Tips on landmarking IM injections

Jolie, BSN · Jul 31, 2009

[quote=frankmitch;3776122one nurse told me when she gives this injection she starts from the top of the buttock where the crack just begins and goes 3 inches over towards the hip and injects. is this a good trick to use.

no. injecting 3 inches from the "crack" on a small person may not place you in the same position with regards to anatomical landmarks as injecting 3 inches from the "crack" on a very large person. always use anatomical landmarks, not measured distances for this reason.

i find it hard to landmark this site sometimes due to increased weight or sagging skin.

again, using anatomical landmarks will enable you to locate the safest point to inject, regardless of plumpness, sagging skin, or any other superficial difference in appearance.

does anyone have any good tips/trick to give this shot. ( i have heard this site is no longer preferred but this is were we still give some injections)

my best tip is to avoid the dorsogluteal site altogether. even with proper location of landmarks, some people will have variations in anatomy, crating the risk of injecting into a major nerve or blood vessel. the ventrogluteal site is preferred because it does not contain any major nerves or vessels. it is a safer site to use, as is the thigh. although the thigh is more sensitive, and most patients prefer to avoid it.

allnurses Guide · Jul 31, 2009

Put your hand with the fingers pointing out toward the hip, fingers on the top of the hip bones, the thumb on the top of the femur (palm on the buttock). Place your shot in the middle of that triangle formed by your fingers.

allnurses Guide · Jul 31, 2009

I was wondering if anyone had any tips on IM injection landmarking, esp for the dorsogluteal site. I have had dif nurses give that injection in dif parts of the buttocks. I know upper outer quad is what it is supposed to be. I know to divide buttock in to fours, but it seems the needle is still given if different areas when dif people give injection. Or find the iliac crest and greater trochanter and draw diagonal line.
One nurse told me when she gives this injection she starts from the top of the buttock where the crack just begins and goes 3 inches over towards the hip and injects. Is this a good trick to use.
I find it hard to landmark this site sometimes due to increased weight or sagging skin.
Does anyone have any good tips/trick to give this shot. ( i have heard this site is no longer preferred but this is were we still give some injections)

I always just mentally divide the buttock into 4 quadrants and give in the upper outer quadrant. By the way look at this picture from wikipedia on the sciatic nerve. http://en.wikipedia.org/wiki/Sciatic_nerve Giving an injection where this one nurse suggest brings you really close to the sciatic nerve....

boggle, ASN, RN · Jul 31, 2009

Save yourself the effort of this......Just don't use the dorsogluteal! It is no longer recommended or taught. Just "because we always did it that way" is not good enough evidence for current practice. Check current nursing texts and research.

Instead, seek out the ventral gluteal. (It's below the "love handles/ muffin top" for many of us) To find the landmarks, place your hand on the patient's hip, with your thumb pointing toward the pubis, and your palm over greater trochanter of femur. Let pointer finger find the anterior superior iliac spine. Sweep the remaining fingers back towards the iliac crest. That creates a V at the base of your pointer and 3rd finger. Inject in the mid/bottom of the V with needle at a 90 degree angle. Keep in mind the differences in anatomy here. Palpate the muscle. You may have to use a shorter needle on those with small muscle mass here.

Good luck to you.

kimmie4476, ASN, RN · Jul 31, 2009

I divide the butt into quads, then in the upper outer quad, I divide it again into it's own 4 quads then give in the upper outer of that one (My preferred site is the outer thigh though, pretty rare that I give here)

frankmitch · Aug 1, 2009

Could you try to explain this one more time. please.. I cant quite understand how to place this to make a triangle. Thanks in advance

frankmitch · Aug 1, 2009

Put your hand with the fingers pointing out toward the hip, fingers on the top of the hip bones, the thumb on the top of the femur (palm on the buttock). Place your shot in the middle of that triangle formed by your fingers.

Could you try to explain this one more time. please.. I cant quite understand how to place this to make a triangle. Thanks in advance

JustEnuff2BDangerous, BSN, RN · Aug 1, 2009

Could you try to explain this one more time. please.. I cant quite understand how to place this to make a triangle. Thanks in advance

I had a hard time visualizing this as well, so I searched Google and found a picture! Hope this helps:

http://www.ino.ie/_INO/images/IMInj_Ventrogluteal.jpg

journey_bound · Nov 9, 2009

this gives a really good explanation on landmarking IM's:

http://hubpages.com/hub/Ventrogluteal-Injection

ShantheRN, BSN, RN · Nov 9, 2009

Dorsogluteal is still taught. I asked my instructor, "If we're not supposed to use that site, why do we have to learn it?" and she told me, "Because you still need to know it."

Yeah. It still doesn't make sense to me, either LOL I routinely get my Depo in this site, too. I don't recall ever getting an injection in VG - only deltoid and DG.

Charlesincharge · Nov 23, 2011

I have a question regarding ventrogluteal IM's. Due to the nature of my patients, physical landmarking is not allowed so I had a fellow nurse show me how she visually landmarks for the ventrogluteal site. Doing an injection today, I visually landmarked it and injected and hit bone once I was almost the entire way in. I was taught that if you hit bone to pull back a tad and continue with the injection. Does this still hold true?