Trouble with Dorsogluteal injections!!

Hello,

No matter what I do, I seem to hit a bone with I'm injections. I obviously palpate and hold the skin taut before I inject. Also, I aim to above the butt crack , make a "window" and choose the left/right outer upper half. I dont know what else I can do to improve this skill...all my patients keep complaining of "pain at the site, unable to walk, feeling dizzy..." this is a nightmare. I keep thinking I hit the sciatic nerve, too, which is another constant concern of mine. IDK what else I can do to be better?

[KatieMI, BSN, MSN, RN]

1) just letting you know: if you really hit schiatic nerve only ONCE, you'll remember it to the end of your life. So, if you really shoot in the outer upper quadrant, you might relax about it. The nerve is just not there.

2). Unless you do injections to seriously cachectic people, you have very low chance to hit the bone. It is way too deep for normal needle, as for normally nourished human the average thickness of fat over there is 2+ inches. You hit a huge and the second strongest skeletal muscle in a human body.

3). Make sure patient is well relaxed before a shot. In most cases, it solves the problem.

[Marythenurse1994]

It's just a little odd, because I am taking over from a fellow co-worker and they claim they never experienced these symptoms before after the injection, and this happened with 2 patients..so I am FREAKING outtttttttttttttttt, I am thinking it's most definitely my technique....not sure what else to do ?

[JKL33]

16 hours ago, Marythenurse1994 said:

Also, I aim to above the butt crack , make a "window" and choose the left/right outer upper half.

Can you clarify? I ask because locating a proper site for dorsogluteal injection has very little (pretty much nothing) to do with the gluteal cleft (so-called "butt crack").

Also, can you just use ventrogluteal site?

[heron, ASN, RN]

Sounds like a vaso-vagal reaction. A tense patient will likely hold their breath and “bear down” while waiting for the injection = vagus nerve stimulation. Try to get the pt relaxed and take a deep breath - do the shot as they exhale slowly. And get a grip on your own nerves ... your anxiety flows directly to your patient.

ETA: and, obviously, review the anatomy ...

[LibraNurse27, BSN, RN]

fyi dorsogluteal is no longer a recommended route for I'm injections. Ventrogluteal is safer ? then you have no chance of hitting the sciatic nerve. It's unlikely to hit it doing dorsogluteal unless you don't do it in the correct location but some patients have atypical anatomy so ventrogluteal is safer. There are lots of studies and tutorials if you're interested!

[TriciaJ, RN]

I agree with Libra. Ventrogluteal is way easier to landmark, very safe and currently the preferred site for IMs not appropriate for the deltoid.

[ComeTogether, LPN]

I believe that site is no longer to be used because of the risk of nerve damage.