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!:)

[K205]

I work in geriatrics, so I mostly use ventrogluteal. It' difficult to position an elderly and, possibly demented patient. I just find the best muscle pad that I can, since MOST of my pts are cachexic. Hope that helps:)

celestlyn said:

I use dorsogluteal most of the time. Will occassionally use vastus lateralis, also, but people say it hurts more.

[K205]

Vistorol, Iron, and anything caustic to sc tissue.

florry said:

: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!

[florry]

K205 said:

Vistorol, Iron, and anything caustic to sc tissue.

:wink2: Thank you again!

If I do understand the issue in the way the terms or description for IM AND SC is used. I understand us are using the term VENTROGLUTEAL OR DORSOGLUTEAL if giving IM.

And of course iron an B12 require deep IM injection.

I understand the Z-track method, too, that we also use described in an other way, beause the language.

Though I DO HAVE MANY DICTIONARIES RELATED TO HOSPITAL ENGLISH, - I STILL CANT FIND THE WORD VENRTO- AND DORSOGLUTEAL. I AM NOT SURE I UNDERSTAND THAT THAT IS IN MUSCULUS GLUTEALIS, BOTH OF THEM, OR IF ITS EITHER THE M. QUADIPPLEX OR THIGH? Would anybody try to give me an answer in that?

Sorry that my language is that bad, but you dont learn, if you dont ask. I certainly know and educate norwegian studenst in that par of nursing, but we use norwegian as a language...:wink2: I REALLY DO APRESSIATE YOUR MANY ANSWERS, THANK YOU FOR TAKING TAME FOR DOING THAT:wink2:

I am only interested in learning the Terms!!

[florry]

:wink2:

student4life said:

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!!

:wink2: Its all right!! I apology my bad English! I tell my self: If you dont ask, you dont learn..So my intention was to learn! Yes, I speak norwegian, and are from Norway, and have a terrible English. I dont mean to offend anybody!!!!:wink2:

[UM Review RN, ASN, RN]

florry said:

:wink2:Its all right!! I apology my bad English! I tell my self: If you dont ask, you dont learn..So my intention was to learn! Yes, I speak norwegian, and are from Norway, and have a terrible English. I dont mean to offend anybody!!!!:wink2:

Americans are not usually offended by bad English. We have a lot of different cultures here and we welcome all. ?

So keep asking, florry. Keep learning. You're doing just fine.

[florry]

Angie O said:

Americans are not usually offended by bad English. We have a lot of different cultures here and we welcome all. ?

So keep asking, florry. Keep learning. You're doing just fine.

:kiss THANKS AGANIN! THAT WAS MAKING ME MY DAY VERY GOOD! YKINOUR ATTITUDE SHOW ME THAT YOU ARE THINKING AND ACTING IN A NICELY ETICAL WAY! Thinking about my own behaviour against people, and my way to wellcome them espescially in healtcare, when we use to talk about it here. Its NOT EASY TO COME TO LITTLE NORWAY(WE USUALLY THINK WE ARE THE BEST IN EVERYTHING, ESPESSIALLY IN HEALTCARE....) AND TRYING TO LEARN, SPEAK, WRIGHT OUR LANGUAGE, IF YOU ARE FROM ANOTHER CULTUR/MINORITY.....I am white female, but if you also have another color of your skin...its harder for them, unless we pretend to say "we have no rascism problems!!" I wish i learn more, and sure I do, by listening to other people/nurses around the world!!!!:kiss and

[pvjerrys]

florry: i wish i learn more, and sure i do, by listening to other people/nurses around the world!!

hello from southern california, florry.

here is a link for medical dictionary that may help.

http://www.medterms.com/script/main/hp.asp

dorsum: the back or posterior side of a structure. "dorsum" is the latin word for the back. something pertaining to the dorsum is dorsal.

the opposite of dorsum is ventrum, which comes from the latin "venter" meaning belly. something that is ventral is oriented toward the belly, toward the front of the body.

current nursing texts from the usa recommend the ventrogluteal site for intramuscular injections. they no longer recommend the dorsogluteal site. community practice usually lags behind current theoretical knowledge.

[RNHungryForKnowledge]

I graduated from a BSN program in 1983. We were not even taught how to administer an IM injection via dorsogluteal site because of the danger of sciatic nerve damage (we were educated as to its inadvisability). We were taught to use the ventrogluteal site in adults (for 2 or more mls), and I have been using it ever since, unless there is a reason the vastus lateralis is preferred, which I won't go into here. What I don't understand: since I have graduated 23 years ago, most other nurses I've worked with have been using the dorsogluteal site! After a while, I began wondering if I missed the boat. Maybe my school was backwards or something--after all, it was in Indiana! Most of the literature now tells us that the ventrogluteal site is preferred over the dorsogluteal, and I think it is our responsibility to get the word out. I also have had a painful injection in the dorsogluteal location which I felt when it was given--made my leg jump. And, I have had some numbness and tingling in that leg ever since. It is not pleasant, but there are plenty of people who have not sued anyone about it. We shouldn't just be afraid of lawsuits, right? Let's do what is best for the patients/clients/residents of our communities. Thanks for listening to my sermon. Feel free to give me yours. I'm all ears

[ayla2004, ASN, RN]

I can understand the norwegian nurse we UK commonly use the term upper outer quater of the buttocks to mean dorso glut. an currently a student who was warnmed about the risks to the sciatic nerve and also if pt have a lot of fat in that area is hard to judge needle length to get to the muscle not the fat. As the deltiod is out all but for small amounts this leaves ventrogluteal which i have used to give a tetorifice booster to a very thin older person instead of the deltoid.

[mfh157]

The dorsalgluteal is longer acceptable or used for IM sites. The ventralgluteal is used. Nursing education text books no longer include the dorsal as an option for injections. I no longer teach dorsal to my students. Many lawsuits over injury to the sciatic nerve. I call the doral-"the droopy draws"-meaning in our aging population- gravity pulls the anatomy downward -more at risk of hitting a major B.V. or nerve. As an educator, my biggest issue are those nurses that refuse to use the ventral site.-It is actually less painful and safer.

Mary

[chenoaspirit, ASN, RN]

the dorsogluteal site is dangerously close to the sciatic nerve and is covered with abundant subcutaneous tissue in many people. its landmarks, especially the outer boundary, are poorly defined. i do not recommend this site unless no other muscle area is available for an im injection.

on the other hand, the 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, even in infants. simply place the palm of your hand over the greater trochanter (hip joint), 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. of course, every effort should be made to reduce the pain of the injection by using good technique and pain control measures, such as emla or a vapocoolant.

[miss81, BSN, RN]

We didn't even learn the dorsogluteal. Our instructors only taught the Ventroglueteal. What is the problem that they have been experiencing with the landmarking??? We were taught that "the ventrogluteal injection site is the preferred injection site for adults and children over 7 months. The muscle that is injected into at the ventrogluteal injection site is the gluteus medius. The advantages to a ventrogluteal injection are that it is reasonably free of major nerves and vascular branches. The bony landmarks such as the greater trochanter and the iliac spine make this injection site easy to locate. The muscle mass at the ventrogluteal injection site is adequate enough for deep IM or Z-track injections. It can be administered from numerous patient positions such as the supine, lateral (left or right), and on the abdomen."