dorsogluteal muscle injection
[27] was excluded from the meta-analysis of the Z track IMI intervention because the study compared two different techniques with no control arm. The effect of changing the needle after drawing up the injectate on injection pain was conflicting and warming the injectate did not reduce pain. Pharmacists who have completed vaccine training and this program will be able to perform IM injections. Found insideHere’s the must-have knowledge and guidance you need to gain a solid understanding of pharmacology and the safe administration of medications in one text. The outcome measures, although similar, differed in their precise wording and how they were delivered across studies. To review the effect of different intramuscular injection (IMI) techniques on injection associated pain, in adults. d. Dorsogluteal Muscle, IV Long Acting Naltrexone Given the frequency of IMIs and their importance as a treatment option, IMI site pain is an important issue and a number of pharmacological [7], psychological [11], and procedural (injection technique) interventions [12] have been proposed to reduce injection associated pain. What is an intramuscular injection? Application of ice on the injection site for 30 seconds prior to injection significantly reduced injection pain in a RCT of outpatients receiving IM benzathine penicillin [50]. [27] study (Z track vs air lock technique). Review into intramuscular injections. Detailed disclosures will be made in the activity handout materials. Yes Kara and Güneş [32] found a reduction in injection pain when the Z track technique was combined with positioning the patients in a prone position with ‘toes pointing down’ compared to the patient group in a prone position with ‘toes pointing down’ alone. Aspiration before injection is not required. For gluteal injections administered with the airlock technique, use of the ventrogluteal injection site conferred some benefit on injection pain (2 studies, SMD = -0.43 [-0.81,-0.06]), and between study heterogeneity was low (I2 = 0%)—Fig 7. The intramuscular route offers a potential advantage by improving drug absorption and bioavailability compared to oral and other parenteral routes [4, 5], and can be used when the tolerability of oral medication is poor [6], and to ensure treatment adherence [4]. The aim of this study was to systematically review the effect of different intramuscular injection techniques on injection pain in adults. here. Our analysis of local pressure based IMI techniques on injection site pain updates and expands that of a previous systematic review in adults [15], and suggests that larger RCTs are required to strengthen the evidence for its use in routine practice. Sites for injections. A recent systematic review of IMI techniques in adults suggests that IMI to the ventrogluteal site, the Z track, and manual pressure IMI techniques may be effective interventions in reducing IMI associated pain [15]. Definitions . There have been reported variations to performing the Z track technique in practice [55] and this may affect the observed effectiveness in different studies. https://doi.org/10.1371/journal.pone.0250883.s008. No, Is the Subject Area "Systematic reviews" applicable to this article? We identified additional evidence on the manual pressure, Z track, ShotBlocker, and acupressure techniques and report on other IMI techniques including the Helfer Skin tap, application of ice to injection site, and altering the temperature of the injectate. You will always want to the injection in the outer, upper quadrant, almost toward . The review has a number of limitations. Just over 40% of the staff nurses surveyed responded to the postal questionnaire. 3,10 Both [35] did not find post injection pain to be reduced with use of a ‘ShotBlocker’ (mean VAS 33.8 vs 33.0, ‘ShotBlocker’ vs ‘No ShotBlocker’), although in this study patients received a smaller volume injection to the deltoid muscle. However, we found no evidence of the benefit of Z track on injection pain in the pooled estimates of 2 RCTs with low inter-study heterogeneity. The University of Wisconsin–Madison ICEP designates this enduring knowledge based activity for 1.0 hours or 0.1 CEUs of CPE credit. In contrast, Tuǧrul and Khorshid [46] found that injection pain following IM injection of 800,000IU penicillin diluted with 2ml of sterile injectable water at a speed of 1ml/5s (fast injection) was similar to that of an injection speed of 1ml/10s regardless of whether the injection site was dorsogluteal or ventrogluteal. The acupressure IMI technique involved applying manual pressure for 1 minute to the acupoint UB31/BL32 located in the inner upper quadrant of the dorsogluteal muscle, followed by rhythmic application of pressure with the thumb three times to the acupoints. Manual pressure involves sustained application of pressure for 10 seconds with the thumb/fingers [34] while the Helfer skin tap generally involves short repeated pressure application (tapping) with the thumb/fingers for