Running head: VENTROGLUTEAL VS DORSOGLUTEAL

Pain in Ventrogluteal vs. Dorsogluteal IM injection sites Fawn Beatty, Braydon Bird, Ryanne May, Lawrence Merket, and Jentry ielsen, Di!ie "tate #niversity

VENTROGLUTEAL VS DORSOGLUTEAL

Pain in Ventrogluteal vs. Dorsogluteal IM injection sites Many $eo$le are a%raid o% needles. May&e it's t(e sig(t o% t(e needle, )ay&e it's t(e &lood o%ten associated, or )ay&e it's t(e $ain. *(is $a$er addresses t(e $ain associated wit( IM injection in t(e gluteal region. *(e +uestion is w(et(er t(e dorsogluteal or ventrogluteal site is less $ain%ul. Five studies w(ic( %ocus on t(is su&ject are reviewed. *(e %indings indicate t(at t(e ventrogluteal site %or IM injection carries less risk %or injury, and )ay cause less $ain t(an t(e dorsogluteal site. Researc( reveals (owever, t(at t(e ventrogluteal site is used )uc( less &y nurses t(an t(e dorsogluteal site. More education a&out t(e decreased $ain and risk %or injury associated wit( t(e ventrogluteal site %or IM injection s(ould &e $rovided to nurses. ,ducation will (el$ nurses learn and %ollow evidence &ased $ractice. Practice Question Many nurses use t(e dorsogluteal site %or IM injections, even t(oug( evidence &ased $ractice suggests t(e ventrogluteal site is sa%er t(an t(e dorsogluteal. *(e +uestion w(ic( t(is $roject seeks to answer is w(et(er use o% t(e ventrogluteal site causes adult $atients less $ain t(an use o% t(e dorsogluteal site. P- Patient Population or Problem *(e $atient $o$ulation is adults. I- Intervention *(e intervention o% interest is IM injections in t(e ventrogluteal site. C- Comparison

VENTROGLUTEAL VS DORSOGLUTEAL

*(e co)$arison intervention is IM injections in t(e dorsogluteal site. O- Outcomes -(ic( site %or IM injection is associated wit( less $ain. The Following Question was Developed Does t(e ventrogluteal IM injection site cause adult $atients less $ain t(an t(e dorsogluteal site. Evidence *(is +uestion is a t(era$y +uestion, as it involves IM injection t(era$y. *(e )ain resource used to %ind articles on t(is su&ject was Health Source: Nursing/ Academic Edition (osted &y EBSCOhost. *(is data&ase, as accessed t(roug( Di!ie "tate #niverty's li&rary $age online, was invalua&le in t(is researc(. Search Items and esults o! Search "earc( ter)s develo$ed %ro) t(e PI/0 +uestion included1 2ventrogluteal,3 2dorsogluteal,3 2IM injection sites,3 and 2$ain, IM injections.3 /(anges )ade to t(e searc( ter)s included 2IM injection co)$lications,3 2dorsogluteal vs ventrogluteal.3 -e %ound 4 articles t(at address t(e di%%erences &etween dorsogluteal and ventrogluteal IM injection sites. *(ree literature reviews, one co(ort, and e!$ert article were reviewed %or t(is in%or)ation. Stud" One /arter5*e)$leton and Mc/oy 67889: $er%or)ed a syste)atic review o% %ive nursing %unda)entals te!t&ooks. *(e %ocus o% t(e review is w(at t(e te!t&ooks instruct and reco))end

