Assessment rate of true dorsogluteal intramuscular drug injection using ultrasonography

Abstract

Objective: Medications are generally administered by either the enteric or parenteral route. With parenteral administration, intramuscular (IM) is the preferred approach because it increases the bioavailability of the drug, acts more quickly than the enteric route. The aim of this study was to determine the rate of true dorsogluteal intramuscular drug injection and to determine the causes for application failures in practice by ultrasonography (US).
 Methods: The study was conducted from May 1 to May 30, 2017 in Giresun University Education and Research Hospital, Giresun, Turkey. We examined 60 patients who were administered dorsogluteal IM injection with a 38.1mm length needle. After the injection, localization of medications (whether intramuscular or subcutaneous adipose tissue [SAT]) was evaluated by Ultrasound.
 Results: Female/male ratio of the patients was 27/33, with a mean age of 39.78±2.16 years. Obese/normal weight ratio was 20/40. The mean dorsogluteal area SAT thickness of obese and normal weight patients were 32.34±2.17 mm and 20.85±1.20 mm, respectively. In 23 of the patients, IM injected drug was observed in the SAT, while it was observed in the IM area in 37 patients. Medication was observed in IM area in 37 of 50 patients who dorsogluteal region SAT thickness was appropriate (SAT thickness lower than 33.1mm) for IM injection while it was seen in SAT area in 13 patients.
 Conclusions: SAT thickness values are important if IM drug injection is to be administered correctly. Unsuccessful IM injections may be seen even in patients with appropriate SAT thicknesses.
 doi: https://doi.org/10.12669/pjms.35.4.313
 How to cite this:Ozen O, Gunaydin M, Tosun A, Coskun ZU, Aytekin K, Takir S. Assessment rate of true dorsogluteal intramuscular drug injection using ultrasonography. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.313
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dorsogluteal intramuscular injection depth needed to reach muscle tissue according to body mass index and gender: A systematic review

“…Intramuscular (IM) injections are a vehicle to dispense medications such as antibiotics, vitamins, infertility drugs, allergy medications and antipsychotic medications. These and other medications need to be administered IM into large gluteal muscles to allow for better absorption of high‐volume medication (Ozen et al, 2019).…”

“…Over the last four decades, studies have shown that numerous dorsogluteal IM injections intended for intramuscular placement were instead injected into the subcutaneous adipose tissue (SAT) due to needle lengths that were too short to reach muscle tissue (Chan et al, 2006; Cockshott et al, 1982; Ozen et al, 2019). Excessive adipose tissue may lead to higher risk of injections placed into subcutaneous tissue instead of muscle, especially in women (Ajana et al, 2008; Bhalla et al, 2013; Chan et al, 2006; Dayananda et al, 2014; Shah et al, 2014).…”

“…Several studies show reduced bioavailability with IM injections administered into the SAT rather than the muscle (Bhalla et al, 2013; Middleman et al, 2010; Shah et al, 2014; Tanioka et al, 2013; Weber et al, 1985). Complications from SAT injections due to lack of drainage from fatty tissue include irritation, pain, infection, calcified granulomas, abscessed, tissue necrosis or muscle contraction (Chan et al, 2006; Cocoman & Murray, 2010; Ozen et al, 2019).…”

Evaluation of the effect of selecting gluteal injection site on the pain injection based on anthropometric indices and body shape pattern: A randomised controlled trial study

“…Safe and reliable outcomes from these injections cannot be thoroughly evaluated clinically, however, studies using paraclinical diagnostic techniques, including MRI, Computerised Tomography (CT) scan, and Ultrasound to evaluate injection success have reported success rates of 32%–52% (Ozen et al, 2019; Soliman et al, 2018).…”

“…The gluteal muscles are a common site for the administration of IM medications (Ozen et al, 2019) and nurses have expressed a preference for utilising the dorsogluteal site rather than the ventrogluteal site (Kara et al, 2015). In comparing patient safety, it has been suggested that injections into the ventrogluteal site are safer for the patient due to a sufficient distance from the sciatic nerve, but when accurately identified, an injection into the dorsogluteal area carries no greater risk (Larkin, Ashcroft, Elgellaie, et al, 2017; Larkin, Ashcroft, Hickey, et al, 2017).…”