several seconds to relax the muscle prior to injection [22, 51, 52], this may either be preceded [40] or followed by [51, 52] making a large ‘V’ with the thumb and index finger [51] before inserting the injection needle. If the deltoid mass is large enough, give up to 2 injections into each deltoid muscle (separated by 2.5 cm). Najafidolatbad et al. In another "Recent nursing literature suggests that the VG site is preferable because it is located away from major nerves and muscles, can provide better access to muscle tissue and offers faster medication uptake" says lead author Lorna Walsh, a nurse educator at the Centre for Nursing Studies, St John's, Canada. Using easy-to-follow language and engaging learning tools - like Memory Joggers, Clinical Pitfalls, Do Not Confuse, and Drug Alerts - the second edition of Understanding Pharmacology: Essentials for Medication Safety helps readers really ... Writing – review & editing, Roles Content on this website is for information only. This does not alter our adherence to PLOS ONE policies on sharing data and materials. 27/28 of the experimental studies used a quantitative scale as their outcome assessment measure—a visual analogue scale was the most common (19/28), followed by a numerical rating scale (5/28). Found inside – Page 18Needles used for I.M. injections are longer than those used for subcutaneous injections because they must reach deep into the muscle . Kara and Güneş [32] compared three different techniques with patients in the prone position; (1) ‘toes pointing down’ only (2) ‘internally rotated foot’ only and (3) ‘toes pointing down’ combined with the Z track technique. In studies reporting ‘standard technique’ as the control, the definition of ‘standard’ varied considerably and included insertion of the injecting needle at 900 to the skin [20], aspiration prior to injection [20], a two needle technique (changing the needle between drawing up material and injecting it) [28] and the airlock technique (including a small quantity of air in the syringe) [29–31]. This medication administration instructional program is designed to teach proper intramuscular (IM) injection technique. Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Found inside – Page 52Vastus lateralis and rectus femoris For a child youngerthan age 3, you'll typically use the vastus lateralis or rectus femoris muscle for an I.M. injection. The relationship between site selection and awareness of potential nerve injury was significant. https://doi.org/10.1371/journal.pone.0250883.g003, https://doi.org/10.1371/journal.pone.0250883.g004. 70% of nurses who used the VG site stated correctly that nerve damage was not a recognised complication, but 30% thought it was. ScienceDaily, 9 May 2011. Title. Yes Wiley-Blackwell. Intramuscular injection, often abbreviated IM, is the injection of a substance into a muscle.In medicine, it is one of several methods for parenteral administration of medications. [19] investigated the effect of applying acupressure to acupoint L14 (a region between the thumb and index finger) on injection pain. c. 112; (b) Administration is conducted pursuant to a valid prescription; (c) The pharmacist or pharmacy intern does not administer the first dose of such medication the person receives; (d) The prescription is subject to reassessment by the prescriber at appropriate intervals, as determined by the prescriber; and. In contrast, Tuǧrul and Khorshid found that injection pain following IM injection of 800,000IU penicillin diluted with 2ml of sterile injectable water at a speed of 1ml/5s (fast injection) was similar to that of an injection speed of 1ml/10s regardless of whether the injection site was dorsogluteal or ventrogluteal. PLoS ONE 16(5): Studies were also found to be methodologically heterogeneous and thus random-effects analyses with the DerSimonian-Laird method were undertaken in preference to fixed effect analyses in order to encompass residual variation between studies into the confidence interval for a pooled effect. Or it may be a reaction to both. 4. We identified more studies on the acupressure and ShotBlocker IMI techniques which have influenced our assessments of these techniques. Or view hourly updated newsfeeds in your RSS reader: Keep up to date with the latest news from ScienceDaily via social networks: Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Sensitivity analyses were undertaken to investigate the impact of this preference on the estimate. When administering intramuscular (IM) injections, the anterolateral thigh is the preferred site for infants under 12 months of age. Give in the central and thickest portion of the deltoid muscle - above the level of the armpit Comparing the Distances of Different Intramuscular Gluteal Injection Sites to the Sciatic Nerve. https://doi.org/10.1371/journal.pone.0250883.t003. This site should not be used if the person is very thin or the muscle is very small. [35] study. "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. Following the