![]() ![]() ![]() The Ventrogluteal site provides the greatest thickness of gluteal muscle (consisting of both the gluteus medius and gluteus minimus), is free of penetrating nerves and blood vessels, and has a narrower layer of fat of consistent thinness than is present in the dorsogluteal. It is important to limit volume of medication based upon size of muscle, ie. Insert the needle at a right angle to the skin in the centre of the inverted triangleĬaution: This is a small site – give only 1-2ml or less of fluid in this site.Stretch the skin and then bunch up the muscle.The top border of an inverted triangle is two finger widths down from the acromion process.Find the knobbly top of the arm (acromion process).Giving an IM injection into the deltoid site 9 This is a relatively small area and muscle mass, especially in atrophied patients compounded by the close proximity of the radial nerve, brachial artery and bony processes to this site means that more substantial injuries can occur. This site is used for immunisations/non-irritating medications, hence vaccines which are usually small in volume tend to be administered into the deltoid site. The ease of access, especially in an outpatient setting, possibly adds to the frequency with which the deltoid site is used for IM injections. Too much fatty tissue – poor absorption rates.Contact with the superior gluteal artery.Risks associated with an IM injection to the dorsogluteal site Palpating the ileum and the trochanter is important using visual calculations alone can result in injection being placed too low and injuries to other structures. 7 The sciatic nerve and superior gluteal artery lie only a few centimetres distal to the injection site, thus great care needs to be taken to identify landmarks accurately. The presence of major nerves and blood vessels, the relatively slow uptake of medication from this site compared with others and the thick layer of adipose tissue commonly associated with it, makes this site problematic. Up to 3ml of fluid can be given in this site.Insert the needle at a right angle to the skin Hold the syringe like a pencil or dart.After locating the centre of the imaginary line, find a point one inch toward the head.Draw an imaginary line between the two bones.Many people have ‘dimples’ over this bone It is the knobbly top portion of the long bone in the upper leg (femur). IM injection into the Gluteus medius site (buttock) This site is commonly referred to as the outer upper quadrant and is contraindicated in children. Needle length used is usually 2.5cm or less. This site can be used for infants, children and adults. However, the main disadvantage is that injections in the Rectus femoris site may cause considerable discomfort. ![]() The thigh may be utilised when other sites are contraindicated or by clients who administer their own medication, as it is readily available in the sitting or lying back position. Up to 2ml of fluid may be given into this site.Insert the needle at a right angle to the skin (90°) straight in.One hand’s width above the top of the knee becomes the lower border of the box One hand’s width below the groin becomes the upper border of the box To find the thigh injection site, make an imaginary box on the upper leg.5 Giving an IM injection into the Vastus lateralis site The uptake of drugs from the thigh region is slower than from the arm but faster than from the buttock, thus facilitating better drug serum concentrations than is possible with the gluteal muscles. Sites of the thigh (Rectus femoris and Vastus lateralis) 3 Furthermore, the technique and preparation by certain staff may not be substantiated by evidence. 3,4 It has been outlined that there are no working policies or procedures on administering injections to which nursing staff can refer. 2 Although IM injection is a commonplace nursing practice, there is a dearth of guidelines for nursing staff in this area. It should not be forgotten that among potential complications of IM injection are abscess, cellulites, tissue necrosis, granuloma, muscle fibrosis, contractures, haematoma and injury to blood vessels, bones and peripheral nerves. The importance of good injection technique cannot be understated. 1 This article aims to, raise awareness in relation to the injection sites used for intramuscular injection and, to highlight best practice in relation to IM injection administration. The administration of intramuscular injections is a common nursing intervention in clinical practice. Good injection technique can mean the difference between less pain and injury. ![]()
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