Using Ventrogluteal Site In Intramuscular Injections Is A .
International Journal of Caring SciencesMay-August 2015 Volume 8 Issue 2Page 507Review ArticleUsing Ventrogluteal Site in Intramuscular Injections is a Priority or anAlternative?Dilek Kara, MSc, InstructorUludag University School of Health, Department of Nursing, Bursa, TurkeyDerya Uzelli, MSc, InstructorIzmir Katip Çelebi University Faculty of Health Sciences, Department of Nursing, Izmir, TurkeyDilek Karaman, MSc, InstructorBülent Ecevit University Ahmet Erdoğan Health Services Vocational School, Department of Health CareServices, Aged Care Program, Kozlu, Zonguldak, TurkeyCorrespondence: Dilek Kara, Uludag University School of Health, Department of Nursing, 16059 Görükle/Bursa,Turkey. e-mail: dilekkara15@hotmail.comAbstractOne of the most commonly used treatment modality in injection applications is intramuscular injection application.Despite it considered as a simple technique, when intramuscular injection process is not done carefully, it can causeserious complications. The injection site that used for intramuscular injection is one of the most important determinantsof complications. As well as selection of site for intramuscular injection depends on many factors, it is reported thatclinical practitioners often preffer dorsogluteal site. With studies in recent years, it is recommended to use ofventrogluteal site instead of dorsogluteal site for injection because of it is away from the sciatic nerve and large bloodvessels, it is more easy to identify and for reasons such as the subcutanous tissue is being more thinner for intramuscularinjection. However, despite the ventrogluteal site is identificated as the safest area in intramuscular injection practices, itappears that the health professionals working in different countries often use dorsogluteal site. For this reason, it isneeded to make this compilation study for discuss the advantages of use of ventrogluteal site towards dorsogluteal site inintramuscular injection applications, detection of reliable injection site, the disadvantages and reasons of practitioners’use of dorsogluteal site. This compilation study was conducted in order to contribute to make the health professionals,particularly nurses, apply safe intramuscular injections with evaluating the effectiveness of ventrogluteal site usage thatseen as an alternative site and the disadvantages of dorsogluteal site with the results of studies and literature reviews.Key words: Intramuscular injection, Injection site, Dorsogluteal site, Ventrogluteal site.IntroductionToday, injection applications are the most commonlyused forms of pharmacological treatment (Chung etal., 2002, Tuğrul and Denat, 2014). One of the mostcommonly used treatment modality in injectionapplications is intramuscular injection application(Kilic et al., 2014, Tuğrul and Denat, 2014). Inintramuscular injections, the drug is introduced intothe muscle tissue. Because of the muscle tissue isrich in terms of the vein deposits, absorption of drugsdelivered via intramuscular injection is faster thansubcutaneous application and it can be given thatintense drugs which have high irritant effect into thedeep muscle tissue (Berman et al., 2008, g2008). Despite it considered as a simple technique,when intramuscular injection process is not donecarefully, it can cause serious complications. Thesecomplications can be listed as abscess, necrosis,hematoma, ecchymosis, infection, pain, periostitis,vascular and nerve injury (Gülnar and Çalışkan,2014, Hogston and Simpson, 2002, Kaya et al., 2015,Nicoll and Hesby, 2002, Small, 2004). In theliterature, it is stated that, in case of healthprofessionals have the necessary knowledge andskills about intramuscular injections, thesecomplications can be prevent or reduced (Chan et al.,2006, Cocaman and Murray, 2008, Pandian et al.,2006; Stinger et al., 2010).