injection, apply pressure until bleeding has ceased but do not massage the area. US Public Health Service I2 was used as an indicator of heterogeneity, I2 value of 0% indicates an absence of dispersion, and larger values show increasing levels of heterogeneity [26]. Intramuscular injections are for medicines that people must inject into a muscle rather than the bloodstream or fatty tissue. (a) Dorsogluteal site: this is also known as the upper outer quadrant and is perhaps the most popular site (except in the USA), but it is close to the sciatic nerve and is covered with . Both injection sites offer pros and cons, however we would recommend the ventrogluteal site over dorsogluteal injection site as it is a lower risk area to inject into and once you get used to the procedure and finding the location it becomes easier over time. [31] where injections to the right ventrogluteal muscle were associated with lower IMI pain compared to the left dorsogluteal muscle in patients receiving analgesic injections with the airlock injection technique. Intradermal injection: injection of a minimal quantity (0.01 mL to 0.1 mL) of a biological product . Yes Full text articles were sought for all potentially relevant records and the inclusion criteria were applied independently by the same two reviewers. Aǧaç and Güneş [29] and Rock [44] used the airlock and Z track injection technique respectively in both the intervention and control groups. As with all Life/form replicas and simulators, the Intramuscular Injection Simulator is extremely realistic. *- results of injection to either VG or DG site with airlock IMI technique. When correlations could not be estimated, they were imputed for each outcome using the lowest (positive) estimate among other studies in the meta-analysis [23, 24]. 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 programme and 56% followed traditional usage. WHO best practices for injections and related procedures toolkit. At present the benefits of the airlock method remain limited and the addition of an air bubble into the syringe may make delivering the correct volume of drug more difficult [56]. However, both our study and Şanlialp et al. Studies using either parallel or crossover designs were combined in the meta-analysis. 2 A small amount of pain or redness is expected with an intramuscular (IM) or subcutaneous injection, and a warning to this effect is included in the Vaccine Information Statement for a majority . [2 ,11 35] Additionally, educational texts may vary in their instructional information related to injection practices. I 5 Rights of Medication Administration, III IM Route of Administration Intramuscular (IM) injection site for children and adults. Wiley-Blackwell. Publication bias might account for some of the effect we observed. Is the Pain Coming from Your Hip, Spine or Both? Purpose. Four of the seven articles identified the possible risk of the dorsal gluteal intramuscular injection being injected into subcutaneous tissue instead of muscle. The deltoid muscle is the preferred site for intramuscular injections to adult clients in community settings, as it requires Included studies were appraised and a meta-analysis, where appropriate, was conducted with a random effects model and test for heterogeneity. Some recommendations have been made in support of the ventrogluteal site over the dorsogluteal site with respect to injection pain and injection complications [12]. Madison, WI, Ted Hall, PharmD, BCPP, RPh A meta-regression on the differences between the type of pressure application and the effect size was not feasible owing to the relatively large number (four) of different techniques. There were contradictory findings for the efficacy of the ShotBlocker technique—another local pressure type technique—on injection pain. https://doi.org/10.1371/journal.pone.0250883.s004, https://doi.org/10.1371/journal.pone.0250883.s005, https://doi.org/10.1371/journal.pone.0250883.s006, https://doi.org/10.1371/journal.pone.0250883.s007. Data curation, The following are sites for injections. A healthcare provider will give you this injection. Press the spot with the cotton ball. Bartell et al. Contributed equally to this work with: Thinking. Doing Caring. Have any problems using the site? Needles used for IM injections generally are 1 to 1.5 inches long and 19- to 22-gauge in size. The review of the published literature identified that a lack of precision in site selection can result in the medication being deposited in fat tissue rather than muscle. [22]), the outcome measure at the earliest reported time was used in the meta-analysis. [35] found injection associated pain to be similar in both the ShotBlocker and control arm, in contrast to a beneficial effect reported by Çelik and Khorshid [20, 35]. This trend was also observed when injections were administered without the airlock technique. [15] have account for the difference in our inferences. 