needle is withdrawn, thus minimizing reflux (see diagram above). It is most commonly employed in the administration of parenteral iron solutions such as Iron Dextran (Imferon) and Iron Sorbitex (Jectofer). A drug which is highly coloured in solution may be administered by this method. It is sometimes used in the administration of Heparin into the abdominal subcutaneous tissues. Several studies have been carried out to compare the effectiveness of different injection techniques (eg: Keen, 1986; Quartermaine and Taylor, 1995).

References

Johns, M.P. (1989) Drug therapy and nursing care. London: Macmillan Press.

Keen, M.F. (1986) Comparison of intramuscular injection techniques to reduce site discomfort and lesions. Nursing Research, 35(4), 207-210 (Jul-Aug).

Potter, P.A., and Perry, A.G. (1993) Fundamentals of nursing: concepts, process & practice (3rd edition). St. Louis: Mosby-Year Book, Inc (pp 662-663).

Quartermaine, S., and Taylor, R. (1995) A comparative study of depot injection techniques. Nursing Times, 91(30), 36-39 (Jul 26-Aug 1).

:wink2: Thank you, this was wery well illustrated as told! We use some of the same tecknic, but not the "Z" as a term. I am supprised that you in US seem to have that kind of a system, shortenings when doing nursing! Though I have also seen fex. other illnesses as MRSA that sorry to say, is out of control. Certainly we can learn or eacc other, and I appressiate that you took your time to answering me about that issue!!

Thank you, again!