International Journal of Caring SciencesThe injection site that used for intramuscularinjection is one of the most important determinants ofcomplications (Nicoll and Hesby, 2002, Gülnar andÇalışkan, 2014). In the literature; it is emphasizedthat it is important to choose a safe area away fromthe large blood vessels, nerve and bone structures inintramuscular injection practices (Cocoman andMurray, 2010, Kozier and Berman, 2008, Ramontand Niedringhaus, 2004). The areas used forintramuscular injection practices are reported as;dorsogluteal site, ventrogluteal site, deltoid muscle,vastus literalis muscle and the rectus femoris muscle(Gülnar and Çalışkan, 2014, Hunter, 2008, Kilic etal., 2014, Soanes, 2000).As well as selection of site for intramuscularinjection depends on many factors, it is reported thatclinical practitioners often preffer dorsogluteal site.Considering the work on the subject done byEngstrom et al (2000); it have been found thatmajority of nurses prefer the dorsogluteal site ininjection practices. In their study, Floyd and Meyer(2007) stated that 99% of nurses use dorsoglutealmuscle, 9% of nurses use ventrogluteal site for thepurpose of intramuscular injection. In Walsh anBrophy’s study (2011), they stated that 71% of thenurses prefer to dorsogluteal site for intramuscularinjection. In the studies which are handled in Turkey,it have been reported that the majority of nursesprefer to dorsogluteal site during injectionapplications (Gülnar and Çalışkan, 2014, Güneş etal., 2008, Tuğrul and Denat, 2014).In a study carried out by Cocaman and Murray(2008); it is stated that health professionals shouldhave more current information about the injectionsites. With studies in recent years, it is recommendedto use of ventrogluteal site instead of dorsoglutealsite for injection because of it is away from thesciatic nerve and large blood vessels, it is more easyto identify and for reasons such as the subcutanoustissue is being more thinner for intramuscularinjection (Carter and Mccoy, 2008, Cocoman andMurray, 2008, Malkin, 2008, Walsh and Brophy,2011). However, despite the ventrogluteal site isidentificated as the safest area in intramuscularinjection practices, it appears that the nurses workingin different countries often use dorsogluteal site. Forthis reason, it is needed to make this compilationstudy for discuss the advantages of use ofventrogluteal site towards dorsogluteal site inintramuscular injection applications, detection ofreliable injection site, the disadvantages and reasonsof practitioners’ use of dorsogluteal ay-August 2015 Volume 8 Issue 2Page 508ObjectiveThis compilation study was conducted in order tocontribute to make the health professionals,particularly nurses, apply safe intramuscularinjections with evaluating the effectiveness ofventrogluteal site usage that seen as an alternativesite and the disadvantages of dorsogluteal site withthe results of studies and literature reviews.Disadvantages of Using Dorsogluteal SiteDorsogluteal site that often preferred inintramuscular injection practies consists of thegluteus maximus muscle (Güneş et al., 2008).Despite its usage by health care professionalstraditionally, in the literature it is stated thatdorsogluteal site is most risky site for injectionbecause of it is rich in terms of vein number, it isclose to the sciatic nerve and its subcutaneous tissueis thicker than other sites (Newton et al., 1992; Nicolland Hesby 2002, Roger and King 2000, Workman,1999, Wynaden et al., 2006).In literature, it is stated that the most importantcomplication which may develop after injection ofdorsogluteal site is sciatic nerve injury (Beyea andNicoll 1995, Greenway, 2014, Small, 2004; Yavuzand Karabacak, 2011). Injection practises in this siteis not recommended because of the coincide ofneedle with the sciatic nerve could cause pain,temporary or permanent paralysis in lower legs andfeet (Malkin, 2008, Nicoll and Hesby, 2002,Ramtahal et al., 2006). Craven and Hirnle (2009) intheir study, they stated that this site should not beused for the purpose of intramuscular injectionbecause of the dorsogluteal site is close to sciaticnerve and superior gluteal artery, injection could beaccidentally implemented to subcutaneous tissue.Taylor et al. (2008) also stated that the dorsoglutealsite is a site used for intramuscular injection; theadipose tissue in this site is thick and the injection isoften applied to the subcutaneous adipose tissueinstead of the muscle tissue. Beyea and Nicholl(1995) reported that dorsogluteal site is most riskysite for intramuscular injection due to it is rich interms of blood vessels and its subcutaneous tissue isthicker than the other sites. Small (2004) in his study,he stated that in intramuscular injections made to thedorsogluteal site, it is common that accidentally druginjection to subcutaneous tissue and inadequate drugabsorption, tissue irritation and pain occur morefrequently. In the study carried by Nispet (2006), ithas inspected that the deep adipose tissue and it hasfound that 72% of needles applied to thesubcutaneous tissue used in dorsogluteal site. Chan et