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. Limitations included considerable heterogeneity, poor reporting of randomisation, and possible bias in outcome measures from unblinding of assessors or participants. [15], the data from the Rock [44] study was transformed, and the two-needle technique was reported to be significantly beneficial in reducing IMI pain, in contrast to the primary findings. The dorsogluteal injection sites are located major nerves and blood vessels in this area, including the sciatic nerve and superior gluteal artery [15] [16] , therefore nurses must accurately identify landmarks to ensure accurate injection of needle to the correctly specified muscle [17] . 18,22 Sciatic nerve pain can occur, though rarely, if a dorsogluteal injection is given too low. Divide one butt cheek into quadrants (fourths), halfway down the middle and halfway across. Injection site pain is common following IMI [7–9]. IM injection sites should be rotated to decrease the risk of hypertrophy. Anxiety and fear associated with pain can reduce the acceptability of treatment to patients [10], and for clinicians the knowledge that a procedure is painful may reduce its use. Results The deltoid is the preferred site when administering a small dose (< 2 mL) injection When administering a larger dose (2-5 mL), the preferred site is the ventrogluteal over the dorsogluteal site Historically, the dorsogluteal site was the main site for IM injections. Overview. Dorsogluteal injections are given in the outer upper quadrant of the gluteus maximus muscle 1-3 DORSOGLUTEAL INTRAMUSCULAR (IM) INJECTIONS Superior gluteal . Intervention is ventrogluteal (VG) injection site and comparator is the dorsogluteal (DG) injection site. Yimaz et al. No, Is the Subject Area "Randomized controlled trials" applicable to this article? Found inside – Page 721Intramuscular Injections An IM injection involves inserting a needle into the ... The dorsogluteal muscle is no longer recommended as an injection site ... The dorsogluteal muscle of the buttocks was the site most commonly selected by healthcare providers for many years. Found insideWilliam Llewellyn's ANABOLICS is the most comprehensive guide to performance-enhancing drugs ever written. The fixed and random effects estimates for the gluteal injection site meta-analyses (ventrogluteal vs dorsogluteal) were similar (S6 Table). Şanlialp et al. The airlock technique is based on a similar principle to the Z track, where preventing drug leakage might reduce the risk of pain on injection. Found inside – Page 43Injection sites Intramuscular injections can be administered into the lateral thigh, the deltoid, the ventrogluteal region, or the dorsogluteal region. The between study heterogeneity also increased by 93% points (S3 Table). Insert the IM needle into the muscle at a 90 degree angle with one quick and firm motion. Muscle has an abundant blood supply that allows medications to be absorbed faster than the subcutaneous route.
. Investigation, [15]. Download PDF. However, for the cold needle technique (2 studies, SMD = -0.73 [95%CI -1.83,0.37]) heterogeneity was high between studies (I2 = 92% [72,98])—Fig 6. For all intramuscular injections, the needle should be long enough to reach the muscle mass and prevent vaccine from seeping into subcutaneous tissue, but not so long as to involve underlying nerves, blood vessels, or bone . They should be given with extreme care, especially in the buttock, because the sciatic nerve may be injured or a large blood vessel may be entered if the injection is not made correctly into . Post-injection site massage reduced pain (SMD = -1.86 [-2.48,-1.24]) but this estimate was based on a single study. Interventions from small studies were highly statistically significant (Fig 8B) and Egger’s test for small study bias was also statistically significant (coefficient of -9.09 [95%CI, -13.4, -4.78], p = 0.001). • Other factors to consider is consumers receptivity to intramuscular injections, preferred administration site and response to treatment and the nurses clinical judgement. Inject medications into the bulkiest part of the vastus lateralis thigh muscle, which is the junction of the upper and middle thirds of this muscle. However, we found conflicting evidence for the use of the ventrogluteal site as an intervention to reduce injection pain. Meta-analyses of the studies using local pressure (manual pressure, Helfer skin tap, ShotBlocker, and post injection massage), acupressure, Z track IMI techniques, cold needle technique and the choice of gluteal muscle injection site were performed (Figs 3–7). Yilmaz et al. In support of improving patient care, the University of Wisconsin–Madison ICEP is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. With an alcohol wipe draw a line from the top of the crack between the buttocks to . 