Dorsogluteal Site Research Articles

Procedures Used to Prepare and Administer Intramuscular Injections: A Study of Infertility Nurses

To describe the procedures infertility nurses use to prepare and administer intramuscular injections of fertility medications. Descriptive survey. Nurses listed as members of the Nurses Professional Group of the American Society for Reproductive Medicine (N = 645) were surveyed. Completed questionnaires were returned by 219 of the nurses. Volume of diluent, needle selection, site selection, internal rotation of the extremity distal to the injection site, and use of the z-track technique. There was wide variation in the gauge and length of needles used to administer the medications, with most nurses using a 22 g, 1-1/2-in needle for all medications. Most nurses changed the needle between preparing and administering medications; however, filter needles were seldom used. There was wide variation in the volume of diluent used to reconstitute medications. Most of the nurses used the dorsogluteal site for injections. Although almost all of the nurses indicated that they routinely rotated injection sites, they infrequently used sites other that the dorsogluteal site. Most nurses did not rotate the extremity distal to the injection site when administering injections and even fewer used the z-track technique. This study demonstrated wide variation in the procedures used by infertility nurses to prepare and administer intramuscular injections of fertility medications. Many nurses did not use procedures that can reduce the pain and tissue trauma associated with intramuscular injections.

Effectiveness of a jet injection system in administering morphine and heparin to healthy adults

Jet injection eliminates the risk of contaminated needlestick injuries when giving intramuscular or subcutaneous medications. Clinical efficacy of the Biojector System was equivalent to that of needle and syringe injection in unpublished trials with vaccines, but had not been studied using other drugs. To compare the effectiveness of the Biojector with conventional needle and syringe injection in administering intramuscular morphine and subcutaneous heparin to healthy adults, as measured by plasma drug concentration. Intramuscular injections of morphine 8 mg (5 mg if weight < or = 65 kg) were given 24 hours apart with the jet injector and with a needle and syringe to 30 subjects at the deltoid site and 10 subjects at the dorsogluteal site. Blood samples for plasma concentrations of free morphine were drawn at 15, 30, 45, 60, 120, and 240 minutes and were analyzed using radioimmunoassay. Abdominal subcutaneous injections of heparin 3500 U were given every 8 hours for 5 days with both injection methods to 29 subjects, with 48 hours between the two series. Daily blood samples for plasma heparin were analyzed by colorimetric assay for antifactor Xa activity. Mean free morphine concentration, peak value, and area under the curve did not differ significantly between the deltoid and dorsogluteal sites or between the jet injector and needle and syringe. Values of mean daily heparin concentrations and area under the curve were low and did not differ between the two injection methods. Plasma drug concentrations provided by the Biojector were equivalent to those provided by conventional needle and syringe when administering intramuscular morphine and low-dose subcutaneous heparin.

A utilização da região ventro-glútea para aplicação da vacina dupla-uso adulto: opinião da clientela

Este trabalho teve por objetivos avaliar reações emocionais e sintomas referidos por funcionários da Escola de Enfermagem da USP que receberam a vacina dT na região ventro-glútea e investigar o conhecimento e a aceitação da população quanto ao local de aplicação. Dos 38clientes, foi necessário reiniciar o esquema vacinai em 50%; 13,1% receberam a 2ª dose, 2,6% a terceira e o restante o reforço. Dos 29 localizados para a entrevista, 22 manifestaram-se favoravelmente à utilização desta região em futuras injeções; 3 escolheriam tanto a região ventro-glútea, como a dorso-glútea, 1 prefere a dorso glútea e o outro a deltóide. Quanto aos demais, 1 utilizaria a região ventro-glútea, dependendo do aplicador, e a última continua indiferente ao local de aplicação.

Pediatric intramuscular injections: do you know the procedure and complications?