International Journal of Caring Sciencesal. (2006) in a study conducted in a similar manner;they found in injection applications that made todorsogluteal area includes just 32% of intramuscularinjection, 68% of it is applied to the subcutaneoustissue. The study carried out by Elizabeth andWinslow (1996) stated that the injections indorsogluteal site has been injected (95% of womenand 85% of men) into the adipose tissue. In anotherstudy, the injections in dorsogluteal site were madespecifically for the mildly obese and obeseindividuals were made adipose tissue and as a resultof this, these individuals get low drug absorptionrates and it is reported the tissue irritation occursmore frequently (Zaybak et al., 2007).The Studies Reviewed The Efficacy of UsingVentrogluteal SiteIn the literature; using ventrogluteal site inintramuscular injection applications has manyadvantages and therefore it should be defined as thefirst intramuscular injection site are reported(DeLaune and Ladner, 2002, Kilic et al., 2014,Yavuz and Karabacak, 2011). However, despide ithas being reported as such in literature, it is statedthat most of the health professionals are not aware ofthe advantages of the using ventrogluteal site inintramuscular injection practices (Donaldson andGreen, 2005, Greenway, 2004, Kilic et al., 2014).Ventrogluteal site, firstly used in the beginning of1950’s by Hochstetter as an intramuscular injectionsite (Greenway, 2014). This site that refersanterolateral (side hip), is composed of gluteusmedius and the gluteus minimus muscle (Nicoll andHesby, 2002, Rodger and King, 2000). In this site,the thickness of subcutaneous tissue is less than otherinjection sites (Hemsworth, 2000, Hunter, 2008) andin this site, nerves and blood vessels are relativelyless. Furthermore, in this site, the muscles are largeand well established. For the injection, it is easy tofind the limit points. Due to its larger ventrogluteal ofmuscle mass, in terms of complications, injectionsdone in this area are reported to be more reliable(Güneş et al., 2008).In the literature, these are stated that the muscles inventrogluteal site are well developed in adults andchildren, it can be used in children after sevenmonths, it is also a suitable site for intense andirritating drugs (Cook and Murtagh, 2006, Gray andMiller, 2008, Tuğrul and Denat, 2014). However,whereas, if there is any complications developed atthe injection site and the children have not reachseven month, it also higlighted ventrogluteal siteshould not be used for injection (Carter and May-August 2015 Volume 8 Issue 2Page 5092008, Cocoman and Murray, 2008).In the literature;ventrogluteal site can be easily applied when thepatient in lying supine, prone or side-lying position,it is easier to position the patient when using thisinjection site (Hemswort, 2000, Potter and Perry,2005, Zimmermann, 2007). Nevertheless, it isreported that this injection site can be used on thinand mildly obese patients, but the length of theneedle should be greater for obese individuals (Carterand Mccoy, 2008, Cocoman and Murray, 2008). Inthe studies, it has been stated that in an intramuscularinjection practice which made with 21 gauge needle,in terms of achieving the needle into the muscletissue, the ventrogluteal site is specified reliable thandorsogluteal site (Diegle and Deeks, 2000; Nisbet,2006).Ventrogluteal site is considered as the most reliableand least painfull site for the injection applications.The reason for this; there is no large blood vessels ornerves and it is far from the bone tissue inventrogluteal site (Beecroft and Redick 1990,Donaldson and Green, 2005, Nicoll and Hesby,2002). Covington and Trattler (2007) in their study,they stated that the ventrogluteal site is the safest andleast painful site for intramuscular injections.Moharreri et al. (2007) in their study, it isrecommended to select ventrogluteal site forintramuscular injection because of it causes less painand bleeding than dorsogluteal site. In a study thatexamined the effects of site that used inintramuscular injection applications on pain byGüneş et al. (2013), it was found that the afterinjections in ventrogluteal site, pain level of patients’were found to be lower than dorsogluteal site’susage.The Studies Focused on Review The Reliability ofThe Detection of Ventrogluteal SiteToday, there is two method are used in detection ofventrogluteal site that “V method” and “G method”(Kaya et al., 2015). In “V method”s usage, if nurseuse patient’s left side hip, uses her right hand, ifnurse use right side hip she puts his left hand on greattrochanter of femur. Nurse moves her thumb tocrotch of patient. Nurse puts her index finger to theanterior superior iliac crest, by open her middlefinger to posterior superior iliac crest, she creates a“V” site. Injection site is the midpoint of this “V” site(Figure 1) (Cook and Murtagh, 2006, Güneş et al.,2008, Kilic et al., 2014). However, it is stated thatthis method was not adopted in many nurses, becauseof the differences in the nurse’s hand structure andpatient’s body structure this method is not practical(Güneş et al., 2008).
