A ventrogluteal injection is an IM injection into an area on the side of your hip known as the ventrogluteal site. Which site is best for IM injection? Intramuscular injections are often given in the following areas: Deltoid muscle of the arm.
The deltoid muscle is the site most typically used for vaccines. Vastus lateralis muscle of the thigh. Ventrogluteal muscle of the hip. Dorsogluteal muscles of the buttocks. Can a shot hit a nerve? Post-injection nerve damage can result from direct needle trauma, chemical irritation, toxic action of the injected solution, and neuritis or fibrotic changes.
Most patients present with an inability to lift their arm or have paralysis of the limb after IM injection. How do you give a deep intramuscular injection? Hold the skin around where you will give the injection: With your free hand, gently press on and pull the skin so that it is slightly tight.
Insert the needle into the muscle: Hold the syringe barrel tightly and use your wrist to inject the needle through the skin and into the muscle at a 90 degree angle. What is the Z track method? When a medication is injected directly into muscle, it is called an intramuscular injection IM. The Z-track method is a type of IM injection technique used to prevent tracking leakage of the medication into the subcutaneous tissue underneath the skin.
These injection locations allow for a high degree of safety, reliability and accessibility when a patient is lying supine, prone or in side lying position. The sites can support large volumes from 2 to 5mL and absorb quickly into the bloodstream. The deltoid is a small volume muscle and has longer peak plasma concentration times for drugs like epinephrine. However, the absorption of SQ injections, whether intended or not intended, can be improved by applying heat or massage.
IM injections have more desirable peak effect times when compared to SQ injections Morphine onset IM: 30 — 90 minutes, SQ: 50 — 90 minutes , but are less desirable given risk of hematoma and increased site pain. Most injectable opioids are marketed for IV and IM injections, but the following medications are commonly used SQ: fentanyl, morphine, and hydromorphone.
Epinephrine Adrenalin Administration of this drug needs more knowledge than meets the eye. There are 3 studied routes for epinephrine administration: IM in the deltoid muscle, SQ in the upper arm, and IM in the lateral thigh. IM epinephrine administered in the lateral thigh using an autoinjector has the fastest increase in serum epinephrine compare to SQ administration. So, IM epinephrine into the lateral thigh is the preferred route of administration. However, this information cannot be explicitly extrapolated to a syringe used subcutaneously in the upper arm or an intramuscular injection in the deltoid muscle.
Additionally, the effects of obesity and other absorption anomalies are not clear. While this data can be left up to interpretation, IM use of epinephrine is the first line especially when utilizing auto injectors.
Insulin Subcutaneous route of administration is a mainstay for insulin. The two routes have drastic differences in pharmacokinetics as shown below Table 3 :.
The IV route properties allow it to be the desirable route when treating hyperkalemia given the faster onset allowing for quicker movement of potassium intracellularly. Subcutaneous dosing produces gentler effects on glucose or electrolytes.
IV insulin may be ideal for a patient on the threshold of DKA, but not yet ready for an insulin drip. While there are many formulations of insulin, only insulin regular has been studied intravenously. Hypoglycemia treatment is the backbone of glucagon use, but do not forget beta blocker overdose and gastrointestinal diagnostic aids Table 4. While each route has variable times of onset, peak effects are similar among the 3 groups. The IV route is generally retained for beta blocker overdose and hypoglycemia.
Doses greater than 1 mg IV are likely to induce a strong emetic response. IM and SQ dosing are more often utilized for patient comfort. There are a 2 agents approved for intramuscular use in intubation: ketamine and succinylcholine.
The dosing and pharmacokinetic differences are noted. Tables 5 and 6. The muscle thicknesses at this point have also been measured ultrasonographically. The results were evaluated by SPSS statistical software programme. Mann-Whitney U test were used to compare the differences. Eleven of the patients were woman, and 14 of them were men. The distance of this point to the spina iliaca anterior superior obliquely is 9.
There was a significant difference between the distance to the sciatic nerve of dorsogluteal and ventrogluteal injection sites while no significant differences were found between the muscle thickness of the ventrogluteal and dorsogluteal injections sites.
This point seems very safe to inject but in emergency cases and in unstable patients small deflections could cause siatic nerve injuries. It is known that the muscle thickness at the injection side is important for emulsion of the drugs.
No statistical difference has been found between the muscle thickness of the ventrogluteal and dorsogluteal injections sites p There are different sites for injection such as thigh, deltoid, dorsogluteal and ventrogluteal site.
All of them have some advantages and disadvantages to each other. For dorsogluteal injections, the sciatic nerve and superior gluteal artery lies very near to the injection site, so great caution should be taken during the procedure. On the other hand, the ventrogluteal side has a thicker gluteal muscle layer and thinner fat layer and is free of penetrating nerves and blood vessels [4].
Studies have shown that adults with lower BMI and children have a higher risk of injury because of a thinner gluteal fat pad [2]. Especially for this kind of patients, it is better to choose an alternative injection site rather than dorsogluteal point.
Also in many guidelines this dorsogluteal site is contraindicated for children. But traditionally in many settings dorsogluteal site is the first choice to inject.
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