The practice of outpatient intramuscular antibiotic therapy for infants and children at risk for serious bacterial infections is an attractive alternative to hospitalization. The use of this alternative is likely to increase. Pediatric emergency physicians and pediatric residents at our institution were surveyed to determine their knowledge of intramuscular injection techniques. The dorsogluteal site is contraindicated in infants and children, but it was selected for 14 (21%) of the patients presented in the survey. One-inch needles are recommended for children 0 to 24 months of age, but 1 1/2-inch needles were preferred for 13 (30%) of these younger children. A volume of 1 ml to be injected at one site was exceeded 10 (47%) times. Such practices increase the risk for infectious complications and neurovascular and muscle injuries. To avoid these complications, guidelines for pediatric intramuscular injections are presented.

Effect of Positioning on Discomfort from Intramuscular Injections in the Dorsogluteal Site

An intramuscular injection into a relaxed muscle is believed to result in less discomfort than an injection into a contracted muscle. When the femur is internally rotated, the gluteus maximus muscle is relaxed. The hypothesis that a dorsogluteal injection with the femur internally rotated will cause less discomfort than when the femur is externally rotated was tested in 44 surgical patients who received two injections of preoperative medication. Each patient received an injection of a narcotic medication and one of diazepam. All possible combinations of the factors--position (internal and external rotation), order of injection (first or second injection), and medication (narcotic or diazepam)--were determined, and patients were randomly assigned to one of these conditions. Patients rated their perceived discomfort after each injection on a five-point scale. The hypothesis was supported by discomfort ratings from injections of both types of medications, although diazepam injections caused significantly more discomfort than injections of narcotics. Older patients tended to report less discomfort from diazepam injections than younger patients. Sex, order of injection, and nurse administering the injection did not significantly influence discomfort ratings.

Reducing Discomfort from IM Injections

jections, a literature review showed that the effect of position on discomfort had never been tested systematically. Therefore, we undertook a controlled study with 44 patients at a university medical center who were to receive preoperative injections(2). Seventeen men and 27 women, aged 20 to 65 years (mean 42.6 years), agreed to participate. We selected only patients who were oriented to time, place, and person; who could easily assume a prone position; who were to receive preoperative medications of atropine, morphine, and diazepam; and who could safely receive injections in the dorsogluteal site. Each patient received one injection of atropine and morphine, and a second injection of diazepam. To rotate their femurs internally, patients were told to point their toes inward. To rotate them externally, they were instructed to point their toes outward. Each patient received one injection with femurs internally rotated, the other with them externally rotated. The study conditions were specified before the study began and provided all possible combinations of the following factors: position, medication, and order of injection. The injections were given by two nurse researchers. All injections were given with a 23gauge needle. Needle length varied from 1 to 1-/2 inches, depending on the patient's size and weight. Each patient received an equal amount of medication (1.5 to 2 cc.) in each of the two injections. After each injection, patients rated their discomfort on a five-point scale: 1-no discomfort, 2-slightly uncomfortable, 3-moderately uncomfortable, 4-very uncomfortable, and 5extremely uncomfortable. The scale was purposefully kept simple to minimize demands on patients awaiting surgery. We anticipated that diazepam, an irritating drug, would cause more discomfort than atropine-morphine injections(3). Therefore, we examined the effect of patient position on discomfort scores separately for each medication.

Sciatic palsy in premature infants. A report and follow-up study of ten cases.

Ten premature infants with partial sciatic palsy were followed-up for an average period of three years and four months. In all but one patient, recovery of a functional degree of dorsiflexion of the foot occurred in an average of four months. Six patients developed a mild, easily correctable equinovarus deformity, and all but one showed 1 to 2 cm. of shortening of the involved foot. In the absence of other demonstrable causes, the authors concluded that the sciatic nerve lesion originated in an inadvertent injury by an injecting needle or from a neurotoxic effect of the agent injected. The one constant finding in all cases was a history of intramuscular gluteal injections starting on the first day of birth. The ventrogluteal injection site is safer as suggested than the traditional dorsogluteal site.