Does obesity prevent the needle from reaching muscle in intramuscular injections?

Zaybak, Ayten; Güneş, Ülkü Yapucu; Tamsel, Sadık; Khorshıd, Leyla; Eşer, İsmet

doi:10.1111/j.1365-2648.2007.04264.x

Cited by 69 publications

(106 citation statements)

References 8 publications

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“…2 Similar studies have shown that problems with under-penetration are even more pronounced at the gluteal IM injection sites. 7,8 In a study done in South Korea it was found that boys over 14 years of age had statistically significantly thinner subcutaneous tissue at all injection sites than that of age matched girls. It was also found that body mass index (BMI) was statistically significantly correlated with subcutaneous tissue thickness at all sites.…”

Section: Introductionmentioning

confidence: 99%

Influence of skin-to-muscle and muscle-to-bone thickness on depth of needle penetration in adults at the deltoid intramuscular injection site

Shankar

Saxena

Lokkur

et al. 2014

Medical Journal Armed Forces India

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Needles Subcutaneous fat a b s t r a c tBackground: The objectives of the study were to estimate the following in adults of Indian origin: a) Gender and side differences in the skin-to-muscle (SM) and muscle-to-bone thickness (MB) at the deltoid intramuscular injection site; b) Correlation of SM thickness with the BMI, age and gender; c) The prevalence of under and over-penetration assuming a standard needle length of 25 mm and following prescribed guidelines for IM injection. Methods: The SM, MB and skin-to-bone (SB) thicknesses were bilaterally estimated in two hundred adult Indian subjects (100 male and 100 female) using an ultrasound probe at a pre-determined point on the upper arms of the subjects. The BMI of each subject was calculated. The unpaired sample 't' test and paired 't' test were used to analyse differences between groups. Pearson's correlation coefficient was used in correlation analysis and suitable linear regression equations were generated. Results: Females had a significantly higher SM thickness and lower MB thickness. The SM thickness was significantly greater on the left side, while the SB and MB thickness were significantly greater on the right. Multiple linear regression equations for both the dominant and non-dominant arms had good model fit properties. Under-penetration would have occurred in 2 (1%) subjects while over-penetration would have occurred in 50% of the subjects. Conclusion: Over-penetration of deltoid IM injections is likely to be more prevalent as compared to under-penetration. Therefore, the technique of IM injection needs to be modified based on the body type of the individual patient.© 2014, Armed Forces Medical Services (AFMS). All rights reserved. m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 0 ( 2 0 1 4 ) 3 3 8 e3 4 3http://dx

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Section: Introductionmentioning

confidence: 99%

Influence of skin-to-muscle and muscle-to-bone thickness on depth of needle penetration in adults at the deltoid intramuscular injection site

Shankar

Saxena

Lokkur

et al. 2014

Medical Journal Armed Forces India

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“…[4,5,30,34] Even though worldwide injection practices are based on these guidelines, there is increasing evidence validating IM injections with a 1.5-inch long needle may not be reaching muscle, especially in females exceeding a BMI of 30. [2,11,35] Additionally, educational texts may vary in their instructional information related to injection practices.…”

Section: Injection Depthmentioning

confidence: 99%

Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

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Background and Objective: Intramuscular (IM) injections are administered to patients in all health care settings. Even though this procedure is invasive and the evidence supporting the process of administration is extensive, techniques and procedures vary throughout the literature and in practice. The purpose of this descriptive correlational study was to 1) investigate the literature on current evidence-based IM injection procedures pertaining to gender, patient weight, injection site, needle length, and technique, 2) compare surveyed healthcare personnel self-reported IM injection practices, and 3) query respondents on informational resources they access, continuing education they receive, and their years of healthcare experience and higher education. Methods: The Intramuscular Injection Questionnaire (IIQ) was sent via email to various professional healthcare facilities and their respective social media sites. Two hundred and six (206) healthcare personnel of various healthcare backgrounds and educational levels accessed the IIQ via a link to Qualtrics software. SPSS Version 24 was used for data analysis. Results: Most respondents were registered nurses with 4 -15+ years of experience. Seventy-eight percent of respondents considered their IM injection knowledge at above average or expert levels. Gender was not considered an important factor when selecting an injection needle among 75% of participants. Of all respondents, 61% use z-track technique, 59% use the ventrogluteal site and 34% always bunch or stretch the skin during injection. IM injection education was not provided in 75% of healthcare facilities. Conclusions: IM injection practices vary among respondents and in the literature; some reported practices are contrary to current evidence-based practice. While the evidence provides some sound recommendations, some procedures are not well-documented or supported including in nursing texts. Nurses and other healthcare personnel must critically analyze the site, depth, needle, volume, medication, vaccine, and whether to bunch or stretch, according to evidence-based practice. Healthcare facilities should provide IM injection education routinely to ensure safe practices. Future studies (Level 1 and 2) are needed to further demonstrate the best evidence leading to safe and effective IM injections.