International Journal of Caring SciencesMay-August 2015 Volume 8 Issue 2Page 510Figure 1. Determination according to the V method of intramuscular injection site in ventrogluteal site.(Reference; Kaya et al. The reliability of site determination methods in ventrogluteal area injection: a cross-sectionalstudy. International Journal of Nursing Studies, 2015; 52: 355–360).Güneş et al (2008) in a study conducted in order toexamine the reliability of the detection method; itwas stated that this method is reliable on body massindex of all the individuals between 18.5-29.9(100%), 15% of individuals between 30-39.9, and allof the individuals who are 40 or over, this method isnot reliable. Also in this study; it is indicated that thereliability of the method used decrease in particularlyobese individuals. In method of detecting theventrogluteal site by using “Geometric methods (Gmethod)”, by referencing the bone prominences, andimaginary lines are drawn in between the bone ends.With this, an imaginary line is drawn from thegreater trochanter to the iliac crest of the iliactubercule, then to the anterosuperior iliac spine, andfrom the greater trochanter to the anterosuperior iliacspine. Thus, a triangle is created by imaginary lines.After that, median lines are drawn for every singlecorner of triangle. As shown in Fig. 2, theconvergence point of the three median lines is thebarycenter for the triangle. In other words, thisbarycenter is the needle entry point for intramuscularinjections (Meneses, 2007; Kaya et al., 2015). In astudy carried out by Meneses (2007), it is found thatG method is 100% reliable in determination of theventrogluteal site in intramuscular injections. In astudy conducted to examine the reliability of the twodifferent methods that “V method” and “G method”which are used in determine the ventrogluteal site byKaya et al (2015), it is found that in the site whereused the G method, the thickness of subcutaneoustissue less than the site defined by the V method, andthe thickness of gluteus minimus muscle has und larger. Thus, in the light of results of the study;G method is determined as a realiable method fordetermination of ventrogluteal site.Reasons of Not Preference of The VentroglutealSite in PracticesIn the literature, it is stated that the healthprofessionals’ knowledge and skills in the use ofventrogluteal site are not adequate and therefore, theyare reluctant to give injections in this site.(Greenway, 2004, Nioll and Hesby, 2002). Floyd andMeyer (2007), stated that in some nursing schools,injection techniques on ventrogluteal site has beentaught, but students rarely observed this technique inpractice.In lifht of the studies, when it is examined that thereasons to not use this site in practice; it is shownthat they believe ventrogluteal site is not secure asdorsogluteal site and difficulties in experiences ofdetermination of the site. In addition, if the injectionhave done in this site, a vast majority of healthprofessionals think they can harm the patients (Cookand Murtagh, 2006, Donaldson and Green, 2005,Greenway, 2004).Wyaden et al. (2006) in their study; they stated thatnurses do not use the ventrogluteal site constantly,they are extremely resistant to change and it is verydifficult to give up this habit for them. Nurses in thisstudy, as justification for their not use in this site,they stated that the ventrogluteal site is not secure asdorsogluteal site they think, it is difficult to identifythis site anatomically and injection between the
