Intramuscular Injections: Not As Simple As They Seem
I don’t like giving shots in the hip/buttock/anywhere around there. I learned the method of finding the ventrogluteal muscle when I was in nursing school, and it is of little help to me in practice with patients who are standing or uncooperative (thus leaving very few). Most nurses seem to use some variation of what an old, old experienced nurse told me in clinicals: “poke around until you find a deep muscle and give it there.” But there are nerves and vesses lurking around in there, and that makes me nervous.
Intramuscular injections are tricky these days even if nurses know and use the correct and recommended landmarks because are patients are, shall we say, chubbier than ever before. I’ve used the longest needle I can find on some of them and remain afraid I’ve actually given a subcutaneous injection simply because the needle is not long enough to reach the muscle. Short of using a spinal needle, I don’t know how to solve this problem. If I have to give more than 2 mL of volume to someone, I can’t in good conscience use the deltoid, which may anyway be plagued with the same issues. I looked around online to see if anyone has any ideas for coping with this problem, and the answer seems to be simply that many nurses, like me, are secretly worried they’re giving subcutaneous injections unwittingly.
However, following best clinical practice is always the appropriate course of action, and for anything greater than 1 mL in adults this area is murky. Traditionally people get “a shot in the butt” (patients all say that, don’t they? “Are you going to give me a shot in the butt?”), and that is usually the dorsogluteal muscle, which is plagued with many horrors, including the sciatic nerve. Instead our options should be the ventrogluteal and, depending on which source you consult, the vastus lateralis (in the literature, I found limits from 1 to 5 mL for the vastus lateralis for adults; I was taught up to 3 mL in school). I like the vastus, personally. In the summer nobody has to get undressed, and I don’t have to mess around with poking and prodding for bony eminences and waving my fingers about in a “V” shape (that’s asking to get stuck, if you ask me).
Which brings me to the appropriate method of giving IM shots in the hip, or the ventrogluteal method. A good description can be found on Impacted Nurse’s site. I found Ian’s instructions easier to follow, but here is another set, from drugs.com:
“Place the heel of your hand on the hip bone at the top of the thigh. Your wrist will be in line with the person’s thigh. Point your thumb at the groin, fingers point to the person’s head. Form a “V” with your fingers by opening a space between your pointer finger and the other three fingers. Your little finger and ring finger will feel the edge of a bone along the fingertips. The place to give the shot is in the middle of the V-shaped triangle.”
As I’ve said, this is not practical for standing patients, and depending on what area of practice is involved it may ill advised to have a needle that close to your fingers. I can’t see myself chasing down a psychotic violent person with a syringe and a long needle and then doing all that positioning followed by putting the needle between my first two fingers. Still, whatever muscle group nurses choose, remember: “a shot in the butt” no longer means the dorsogluteal.
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