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“…Increasing body fat, as measured by BMI in this investigation, was significantly associated with developing an abscess following injection of pf-MPA. Previous studies have identified the need to take into account weight and fat pad depths when administering intramuscular injection, and as such, alter needle length and gauge accordingly [20][21][22]. Although this facility did increase needle length (from 1 inch to 1.5 inches) for patients with BMI greater than 25, the needle length selection was still likely insufficient to reach the intramuscular depth required for injection [22].…”

Section: /6mentioning

confidence: 99%

“…Previous studies have identified the need to take into account weight and fat pad depths when administering intramuscular injection, and as such, alter needle length and gauge accordingly [20][21][22]. Although this facility did increase needle length (from 1 inch to 1.5 inches) for patients with BMI greater than 25, the needle length selection was still likely insufficient to reach the intramuscular depth required for injection [22]. Facilities administering these types of injections should have written protocols for intramuscular injections that account for the increased fat pad of some patients and specify the appropriate needle length and gauge.…”

Section: /6mentioning

confidence: 99%

Polymicrobial Injection-Site Abscesses Associated with Contaminated Methylprednisolone Injections in Florida

Matthias¹

2017

RMES

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Objective: Identify injection-site abscesses and quantify risk factors from injections with subsequently recalled preservative-free Methylprednisolone acetate (pf-MPA) from Main Street Family Pharmacy (MSFP). Design:Outbreak investigation and retrospective cohort study. Setting:Private primary healthcare facility.Patients: Three hundred and seven patients that received pf-MPA injections manufactured by MSFP from December 1, 2012 through February 28, 2013.Methods: Medical records were abstracted for individuals with an adverse event and individuals with known exposure to pf-MPA lots 011413dan and 120612dan. Records were analyzed for factors related to injection-site adverse events using logistic regression. Facility records from 2006 through 2013 were queried for International Classification of Diseases, 9 th edition, Clinical Modification (ICD-9-CM) diagnosis codes 682.5 and 680.5 to identify additional adverse events. Results:Sixteen of 307 injected individuals (attack rate = 5.2%) were identified with adverse events consisting of soft tissue infections at the injection site. Increasing body mass index (BMI) (odds ratio [OR] =1.17; 95% CI=1.04-1.33), age of vial at injection (OR=1.13; 95% CI=1.00-1.27), and date of injection (OR=10.01; 95% CI=1.49-67.11) were associated with adverse events. Conclusion:Risk of soft tissue infections following injection of recalled MSFP pf-MPA was greater among persons with higher BMI, receiving older product, and receiving injections from February 5 through February 15, 2013. Appropriate needle length was not used for patients with a greater BMI. A written protocol for pf-MPA injections including needle length and gauge should be created and trainings on this protocol provided to staff administering injections. Compounded pharmaceuticals, especially preservative-free formulations, should not be utilized for multiple injections.

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Does obesity prevent the needle from reaching muscle in intramuscular injections?

Cited by 69 publications

References 8 publications

Influence of skin-to-muscle and muscle-to-bone thickness on depth of needle penetration in adults at the deltoid intramuscular injection site

Influence of skin-to-muscle and muscle-to-bone thickness on depth of needle penetration in adults at the deltoid intramuscular injection site

Evidence calls for practice change in intramuscular injection techniques

Polymicrobial Injection-Site Abscesses Associated with Contaminated Methylprednisolone Injections in Florida

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