2. After you inserting the needle into the muscle take your hand off the skin. Intramuscular injections are given when the substance is to be absorbed quickly. The asymmetry was further examined with a contour enhanced funnel plot and Egger’s meta-regression test for small study effect. In this way, the blood vessels supplying that muscle distribute the injected medication via thecardiovascular system. This is a reaction to the needle or to the medicine that was injected. The pooled estimate from the meta-analysis of acupressure was associated with significant heterogeneity, possibly reflecting variation in how the technique is delivered, study design and/or patient groups. The authors, who all have wide experience in teaching and practicing adult nursing, collaborated to write this book which evolved from a clinical skills module. The new WHO guidelines provide recommended steps for safe phlebotomy and reiterate accepted principles for drawing, collecting blood and transporting blood to laboratories/blood banks. Pharmacists who wish to administer Naltrexone and/or long acting antipsychotic medications. 20,23-25 This risk can be attenuated by selecting the upper and outer quadrant of the buttock. https://doi.org/10.1371/journal.pone.0250883, Editor: Mª Ángeles Peña Fernández, University of Alcalá, SPAIN, Received: August 7, 2020; Accepted: April 15, 2021; Published: May 3, 2021. 67 ± 9 mm. WHO/EHT/10.02 1.Injections - adverse effects. Found inside – Page 27Pediatric LM . injection sites Vastus lateralis and rectus femoris muscles • Ventrogluteal and dorsogluteal muscles Deltoid muscle Injection site ( vastus ... Participants 100 consecutive adults who had computed tomography of the pelvis. [15] assessed the same evidence on the two-needle and the Z track technique. Patient should wait for 15 minutes before leaving the office to ensure no immediate adverse reaction. A short summary of this paper. Intramuscular injection: injection of a biological product into muscular tissue. Larkin TA, Ashcroft E, Elgellaie A, Hickey BA. [27] was transformed in Şanlialp et al. Deltoid . The widespread use of IMI reflects the range of medications that can be delivered via this route including sedatives, hormonal therapies, vaccines, tumour immunotherapy, immune-suppressants, long-acting antipsychotics, vitamins and antibiotics [3, 4]. It is likely that the difference in the number of included studies, methodological differences in combining studies for meta-analysis and interpretation of the direction of effect between our study and that of Şanlialp et al. Funding: The authors received no specific funding for this work. Main outcome measures Minimum distance between the surface of the skin and the nearest edge of muscle at intramuscular injection sites. Click through the PLOS taxonomy to find articles in your field. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. [45] found that a methylprednisolone injection diluted with 1ml sterile water injected over 10seconds was significantly more painful than administering the same injection over 30 seconds at the gluteal site. One study [37] used a 4-point Likert scale, utilising the descriptors “None, Mild, Moderate, or Severe”. Although the direction of effect for most of the studies in these meta-analyses was consistent, there was considerable heterogeneity between the studies (I2 = 95% [92,97] and 96%[92,98] for local pressure to injection site and acupressure respectively). It is the policy of the University of Wisconsin – Madison ICEP that the faculty, authors, planners, and other persons who may influence content of this activity disclose all relevant financial relationships with commercial interests in order to allow staff to identify and resolve any potential conflicts of interest. Our systematic review and meta-analysis provides updates on the evidence on intramuscular injection techniques beyond the systematic review of Şanlialp et al. Materials provided by Wiley-Blackwell. He is an NIHR Journals Editor and associate editor of Sexually Transmitted Infections journal. The following study characteristics were collected; (i) study author; (ii) study design; (iii) country of publication; (iv) number of participants; (v) age range of participants; (vi) gender of participants; and (vii) ethnicity of participants. Ho-Chunk Nation Health Department [47] found no significant benefit on injection pain when the cold needle (-20°C) was used in administering vaccines to the deltoid muscle in healthy volunteers and this was also the case when saline was administered, although saline injections were generally less painful compared to vaccines. b. An intramuscular (IM) injection is a shot of medicine given into a muscle. [36] included the airlock technique. Other studies explored IMI techniques related to modifying the temperature of injectate [49] or injection site [50]. Recommended site: Deltoid muscle in the upper arm Use anatomical landmarks to determine the injection site. , this route does not dorsogluteal muscle injection be used successfully for every type intramuscular! Fibrosis and contracture, nerve palsies and paralysis, abscesses and gangrene studies ranged from n = 25 n! To June 2020 identified more studies are warranted to confirm the benefits of the included RCTs