International Journal of Caring Sciencesforefinger and middle finger is hard to apply.Alannah and Floyd (2007), in their study, as thereason for nurses do not use this injection site; theystated that it is difficult to identify this site, theevidences on this issue is not enough to changenurses’ practice, nurses slog to change theiraccustomed method with another method. In theMay-August 2015 Volume 8 Issue 2Page 511study carried out by Tuğrul and Denat (2014), it isindicated that most of the nurses have insufficientinformation about ventrogluteal site, they found thisarea safe, but they are accustomed for other injectionsite and for this reason they not prefer to useventrogluteal site.Figure 2. Determination according to the G method of intramuscular injection site(Reference; Kaya et al. The reliability of site determination methods in ventrogluteal area injection: a crosssectional study. International Journal of Nursing Studies, 2015; 52: 355–360).ConclusionIn the light of literature and studies, as a result of thiscompilation we made; it is risky that usingdorsogluteal site in intramuscular injection practices,using ventrogluteal site have many advantages andfor this reason it was concluded that usingventrogluteal site should not be defined as aalternative, it should be defined as a priority site forintramuscular injection practices. Furthermore,although the ventrogluteal site is defined as the safeinjection site, it was seen that most of healthprofessionals in many applications, they not preferthe ventrogluteal site. Based on these results; To teach the intramuscular injection practiceinto the ventrogluteal site as applied within scope ofthe in-service training for health professionals andregulation of interval training program to make itpracticable, To share the results of studies conducted onthe use of ventrogluteal site in intramuscularinjections, To do more studies regarding to thereliability of detection method of ventrogluteal site,www.internationaljournalofcaringsciences.org It is recommended to emphasize to especiallynursing students, health professionels, students andclinical practitioners that it sh
less. Furthermore, in this site, the muscles are large and well established. For the injection, it is easy to find the limit points. Due to its larger ventrogluteal of muscle mass, in terms of complications, injections done in this area are reported to be more reliable (Güneş et al., 2008)
Self-Injection . What is an Intramuscular Injection? An intramuscular injection, as illustrated in the figure below, delivers medication deep into the muscle tissue. This allows the medication to be quickly absorbed into the bloodstream f
SOP: INTRAMUSCULAR INJECTIONS IN SWINE 2 Needle Selection Guide for Intramuscular Injections (adapted from National Hog Farmer) Size of Pig Gauge Length Baby Pigs (up to 25kg) 18 or 20 5/8 to ½ inch Grower (25 to 70kg) 16 or 1
Jun 26, 2021 · Resume economic, educational, and other societal-level endeavors. Understanding Herd Immunity Vaccination or infection provide immunity . MECHANISM mRNA mRNA Adenovirus vector ADMINISTRATION Intramuscular Intramuscular Intramuscular STORAGE
However, few evidence-based guidelines for IM injections are available, and discrepancies within nursing textbooks have been noted. 10-13 In addition, current guidelines do not address administration of large-volume injections. The dorsogluteal site for IM injections is the one nurses have the most experience using, as this is what is tradi-File Size: 256KBPage Count: 6Explore furtherLarge-volume IM injections: A review of best practices .www.oncologynurseadvisor.comInjection Safety CDCwww.cdc.govGUIDELINES ON THE ADMINISTRATION OF INTRAMUSCULAR www.olchc.ieSECTION 20: PEDIATRICS: Medication: Intramuscular .www.vnhcsb.orgIntramuscular injection: Locations and administrationwww.medicalnewstoday.comRecommended to you b
Administer the injection according to the local guidelines for performing large volume intramuscular injections. NOTE: Due to the proximity of the underlying sciatic nerve, caution should be taken if administering FASLODEX at the dorsogluteal injection site [see . Warnings and Precautions (5.3) and . Adverse Reactions (6.1)].File Size: 2MB
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The Roundtable API procedure is deployed as source and is located in /rtb/p/rtb_api.p. Complete details on using the API can be found in the definitions section of the API procedure. 3.2 Example – Creating a Task 3.2.1 Initializing the API In its most basic form, initializing the API is just a matter running the API procedure
