Study Finds Most Nurses Don’t Use Recommended IM Injection Site
A Canadian nursing study has found 7 out of 10 hospital nurses don’t routinely use the recommended ventrogluteal (VG) hip site for intramuscular (IM) injections, instead they use the dorsogluteal (DG) buttock site which has a higher potential risk of sciatic nerve injury.
The study by Lorna Walsh, a nurse educator at the Centre for Nursing Studies, St John's, Canada and colleagues is published in the May issue of the Journal of Advanced Nursing.
Recommendations in the recent nursing literature advocate preferential use of the ventrogluteal (VG) site over the dorsogluteal (DG) site as it is located away from major nerves.
Even though the focus of this study was to determine the site of choice for IM injections by nurses in one Canadian province, its findings have international relevance. Both novice and experienced nurses are expected to be competent in safe medication administration, including the IM injections. There is the added expectation, as in all of medicine these days, to use evidence-based best practices.
Advantages of IM injections include a faster rate of absorption than the subcutaneous route, and muscle tissue can often hold a larger volume of fluid without as much discomfort. Medication delivered by IM injected is absorbed less rapidly and takes effect more slowly that medication that is injected intravenously which is favorable for some medications.
Adverse reactions from IM injections may be due to either the local trauma of the injection itself or the irritating properties of the drug. The reactions consisted of abscess formation, induration, erythema, hemorrhage, nerve injury, or persistent pain.
Walsh and colleagues mailed questionnaires to acute care nurses identified through a database at the Association of Registered Nurses of Newfoundland and Labrador. A total number of six hundred and fifty-two (n = 652) questionnaires were sent and two hundred and sixty-four (n = 264) questionnaires were returned for a response rate of 42·2%. Most of the 264 respondents were aged between 30 and 49 years and had been working in nursing for more than ten years. The data was collected during 2007.
Walsh states, "It's estimated that more than twelve billion intramuscular injections are administered every year throughout the world and unsafe injection practices have a significant impact on patient ill health and death.”
The researchers found 71% of the nurses preferred using the DG site (buttock), 14% the VG site (hip), 7% the deltoid site (upper arm) and 7% the vastus lateralis site (thigh).
The nurses who had been in nursing the longest were most likely to use the DG site (81% for 20 plus years versus 41% for one to four years) and newer nurses were most likely to use the VG site (44% for one to four years versus 5% for 20 plus years).
Only 15% of nurses based their site selection on the recommendations in the nursing literature. Most (85%) used the site they felt most comfortable with, 80% said ease of locating the injection site influenced their choice, 60% followed the recommendation of their nursing education program, and 56% followed traditional usage.
Patient discomfort was the most frequent complication - 78% for the DG site, 88% for the VG site, 90% for the vastus lateralis site and 100% for the deltoid site.
The potential for nerve injury was the second most mentioned complication - by 74% using the DG site, 30% using the VG site, 32% using the vastus lateralis site, and 53% using the deltoid site.
Three-quarters of the nurses in the who routinely used the DG site recognized the potential for nerve injury, but 26% did not.
Site selection also varied by education, with 30% of baccalaureate prepared nurses using the VG site, compared with 5% of diploma prepared nurses.
Staff nurses' sites of choice for administering intramuscular injections to adult patients in the acute care setting; Walsh L and Brophy K; Journal of Advanced Nursing. 67.5, pp1034-1040. (May 2011) DOI: 10.1111/j.1365-2648.2010.05527.x
Pharmacology for Nurses; Medication Administration Techniques: Injections