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a&out IM injections, and several as$ects o% t(e injections are considered. *(e researc(ers %ound )any discre$ancies &etween t(e te!t&ooks in relation to w(ic( site t(ey reco))ended %or IM injection. ;ll %ive &ooks (ad instructions on (ow to %ind and use t(e ventrogluteal site, and t(ree s$eci%ically advised against t(e dorsogluteal site. *(ere were several reasons listed %or c(oosing t(e ventrogluteal site over t(e dorsogluteal site. 0ne reason was t(at it (ouses no )ajor nerves and &lood vessels, or e!cess adi$ose tissue. ;long wit( t(e te!t&ook review, t(e researc(ers did a survey o% nurses %ro) local clinical institutions. *(e study %ound t(at t(e dorsogluteal site was t(e $re%erred site %or seventy5%ive $ercent o% t(e 7< nurses w(o res$onded, even t(oug( )ost o% t(e te!t&ooks and ot(er literature suggest using t(e ventrogluteal site as t(e $re%erred location. *(is $a$er did not e!actly answer t(e +uestion $osed &y our grou$, &ut it did o%%er so)e insig(t into w(y t(e ventrogluteal site )ig(t &e less $ain%ul t(an t(e dorsogluteal. *(e $a$er also revealed t(at )any nurses use t(e dorsogluteal sig(t %or IM injection, des$ite )uc( researc( against suc( $ractice. Stud" Two /oco)an and Murray 67889: reviewed )any resources in an e%%ort to deter)ine &est $ractice %or IM injection site selection. *(e researc(ers reviewed %orty5%our te!t&ooks and journal articles written &etween =>?8 and 788<. *(e literature was )ostly %ro) ort( ;)erica and ,uro$e. Researc( revealed t(at t(e dorsogluteal site %or IM injection is t(e source o% )ore $otential injuries and co)$lications t(an t(e ventrogluteal site. -it( t(is understanding, t(e researc(ers wanted to %ind out w(y so )any nurses continue to use t(e dorsogluteal as t(e site o% c(oice. Review o% t(e literature %ound t(at ease o% locating t(e dorsogluteal site, and lack o% knowledge concerning t(e ventrogluteal site were t(e )ost likely reasons %or t(is discre$ancy.

VENTROGLUTEAL VS DORSOGLUTEAL

*(e conclusion t(at t(e researc(ers ca)e to was t(at even t(ose w(o are %a)iliar wit( t(e ,BP o% IM injection site c(oice, )ay c(ose against it in %avor o% t(e easier o$tion. Stud" Three ")all 6788@: $resented a literature review on $reventing sciatic nerve injury %ro) intra)uscular injections. "(e reviewed )any researc( studies regarding IM injection $rocedures and also legal data&ases %or court decisions in /anada and t(e #nited "tates dating %ro) =><8 to 788<. In (er researc( s(e %ound t(at even t(oug( t(ere was a lot o% evidence &ased $ractice su$$orting t(e use o% t(e ventrogluteal site over t(e dorsogluteal site, t(e dorsogluteal site was still &eing c(osen &y )any o% t(e nurses. ot only is )aking t(e c(oice o% using t(e

dorsogluteal site $utting t(e $atients at risk %or 2sciatic nerve injury, causing t(e) disco)%ort, )or&idity and lasting disa&ility, &ut it also $rovides t(e &asis %or nursing negligence suits,3 w(ic( s(e covers t(roug(out t(e article. "(e goes on to )ake a $oint o% educating nurses on (ow to locate t(e sites using land)arks, $roviding t(e $atients wit( t(e sa%e care t(ey deserve. *(is $a$er didn't necessarily answer our +uestion directly, &ut it was very t(oroug( on t(e risk o% injury %or t(e $atient and t(e risk o% a lawsuit %or negligence i% injury is caused &y a nurse giving an IM injection in t(e dorsogluteal site over t(e ventrogluteal. Stud" Four *(e Areenway, Merri)an, and "tat(a) 6788?: study s(ows t(at t(e dorsogluteal site is not as e%%ective a location as t(e ventrogluteal site due to t(e t(ickness o% t(e su&cutaneous %at in adults on t(e dorsogluteal area. 2*(is )eans t(at t(e a&sor$tion rate o% t(e drug will &e adversely a%%ected, or t(e tissue )ay &eco)e irritated w(en t(e drug does not reac( t(e intended target )uscle.3 *(e researc( continues on to say 2*(e ventrogluteal site is relatively %ree o%

