I never got a chance to give IM's during school, just watch and do them on a dummy in class. I have tried a couple times now that I just started nursing, but every time I draw up blood. I'm very careful to pinpoint the ventrogluteal site, since I was told it's preferred instead of the dorsal gluteal, to prevent hitting the sciatic nerve or blood vessels. But the few times I've tried, some blood came out and I had to draw up a whole new syringe of med. The nurse watching me didn't let me do it again. I just don't know why I keep hitting a vessel.
Is it always necessary to draw up a whole new syringe when a bit of blood is drawn and exactly where should I be trying to prick to avoid getting blood?
Also, if someone is very overweight where it's hard to make out the hip bones or waist, how do we know where the Ventrogluteal area starts? I feel so hopeless.
First of all, whoever told you that you could possibly hit the sciatic nerve is full of it.
Sciatic nerve injuries are definitely possible. Don't forget, not everyone's anatomy is textbook. (Ask anyone who's cathed a lot of females, for example) Here's a quote from Medscape:
When giving gluteal injections, it is safest to use the upper outer quadrant. The choice of site for injection must be based on good clinical judgment, using the best evidence available and individualized client assessment. There is wide agreement in the literature that the ventrogluteal site is preferable (Small, 2004). Review of the literature on relevant injection procedure found that injury to the sciatic nerve is associated with use of the dorsogluteal site for injection, because the sciatic nerve commonly courses this site (Fig. 1)..
Many nursing schools are now telling the students to stay away from dorsogluteal injections as much as possible due to risk of sciatic injury.
Very true. I graduated last year and we were told to stay away from dorsogluteal injections and to give ventrogluteal injections instead. Dorsogluteal injections were discussed in lab and in passing so we would know the site and method if asked or if mentioned by another nurse but we never practiced them in lab or administered them in the hospitals. We only practiced and gave ventrogluteal IM injections.
I'm a new grad and I've given at least 40 IMs with no problem. The trick is to ensure you are using the correct gauge needle, landmark correctly first, pull the skin tightly to one side, and inject smoothly. The Z track method for IMs has been proven to be most effective and safe. Also, the ventrogluteal site is now recommended, since you could potentially hit the sciatic nerve. Better safe than sorry.
First of all, whoever told you that you could possibly hit the sciatic nerve is full of it.
I beg to differ. It happened to me. Demerol IM, hit my sciatic nerve. That was 19 years ago and I still have pain at the injection site, especially if I get bumped there.
I'm 5'1" and weighed about 95 lbs at the time, not sure if that made a difference, but to make a sweeping generalization such as yours isn't a good idea.
OP: I almost never use either gluteal muscle site. For small amounts I'll use the deltoid; if I have a larger amount or need a bigger muscle to go into, I have had a lot of success with the vastus lateralis.
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Sciatic nerve injuries are definitely possible. Don't forget, not everyone's anatomy is textbook. (Ask anyone who's cathed a lot of females, for example) Here's a quote from Medscape:
http://www.medscape.com/viewarticle/551320_3
Many nursing schools are now telling the students to stay away from dorsogluteal injections as much as possible due to risk of sciatic injury.