Comparison of Gluteal Muscle Intramuscular Injection Sites of Japanese Healthy Subjects: Considerations for Optimal Insertion of Injection Needle Length

Abstract

Long Acting Injectable (LAI) medications for patients with schizophrenia is commonly administered to relieve their symptoms. Through shared decision-making and clinical evidence-based, psychiatrists should systematically offer LAIs to all patients requiring long-term antipsychotic treatment as a first-line treatment. Gluteal intramuscular (IM) injection requires accurate insertion of needles into the specific muscle area, often the outer upper quadrant of the buttocks, in order to achieve the required blood concentration. The purposes of this study were to compare the "Distance from the Epidermis to the Under-Fascia (DEUF)" and "Distance from the Epidermis to the Iliac Bone (DEB)" of the buttocks IM injection sites at the dorsogluteal and ventrogluteal sites among healthy Japanese volunteer subjects, and to identify the optimal insertion injection needle length. The DEUF and DEB at the gluteal regions were measured by ultrasonography. Welch's one-way analysis of variance was used to compare the DEUF and the DEB at the gluteal IM injection regions. There was no statistically significant difference observed between the right and left mean values of DEUF for Hochstetter and Clark's point at the ventrogluteal sites, and the Four and Three-way split or Double Cross point at the dorsogluteal sites. However in the DEB, the Hochstetter's point (P < 0.01) at ventrogluteal site on the right side, and Clark's point (P < 0.05) were significantly shorter than the Double Cross point at dorsogluteal sites (F = 4.38). The left buttocks S. Masuda et al. 204 Hochstetter's point was significantly shorter than the Double Cross point (F = 4.38, P < 0.01). These results, however, did not establish a statistically significant difference in the DEUF among injection sites. It was considered that the difference in the DEB depended on muscle volume and thickness in the gluteal injection sites.

Selection of Site for Administration of Intramuscular Injection to Adult Patients by Nurses: A Cross-Sectional Study

“…Because it has no nerves or large blood vessels, it is far away from bone protrusions, the possibility of delivering the medication to subcutaneous tissue is low, the location is easy to determine anatomically, and it has a large area of muscle. 2,4,[12][13][14][15][16] In the literature, it is pointed out that it is crucial to choose a safe site away from the large blood vessels, nerve and bone structures for intramuscular injections. 3,13,14 Thus, nurses are required to have a good command over the anatomic structure of the administration site and make wise choices.…”

Dolor al administrar medicamento por inyección intramuscular: ventroglútea vs dorsoglútea

“…Por otra parte, es importante señalar que elegir la región ventroglútea para la administración de medicamentos intramusculares se presenta como una opción en otras investigaciones 9,12,[27][28][29][30][31] no incluidas en el análisis de la evidencia, debido a que no hay relación directa con el tema tratado; no obstante, en estas se indicó mayor número de ventajas en el uso del sitio ventroglúteo, tales como el espesor del músculo y la distancia respecto de estructuras nerviosas y vasculares en comparación con el sitio dorsoglúteo, además de no encontrarse antecedentes sobre perjuicios asociados a la elección de este sitio.…”

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

“…Moreover, in administration of injectable medications, physicians and nurses are unable to confirm visually whether or not the tip of the injection needle has reached the muscle. Therefore, physicians and nurses need to select an appropriate injection needle penetration depth in conjunction with patient physique [13], injection site [14] and anatomical understanding of nerves and blood vessels.…”