VENTROGLUTEAL VS DORSOGLUTEAL

)ajor nerves and &lood vessels, t(e )uscle is large and well de%ined, and t(e land)arks %or ad)inistration are easy to locate.3 In continuing t(e co)$arison o% t(ese two sites t(ere were )any disadvantages to using t(e dorsogluteal site, including da)age to t(e sciatic nerve leading to $ain or $aralysisB inadvertently ad)inistering t(e drug intravenouslyB )istakenly injecting into su&cutaneous tissue instead o% t(e )uscle causing irritation and i)$ro$er $lace)ent o% t(e drugB it is also associated wit( tissue necrosis, gangrene, $ain, )uscle contraction and %i&rosis. *(e only disadvantage to using t(e ventrogluteal site is t(at it is a new $ractice t(at $ractioners are un%a)iliar wit( and lack con%idence in. *(is article was a lot )ore s$eci%ic in answering our +uestion and t(e conclusion we get %ro) t(is is t(at t(e ventrogluteal site is )uc( sa%er, wit( less risk o% injury or $ain, and t(at it is ti)e %or nurses to start getting )ore con%ident in using t(is site. Stud" Five Mis(ra and "tringer 678=8: also reviewed )any resources in t(eir study %or t(e &est $ractices in giving IM injections, to deter)ine i% sciatic nerve injury is a continuing $ro&le) and deter)ining t(e availa&ility o% $u&lis(ed guidelines %or t(e nursing co))unity. *(eir studies %ound t(at t(ere was still a continuing $ro&le) wit( sciatic nerve injuries %ro) IM injections given in t(e dorsogluteal site. *(ey did not deter)ine w(et(er t(ey were given &y nurses or doctors, &ut t(ey did deter)ine t(at a )ajority ca)e %ro) a general $ractice setting and t(at )ost injuries occurred in younger $eo$le, ranging in age %ro) c(ild(ood to @8 years old. *(ey were also una&le to %ind very )any $u&lis(ed guidelines %or nurses alt(oug( t(e nursing organiCations clai)ed to su$$ort nurses using t(e ventrogluteal rat(er t(an t(e dorsogluteal site %or IM injections. *(is article didn't answer our +uestion regarding w(ic( site was less $ain%ul, &ut it

VENTROGLUTEAL VS DORSOGLUTEAL

did cover t(e risk o% injury in using t(e dorsogluteal site and t(e need %or )ore $u&lis(ed )aterials and guidelines %or t(e nursing co))unity. Summar" o! Evidence and Practice ecommendation *(e articles reviewed all $resented in%or)ation on ventrogluteal injections vs. dorsogluteal injection. *(is in%or)ation included t(at t(e dorsogluteal site %or IM injection $osed a greater t(reat o% injury t(an does t(e ventrogluteal siteB t(at ,BP suggest use o% t(e ventrogluteal site over t(e dorsoglutealB t(at nurses can &e (eld legally res$onsi&le i% accidents occur wit( t(e dorsogluteal site usageB and t(at nurses use t(e dorsogluteal site %or IM injections )uc( )ore o%ten t(an t(e ventrogluteal site. *(roug( t(is in%or)ation, it was concluded t(at t(ere would &e less $ain associated wit( ventrogluteal IM injections, alt(oug( t(at +uestion was not s$eci%ically addressed. Conclusion -(et(er or not t(e dorsogluteal site causes )ore $ain initially, it is clear t(at it carries )ore risk to t(e $atient's sa%ety and (ealt( t(an t(e ventrogluteal site. *(ere%ore it is reco))ended t(at t(e dorsogluteal site s(ould not &e used %or IM injections, and t(at t(e ventrogluteal site &e used in its $lace. urses and nursing students s(ould &e taug(t $ro$er tec(ni+ue %or %inding and using t(e ventrogluteal site, and s(ould &e in%or)ed on t(e i)$ortance o% t(is $ractice. Re%erences

VENTROGLUTEAL VS DORSOGLUTEAL

/arter5*e)$leton, D., E Mc/oy, *. 67889:. ;re we on t(e sa)e $age. a co)$arison o% intra)uscular injection e!$lanations in nursing %unda)ental te!ts.MEDSUR Nursing, !"6@:, 7F<57@8. /oco)an, ;., E Murray, J. 67889:. Intra)uscular injections1 a review o% &est $ractice %or )ental (ealt( nurses. #ournal O$ %s&chiatric ' Mental Health Nursing, !(64:, @7@5@F@. doi1=8.====Gj.=F?457948.788<.8=7F?.! Areenway, H., Merri)an, /., E "tat(a), D. 6788?:. #sing t(e ventrogluteal site %or intra)uscular injections. )earning Disa*ilit& %ractice,+69:, F@5F<. ")all, ". 6788@:. Preventing sciatic nerve injury %ro) intra)uscular injections1 literature review. #ournal O$ Ad,anced Nursing, -"6F:, 79<57>?. doi1=8.====Gj.=F?45 7?@9.788@.8F8>7.! -als(, L., E Bro$(y, H. 678==:. "ta%% nursesI sites o% c(oice %or ad)inistering intra)uscular injections to adult $atients in t(e acute care setting. #ournal O$ Ad,anced Nursing, ."64:, =8F@5=8@8. doi1=8.====Gj.=F?457?@9.78=8.8447<.!