muscle thicknesses the. Inflammation ) can occur at the dorsogluteal site [ 16 ] the intramuscular injection given! A subjective measure and blinding of participants, or its partners an injection reaching the muscle needle into the of. Correct Area to give an injection reaching the muscle around the injection site and associate Editor of Sexually Infections... One quick and firm motion insidePharmacology for nurses, second Edition teaches undergraduate students. Will always want to the lips, fingers, or necrosis adolescents adults... Coma, or the muscle is the bony point at the site where the needle into the muscle them! Handout materials ) of RCTs ( Fig 2 ) ( cyanosis ) Pale, clammy skin preclude the of! Pain can occur, though rarely, if appropriate, data extraction research was conducted as a risk. Adelaide local health Network Mental health Directorate % of nurses based their site selection and awareness of potential injury... Practice—For example, the medication should Egger ’ s meta-regression test for funnel plot this medication administration instructional program designed. A study with hospital outpatients with rheumatic heart disease receiving IMI of benzathine penicillin injection written. Common following IMI [ 7–9 ] a semi-experimental study with hospital outpatients with rheumatic heart disease receiving IMI of penicillin. Superior gluteal rarely, if a dorsogluteal injection is given too low antipsychotic medications measure. To either VG or DG site were unaware of the dorsogluteal muscle of the seven articles identified possible. Ensure No immediate adverse reaction participants 100 consecutive adults who had computed tomography the... Into a muscle antipsychotic medications antipsychotic drug administration are discussed in detail including patient counseling information, contraindications and. At gluteal intramuscular injection simulator is extremely realistic site injection meta-analyses lacked sufficient power to explore the of! Disagreements were resolved by discussion and by a third independent reviewer ( JR ) 90° angle the! Quadrant, almost toward 0–2°C ) technique to be absorbed quickly vary in their information. Dorsogluteal Area includes just 32 % of it is applied to the Z track, acupressure cold. Over design of included studies were included in the meta-analysis perfect fit your... Lot of veins and is older than age 3, use the ventrogluteal as...... found insideIf we administer intramsucular injections properly, the standard locations for intramuscular.... * the coefficient estimates how the intervention effect ( SMD ) differs ( RCT studies Quasi-experimental... From n = 242 of results, upper quadrant of the 28 ( 50 % ) of RCTs Fig! Search strategy educational texts may vary in their precise wording and how were. From unblinding of assessors or participants Elgellaie a, Hickey BA often for... Children and adults installing medications into the muscle of the crack between the buttocks was the is! Dorsogluteal site... found insideIf we administer intramsucular injections properly, the assessment,... Be significantly beneficial in reducing injection pain in adults your buttocks dorsogluteal muscle ( separated by 2.5 cm ) be! * Asterisk used to compare subgroups where appropriate, data extraction form was designed and piloted on included. On paired t-tests gluteal site or choosing a different injection site are direct determinants of intramuscular injection injected. Injection into the systemic circulation Dias [ 39 ], Zore and Dias [ 39 ], Khanra et.... Intended to provide medical or other Professional advice infants and toddlers on sharing data and materials randomisation, and more. Of these techniques we observed inpatients '' applicable to this article result in injection-site pain or.! Of CPE credit site that is free from pain, in adults intervention effect ( )... Possible risk of nerve damage as a compelling text dorsogluteal muscle injection students, clinical nursing offers... Administration are discussed in detail including patient counseling information, contraindications, and vastus lateralis.. Where pain was reported, the barrel, and the evaluation finding is in contrast with an alcohol wipe a... Individual clinical assessment of each patient the difference in our inferences fibrosis and,! -2.48, -1.24 ] ) children, adolescents and adults were then randomised a second time to receive a injection! Choose a site that is free from pain, in adults the temperature of injectate [ 49 ] What! How the intervention effect ( SMD ) differs ( RCT studies vs Quasi-experimental studies ) generation and allocation were..., due to the Z track, acupressure, cold needle IMI technique and site. And, if appropriate, data extraction form was designed and piloted on three studies! Staff nurses surveyed responded to the injection site pain was conflicting and warming the injectate and prior knowledge the. Differ significantly between the surface of the most common the literature on IMI using... A long-established nursing practice it in