Examination of Subcutaneous Tissue Thickness in the Thigh Site for Intramuscular Injection in Obese Individuals

Zaybak, Ayten; İsmailoğlu, Elif Günay; Ismailoğlu, Eren

doi:10.7863/ultra.15.14.09005

Cited by 4 publications

(10 citation statements)

References 14 publications

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“…Current evidence guides practice to consider gender when administering an IM injection. [2,3,[11][12][13] Recent evidence recommends ventrogluteal site be the preferred site for IM injections. [14,15] Evidence shows the ventrogluteal site is far from major vascular and nerve structures and has a relatively low subcutaneous thickness in comparison with the traditionally used dorsogluteal site.…”

Section: Practice Variationmentioning

confidence: 99%

“…Recent studies show the need for longer needles but our survey shows longer needles are seldom available in the United States. [12,20,25] Autoinjectors supplied with standard-sized needles are too short for obese patients and overweight women, which can lead to unfortunate consequences, especially with epinephrine autoinjectors. [11,19] Again, practice change would occur if manufacturers utilize current evidence to produce autoinjectors with varied sized needles based on weight or BMI.…”

Section: Injection Depthmentioning

confidence: 99%

“…[20,21] Even with documented concern in the literature, populations such as asthma patients, women, and overweight and obese children and adults continue to be impacted by needles not reaching muscle. [3,12,17,[22][23][24][25] Subcutaneous fat distribution differs by gender, age, and ethnicity and determines the thickness of subcutaneous tissue at the IM injection site. For a male with a BMI of 25, a 1-inch needle may be sufficient for an IM injection at the deltoid, but a female with a BMI of 25 and above will most likely require a 1.5-inch-long needle to reach the deltoid muscle due to a thicker fat pad.…”

Section: Injection Depthmentioning

confidence: 99%

“…[18] Longer needles with safety locks should be available in all healthcare facilities and nurses/other personnel must be trained to use longer needles. [12,20,25] Patients weighing greater than 260-pounds or 30+ BMI may require a muscle depth assessment prior to IM injection.…”

Section: Implications For Nursing Practicementioning

confidence: 99%

“…Additionally, we recommend adopting BMI as a standard to determine appropriate needle length throughout the United States comparable to other countries conducting similar research. [6,11,12,24,25] We recommend the CDC and WHO update IM injection recommendations to include BMI and needle length based on various sized populations. [33,52] Lastly, additional research on thickness of subcutaneous tissue (fat pad) is needed similar to Poland's study in 1997.…”

Section: Future Studymentioning

confidence: 99%

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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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Section: Practice Variationmentioning

confidence: 99%

Section: Injection Depthmentioning

confidence: 99%

Section: Injection Depthmentioning

confidence: 99%

Section: Implications For Nursing Practicementioning

confidence: 99%

Section: Future Studymentioning

confidence: 99%

See 3 more Smart Citations

Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

View full text Add to dashboard Cite

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Gluteal muscle and subcutaneous tissue thicknesses in adults: a systematic review and meta-analysis

Gülnar

Ordu

Bayram

et al. 2023

Journal of Research in Nursing

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Background: Nurses often administer intramuscular injections at the gluteal site. This study aimed to determine gluteal muscle and subcutaneous tissue thicknesses in adults. Methods: Systematic review and meta-analysis. The databases Turkish Medline, Ulakbim, National Thesis Center, Cochrane, Web of Science, Science Direct, PubMed, CINAHL Plus with Full text (EBSCO host), OVID and SCOPUS were screened using the keywords ‘intramuscular injection’, ‘subcutaneous tissue thickness’, ‘muscle tissue thickness’ and ‘needle length’ between April and May 2021. The studies were evaluated with ultrasound. This study was reported according to the PRISMA recommendations. Results: Six studies met the eligibility criteria. The total sample size was 734 (women: 432, men: 302). The V method revealed that the ventrogluteal site had a muscle and subcutaneous tissue thickness of 38.071 ± 2.119 and 19.927 ± 2.493 mm, respectively. The geometric method revealed that the ventrogluteal site had a muscle and subcutaneous tissue thickness of 35.989 ± 4.190 and 19.661 ± 3.992 mm, respectively. The geometric method also revealed that the dorsogluteal site had a thickness of 42.560 ± 8.840 mm. According to the V method, females had thicker subcutaneous tissue at the ventrogluteal site than males ( Q = 5.37, df = 1, p = 0.0204). Body mass index did not affect the subcutaneous tissue thicknesses at the ventrogluteal site. Conclusion: The results show that gluteal muscle, subcutaneous and total tissue thicknesses vary across injection sites.

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Considering skin-to-muscle depth for successful intramuscular injections in an increasingly obese population

2023

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Background: Intramuscular (IM) injection practice is an essential nursing skill. Current practice relies on clinical judgement to determine needle length (unless specified in the medicine's product licence). Obesity is increasing in the global population, but guidelines have largely ignored how to select needle length to meet individual patient need. Aim: The aim of this review was to systematically review the skin-to-muscle depth required to achieve injection into muscle in adults. The objectives were to identify any implications of obesity status when selecting an appropriate needle length and site in clinical practice. Search and review methodology: Studies of subjects above the age of 18 years using observational or experimental designs where the distance from the skin to muscle had been measured at any IM injection site, and obesity status was reported, were included in the search strategy. The primary outcome of interest was the distance from skin surface to muscle penetration. Findings: 14 studies were identified that investigated the dorsogluteal, ventrogluteal, deltoid and vastus lateralis sites, all used cross-sectional observational designs. Ten used ultrasound, three used computed tomography (CT) and one used magnetic resonance imaging. Obesity status was reported as BMI or hip-to-waist ratio. In all studies there was a correlation between obesity status and the distance from skin surface to muscle. In females this exceeded 37 mm at both gluteal sites, independent of obesity status. Conclusions: There should be an assessment of obesity status before selecting needle length for IM injections in both genders. Needles longer than the standard 37 mm are recommended for all females, whatever their obesity status, for any gluteal site. Injections into gluteal sites should be avoided in females who are obese. Deltoid injections are more likely to achieve muscle penetration in both genders, and in patients who are overweight or obese. Further research is required.

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Examination of Subcutaneous Tissue Thickness in the Thigh Site for Intramuscular Injection in Obese Individuals

Abstract: A standard needle used in intramuscular injections to the thigh site would be effective in reaching the muscle in the rectus femoris and vastus lateralis sites in all men and in 77.8% of women, although it is not usually adequate for gluteal injection.

Cited by 4 publications

References 14 publications

Evidence calls for practice change in intramuscular injection techniques

Evidence calls for practice change in intramuscular injection techniques

Gluteal muscle and subcutaneous tissue thicknesses in adults: a systematic review and meta-analysis

Considering skin-to-muscle depth for successful intramuscular injections in an increasingly obese population

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