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Tricks for finding landmarks- ventrogluteal IM injection

Posted

Has 11 years experience.

I've been reading a lot about this and think I should be doing ventrogluteal instead of dorsogluteal injections. But I am wondering if anyone has tricks for making sure you have the right landmarks. The procedures say "find the greater trochanter." Can you always feel that? How can you be sure? I think I remember someone teaching us to lift our legs to the side and that area where the dent is is the greater trochanter. But that was 10 years ago, so I could be just making that up. LOL The anterior superior iliac spine is a little easier, especially if someone is skinny. Any thoughts to share about making sure you're in the right place? Thanks so much!

MissIt

Has 11 years experience.

And while I'm asking questions about injections. I've seen on several sites that you can give the ventrogluteal (hip) injection with the patient sitting down. Can anyone talk me through that? Thanks!

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

We always have the patient lay on their side to give this one, or stand. I have never seen it done sitting personally. You put the ball of your hand on the greater trochanter with thumb pointed toward the anterior iliac crest and pinky finger toward the posterior iliac spine. The greater trochanter is easy to feel, even on overweight people. It is basically located at the point where the joint movement occurs. Have them lift their knee or lightly move their leg back and forth. Injection goes between the first and middle finger once your hand is in position.

MissIt

Has 11 years experience.

Thank you for your response! I am so nervous about changing technique, but it does seem like this is a safer site.

MissIt

Has 11 years experience.

I did it! I think I did it right. He said it didn't hurt, so that's great. My biggest trouble was cleaning it and then remembering exactly where I was supposed to go since I couldn't touch it when it was clean. One quick question-- I found the trochanter no problem then pointed my index finger at the anterior superior iliac crest and made a V. Are you supposed to actually touch the anterior iliac crest with your finger or do you just point it in that direction? I wondered if I was a little low. It definitely was in the muscle. I guess it's like the other IMs, the muscle is big enough for a little leeway. He was sort of bunched up, although he was standing, if that makes any sense. He didn't want to take off his pants, so was trying to hold them up while I did the shot.

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

I prefer this site for IM injections...

MissIt

Has 11 years experience.

Another question from me! Talked to him today, site feels great. Yay! However, this is a medication that gives him "flu like symptoms" after administration and he said that these side effects seemed to be intensified. My first thought was that maybe he wasn't really getting IM injections when we were doing it dorsogluteal or that the absorption was faster in the ventrogluteal location? Any thoughts?

Ventro gluteal was taught as the current gold standard in my Bscn (2014) and since arriving in the workplace I've noticed a couple things.

Get your patient lying on their side, landmark the site as described here by others, then get them to bring the knee of the upper leg (the one to be injected) towards their chest a bit.

This relaxes the hip joint. Did anyone else have the hip joint explained in A&P as a series of ropes that tighten/coil around the femur as you stand/straighten? Think about it, this is why young people who drive get hip dislocation in car collisions, their hip is fully flexed and subjected to anterior force. It's at its weakest, most relaxed position.

I've had many people tell my IM injections were the least painful they'd ever had.

Oh , I also use verbal distraction and directed breathing. Deep inhale, breath out, "what's your favorite colour?" STICK.