The ventrogluteal site involves the gluteus medius and minimus muscles and is a safe injection site for adults and children. 5 The rectus femoris is no longer considered a safe injection site because of the risk of damage to the descending branch of the lateral circumflex femoral artery and the muscle branch of the femoral nerve to the vastus lateralis. If a needle hits the sciatic nerve, the patient may experience partial or permanent paralysis of the leg. Because of the sciatic nerve location, the dorsogluteal muscle is not recommended as an injection site. The location of underlying bones, nerves, and blood vessels and the volume of medication to be administered are also considered.
#VENTROGLUTEAL INJECTION SITE FREE#
Injection Sitesįor IM injections, the nurse selects a site that is free of pain, infection, necrosis, bruising, and abrasions.
#VENTROGLUTEAL INJECTION SITE SKIN#
The displacement of the skin and muscle layer closes off the needle track when the skin is released ( Figure 2). After the needle is withdrawn, the skin is released. After cleansing the site, the needle is injected deep into the muscle and the medication is injected slowly. The skin is held in this position until the injection has been administered. The overlying skin and subcutaneous tissues are pulled to the side with the ulnar side of the nondominant hand. 5 To use the Z-track method in an adult, the appropriate-size needle is attached to the syringe, and an IM site is selected. This technique, pulling the skin laterally before injection, prevents medication leakage into subcutaneous tissue, seals medication in the muscle, and minimizes irritation. The Z-track method can be used (except with infant vaccination where skin is compressed) provided that the overlying tissue can be displaced. There may be exceptions for specific medications. 5 For smaller adults or those with less muscle mass, the volume injected may need to be adjusted. For a well-developed adult, no more than 3 ml of medication should be administered in a single IM injection because the muscle tissue does not absorb it well in larger volumes. Muscle tissue is less sensitive than subcutaneous tissue to irritating and viscous medications. 8 The recommended route and site for each vaccine is included in the manufacturer’s instructions for use. More research is needed to investigate the practice of aspiration before administering an IM injection with medications other than vaccines. 2 For all other medications, there is no evidence to either support or abandon the practice of aspiration before administration.
2 The vastus lateralis and deltoid muscle are the only two sites recommended for vaccine administration because these sites do not contain large vessels that are within reach of the needle. 5Īspiration before injection and slow injection of the medication are not supported by research for vaccine administration.
When possible, IM injections should be avoided in muscles that are emaciated or atrophied because these muscles absorb medication poorly. 2 IM injection sites should also be rotated to decrease the risk for hypertrophy. IM injections should be administered so that the needle is perpendicular to the patient’s body or as close to a 90-degree angle as possible.
2, 7 The needle must be long enough to reach the muscle tissue, but not too long to present the risk of hitting underlying neurovascular structures or bone. undefined#ref2">2, 5 The appropriate needle length is determined by the patient’s weight and age and the amount of adipose tissue in the chosen injection site. The needle is inserted at a 90-degree angle this varies from the angle used for subcutaneous and intradermal injections ( Figure 1). Any factor that interferes with local tissue blood flow affects the rate and extent of drug absorption.Īn IM injection may require a longer and larger-gauge needle to penetrate deep muscle tissue. This rich blood supply, however, increases the risk for injecting drugs directly into blood vessels. The IM injection route deposits medication into deep muscle tissue, which has a rich blood supply, allowing medication to be absorbed faster than it would be by the subcutaneous route. Take steps to eliminate interruptions and distractions during medication preparation. Consider contacting the practitioner for an alternative, preferred route of medication administration. Intramuscular (IM) injections have been associated with adverse effects and pain, and this route of medication injection should be used as a last resort. Medication Administration: Intramuscular Injection - CE ALERT
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