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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000403344.05116.1c
In the News

Most Nurses Don't Follow Guidelines on IM Injections

Potera, Carol

Section Editor(s): Pfeifer, Gail M. MA, RN

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Abstract

Age, experience, and comfort levels trump the latest information.

Nurses give more than 12 billion intramuscular (IM) injections each year worldwide. But although the nursing literature recommends that these be given at the ventrogluteal site to avoid complications—skin and tissue trauma, muscle fibrosis and contracture, nerve palsies and paralysis, and abscesses and gangrene, for example—only 14% of hospital nurses use the ventrogluteal site, and 71% still prefer the dorsogluteal site, according to responses to a recent survey from 264 acute care nurses in Canada.

Figure. Younger nurs...
Figure. Younger nurs...
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The ventrogluteal site is considered superior to the dorsogluteal site because it's farther from major nerves and muscles and provides faster medication uptake. But nearly three-quarters of nurses injected at the dorsogluteal site, even though they knew the potential for nerve damage when using the site. Among nurses who favored the ventrogluteal site, 70% knew that it isn't associated with nerve damage, although 30% incorrectly thought that nerve damage could occur.

Younger nurses with bachelor's degrees were more likely to follow the latest recommendations on ventrogluteal IM injections than were older, more experienced nurses with diplomas. Only 15% of nurses relied on the latest information in the nursing literature when choosing the injection site. Instead, 85% used the site they felt most comfortable with. Another 80% said that the ease with which they could find the injection site influenced their choice, and 60% followed what they were taught in nursing programs.

About two-thirds of nurses ages 20 to 24 years used the ventrogluteal site, compared with 28% of nurses ages 25 to 29 years, 10% of those ages 30 to 39 years, 5% of those ages 40 to 49 years, and 8% of nurses 50 years old or older. The opposite was true for injections at the dorsogluteal site, which ranged from 89% of nurses in the oldest age group to 33% of nurses in the youngest age group.

As younger nurses with bachelor's degrees enter clinical practice and older nurses retire, the percentage of nurses using the ventrogluteal site should increase as the result of a "natural evolutionary process," says Lorna Walsh, study leader and a faculty member at the Center for Nursing Studies in St. John's, Newfoundland, Canada. The growing number of obese patients is driving a switch to ventrogluteal injections, too. "There's more subcutaneous fat at the dorsogluteal site, and medication may not deposit into the muscle," says Walsh.

Dorsogluteal injections remain a safer choice for certain types of patients, however. For example, clinical practice guidelines on the care of mental health patients recommend dorsogluteal injections in patients in a controllable, prone position. "Ventrogluteal injections put the nurse at risk because the patient is turned up and facing you," Walsh says. (See February 2010's Think Again for more on these recommendations and guidance on performing injections at the ventrogluteal site.) —Carol Potera

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REFERENCE

Walsh L, Brophy K. J Adv Nurs 2011;67(5): 1034-40.

© 2011 Lippincott Williams & Wilkins, Inc.

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