Has it been a while since you’ve gotten the latest scoop on Intramuscular injections? Here are some facts (evidenced-based, too!) that all nurses should know about it.
1. The Most Popular Site: The Deltoid. That seems to have a clear explanation, since it is the most accessible (no need to drop those drawers!).
2. The Dorsogluteal Site (the upper butt area) Is the Most Dangerous Site to inject in.
3. The sciatic nerve is located near this region.It is actually a few centimeters away, and can be a painful complication if struck. The Superior Gluteal Artery is also near the this region. Obviously, we don’t want to turn our IM injection into an IV push!
4. Fat can hurt. As you might imagine, people have a wide variation in how much fat tissue they have back there. An experiment cited in scholarly articles states that IM injections attempted by nurses and nursing students in the DG site only hit muscle 5% of the time in females and 15% in males! Other studies say that nurses hit the right site just a bit more than half the time – which is still pretty dismal.
5. Older Nurses Are More Likely To Give Dangerous IM Injections. According to a summary of a journal article by the American Journal of Nursing, the older a nurse is, the more likely he/she continues to give Dorsogluteal injections. Inversely, the younger a nurse is, the more likely they are to give injections in the safest site.
6. The Safest Site: Ventrogluteal Site. This is the hip area that you find by putting your hand and making the ‘V’ shape with your fingers. It’s been found by more than enough studies to be the safest. It’s less likely to have a thick layer of fat around it, and has no major nerves in the area.
7. IM Injections Were Done By Doctors until the 1960’s. Even then, it took some time for the practice to take hold and for doctors to trust nurses with this task!
8. Z-Track is Okay. It’s helpful, and it helps prevent medication seepage and heavy bleeding with an IM injection. Don’t pull the Deltoid muscle too far (it’s a small muscle) and you should be fine!
9. Aspirating is Unnecessary but is also harmless. If you’re used to doing it, that’s okay – but many facilities and authoritative sources are not requiring it anymore. The reason cited is that it’s actually not a reliable indication that you’re not hitting an artery – plus you have to do it for ten seconds for it to be effective anyways!
Kevin is President of Brilliant Nurse, and a Psychiatric RN who mass-administers IM injections in conditions too crazy to write about publicly!