best site for IM injection

FionaDikkenberg

Hi, im a 4th yr general nursing student,

whilst doing a quick review of the literature, ive come to the conclusion that the ventrogluteal site is the preferred site for IM injections, as opposed to teh dorsogluteal site.
however, i cant seem to find and random control trials that compare the two. does anyone have any suggestions of where i might find these? i have access to ovid, cinahl, BNI, science direct, wiley interscience, pubmed and TRIP database.
thanks

wireless101

upper lateral quadrant of buttocks?

FionaDikkenberg

yea, im lookin for preferably randomized control trials including the hip site and upper outer quadrant. from what i can see, all the literature is in favour of the hip site, however, i cant find any randomized control trials comparing the two to justify it!

DrIndy

This is a few papers of note - this points out that despite the general feeling is that gluteal is better, the efficacy drops in women over men due to the fact that women have a much greater deposition of adipose tissue over their derriere than men resulting in most intramuscular injections in women being in fact, inter-adipose injections with a standard 37mm needle.

Thus for women, you in fact need a much longer or 3" needle to suitably penetrate their bum to deliver the injection correctly!

I do draw you to the contribution from Tallaght Hospital - I know the gang who did their research and their findings were pretty stark - 56% of men got the injection in the muscle versus only 8% of women! But the interesting thing is of the female recruits - this applied not only to the larger ladies, but even women who considered themselves to have a well toned derriere (and a normal BMI range) - they still carried enough padding for IM injections to be ineffective! We need longer needles for women!

Here's the article:

http://www.bmj.com/cgi/eletters/332/7542/637#130393

Here is the quote from the AMNCH response

Intramuscular injections into the buttocks: are they truly intramuscular?

Sir: We read with great interest the excellent and informative article by Nisbet AC [1] regarding intramuscular injections in the increasingly obese population. We found their contribution to be well written, interesting and of important clinical significance. In the paper the author retrospectively reviews the pelvic computerised tomography CT) scans of 100 patients and measured the distance from the skin to ventrogluteal and dorsogluteal injection sites. The author concluded that the gluteal muscles are beyond the reach of the standard needles used for intramuscular injection.

This study is supported by our findings from a recent prospective study of 50 patients (25 males, 25 females, mean age 53 years, body mass index ranging from 17.7-42.3 kg/m2) undergoing CT scanning of their pelvis and receiving intramuscular buttock injections [2]. In our study, each patient received an IM injection of their prescribed medication along with 1 mL of air into the upper outer quadrant of the buttocks prior to their CT. CT images were subsequently analyzed by two radiologists to determine the position of the injected air bubble. Body mass index (BMI), distance to injection site, subcutaneous fat and muscle thickness were measured in each patient. In our study, only 32% of patients had successful intramuscular injections, with the majority of injections being subcutaneous. 56% of males had intramuscular injections while in females, the efficacy rate was significantly lower at 8%. The rate of successful intramuscular injection was compared with gender and also body mass index. It was found that the probability of unsuccessful intramuscular injection correlated with increased body mass index but also that in patients with normal body mass indices (especially females) there was a significant rate of unsuccessful intramuscular injection.

In, conclusion, these two studies raise the clinically important issue of effectiveness of intramuscular injections in the increasingly obese population. As many drugs are administered via the intramuscular injection in to the buttock consideration must be given to the efficacy of drug delivery and hence drug distribution even in patients with body mass indices within the normal limits.

References

1. Nisbet [AC]. Intramuscular gluteal injections in the increasingly obese population: retrospective study. BMJ 2006: 332: 637-638

2. Chan VO, Colville J, Persaud T, Buckley O, Hamilton S, Torreggiani WC. Intramuscular injections into the buttocks: are they truly intramuscular? Eur J Radiol 2006 Feb 20 (Epub ahead of print)

Competing interests: None declared

Big_G

This doesn't really help, but I know of one OMFS who suggests the tongue as one of the best IM injection sites. No adipose tissue there.

locum-motion

Big_G wrote: »

This doesn't really help, but I know of one OMFS who suggests the tongue as one of the best IM injection sites. No adipose tissue there.

Surely there's loads of nociceptors on the tongue, though, isn't there?
It can be very sore if you accidentally bite your tongue.
And, sorry for my ignorance, but what does OMFS stand for?

Shootenanny

OMFS=Oral and Maxillofacial Surgeon

I never ever thought of the tongue for IM injections!..can't imagine any patient letting you stick a needle into their tongue but it would ensure that the drug is going where its meant to i suppose..

i did a lit review on this before (unfortunately citations long gone) but I can't recall any randomised control trials comparing ventrogluteal and dorsogluteal site... the ventrogluteal site is the preferred site but very few nurses use it...dont really understand why because the hip site is just so much more practical ..

SomeDose

I can't offer much insight into the effectiveness of the different sites of IM administration but, from a practical point of view, bear in mind that in many patient populations there's no advantage or indeed justification for using the IM route. Speaking from a surgical perspective where the oral route can often be contraindicated, it's very common to see analgesia and anti-emetics prescribed as PO/IV/IM and it's left up to the nurse to decide on the most appropriate route. In the vast majority of cases the IV or indeed S/C route is a much better option than IM and carry fewer risks and complications.