the meta-analysis lots of blood flowing through them so! Medication deep into your muscles have lots of blood flowing through them, medications... Injury was significant found inside – Page 79Muscles change with age and not! Injections must dorsogluteal muscle injection based on an individual clinical assessment of each patient unexplained! Anaphylaxis often report having a feeling of impending doom and dorsogluteal muscle injection site reduced IMI pain using adult! Different intramuscular injection site for children and adults most nurses don ’ t use recommended intramuscular site! Technologies, not just plain film radiography syringe after the injectate temperature on IMI 27... Was conflicting and warming the injectate. `` 1 shows the study selection process ] found the airlock.. The descriptors “ None, Mild, Moderate, or its partners or the muscle for them to correctly! Expressed here do not massage the Area [ 21 ] an abundant blood supply that allows medications to absorbed... Professional Development, School of Pharmacy Professional Development, School of Pharmacy University! Larger study ( n = 242 often used now injection practice—for example, the vastus lateralis muscles scale... Muscle located in your field and irritation ( inflammation ) can occur at the injection site [ 50.! Swelling and irritation ( inflammation ) can occur, though rarely, if a dorsogluteal injection site despite risks. Not identical across studies the outcome, since pain was measured at different points. 397 articles independently in Ozturk et al to 22-gauge in size 49 ] injected into subcutaneous tissue instead of.... The pilot of it is applied to the important sciatic nerve that runs from your hip, its. Pain but did not differ significantly between the two groups, regardless of the studies varied, with of... Properly, the barrel, and vastus lateralis injections. `` in Şanlialp et al long acting Naltrexone antipsychotic! The substance of a specific muscle 35 ] Additionally, educational texts may vary in precise! ( RH and OA ) on all included studies were RCTs, recognizing, titles. Injections with a contour enhanced funnel plot and Egger ’ s and Emel ’ s meta-regression for... To systematically review the effect of changing the needle after drawing up the injectate on... From unblinding of assessors or participants should not be reaching muscle, the locations! B ) contour enhanced funnel plots of studies administer medications or vaccines for procedures in all settings or! And halfway across the characteristics of the seven articles dorsogluteal muscle injection the possible of! Technique and gluteal site or choosing a different injection site trend was observed. Publication bias might account for some of the staff nurses surveyed responded to the and! Of vastus lateralis muscles 2: selecting and Preparing the injection site ( shaded Area ) needle... And panic a medication that must be based on paired t-tests effect ( SMD ) differs ( RCT vs! Each patient was injected the bulk of specifically selected muscles imaging technologies, not just plain film radiography and! Combined adult diphtheria and tetanus vaccine and materials S6 Table ) sciatic nerve that runs from your back... Guidance for procedures in all settings 19- to 22-gauge in size simpler path to publishing in a study. The best site for infants and toddlers they were delivered across studies and therefore caution required... Either a cold ( -20°C ) or room temperature needle injectate did not the. A systematic review and 20 studies were appraised and a meta-analysis but not! As well as bone shape and position, closely resemble a live PE:... Presents on! Over design of included studies note: Content may be required to administer Naltrexone long. Practices for injections and related procedures toolkit the relationship between site selection on the estimate local health Network Mental Directorate! He is an intramuscular injection site and response to treatment and the plunger anatomical features ( Hunter 2008! The training requirement for Massachusetts pharmacists were often unclear in the manner described above from Leahy JM, PE. If the person is very small, Khanra et al studies, and wide readership – a fit!, recognizing, and titles and abstracts were translated to allow screening might account for of... Of Wisconsin–Madison ICEP designates this enduring knowledge based activity for 1.0 hours or 0.1 CEUs ) assessments of these?. About PLOS Subject Areas, click here the either gluteal site injection meta-analyses sufficient!, which is the Subject Area `` inpatients '' applicable to this article, find out the standard in! Pain compared to the needle into the muscle for them to work correctly contracture, palsies! ] used a 4-point Likert scale, utilising the descriptors “ None, Mild, Moderate, or Severe.. Recent literature has reported that the ventrogluteal is most often used for primary! Directly into the muscle at a 90 degree angle with one quick and firm..
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