", CLINICAL PROCEDURES FOR SAFER PATIENT CARE: "7.4 Intramuscular Injections. In rare cases when not performed properly, the injection may result in shoulder dysfunction. Cookies policy. The volume to be injected in the muscle is usually limited to 25 milliliters, depending on injection site. 1a). Long-term results of the uncemented acetabular component in a primary total hip arthroplasty performed for protrusion acetabula:a fifteen years median follow-up. When doing hip joint flexion, he felt a sense of bounce at the femoral greater trochanter. [12] The deltoid site is located by locating the lower edge of the acromion process, and injecting in the area which forms an upside down triangle with its base at the acromion process and its midpoint in line with the armpit. J Pediatr Orthop. 1932;14:6879. Some scholars believe that GMC will not be reversed once it occurs, instead, it will gradually exacerbate [13]. Angela Cocoman and John Murray explain. 1990;11(5):2914. Arthrokatadysis from post-injection gluteal muscular fibrosis case report, https://doi.org/10.1186/s12891-020-03766-5, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, [email protected]. [15] The ventrogluteal site is less painful for injection than other sites such as the deltoid site. It is the knobbly top portion of the long bone in the upper leg (femur). Comparison of arthroscopic versus open surgery on external snapping hip caused by gluteal muscle contracture. BMC Musculoskeletal Disord. [12] It is not recommended to use the deltoid for repeated injections due to its small area, which makes it difficult to space out injections from each other. It is associated with the patient's congenital factors, scar constitution, immune factors, genetic factors, trauma factors, infection factors and surgical factors [3, 4]. [12] However, aspiration is not recommended by the Centers for Disease Control and Prevention, which considers it outdated for any intramuscular injection. Most patients with mild GMC have mild clinical symptoms. Use an ice pack for a few minutes before giving the injection. Studies also show this area is less painful than other sites. 3b). 2b). If the distance is3mm for an adult male or6mm for an adult female, arthrokatadysis can be diagnosed. As previously mentioned, the muscles of the ventrogluteal site, or the hip area, are thick and there are fewer veins and nerves in this area. Ries MD. Point the first or index finger toward the anterior iliac crest. We used a three-portals technique near the greater trochanter of the hip joint (Fig. While historically aspiration, or pulling back on the syringe before injection, was recommended to prevent inadvertent administration into a vein, it is no longer recommended for most injection sites by some countries. Patients often present with hip joints dysfunction and abnormal gait. 2003;23(3):224. Then, you would draw imaginary median lines from each corner of the triangle. Saunders: Philadelphia, 1994, Kozier et al. [12] The ventrogluteal site is located in a triangle formed by the anterior superior iliac spine and the iliac crest, and may be located using a hand as a guide. However, the main disadvantage is that injections in the Rectus femoris site may cause considerable discomfort.6. For this reason, unless there are desired differences in rate of absorption, time to onset, or other pharmacokinetic parameters in the specific situation, a less invasive form of drug administration (usually by mouth) is preferred. Liu YJ, Wang ZG, Li ZL, et al. To summarize, this case report describes a patient with moderate arthrokatadysis caused by GMC due to long-term intramuscular injection of penicillin in the buttock, who underwent arthroscopic surgery and finally had good results. Clin Orthop Relat Res. It has a lot of veins and is close to the important sciatic nerve that runs from your lower back down your legs. After arthroscopic release of GMC, the patient recovered well. Patients with arthrokatadysis present with the femoral head indentation that breaks through the wall of the acetabular wall and exceeds the Kohler's line, causing joint pain and restricted movement [9]. [28], To help infants and children cooperate with injection administration, the Advisory Committee on Immunization Practices in the United States recommends using distractions, giving something sweet, and rocking the baby side to side. Alves K, Katz JN, Sabatini CS. Insert the needle at a right angle to the skin, Up to 3ml of fluid can be given in this site. All Ireland J Nursing & Midwifery 2001; 1(5): 185-193, Newton M, Newtown DW, Fudin J. You may need to give or receive injections at home. For example, in very young people or frail elderly people, a normal length needle may be too long to safely inject in the desired muscle. Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices, "Chapter 17 Pharmacologic Management of Patient Behavior", "Drug injection practices among high-risk youths: the first shot of ketamine", "Aspirating during the intramuscular injection procedure: a systematic literature review", "EPIPEN- epinephrine injection, EPIPEN Jr- epinephrine injection", "Best vaccination practice and medically attended injection site events following deltoid intramuscular injection", "Vaccine administration practices: Canadian Immunization Guide", "Covid-19 vacciner skal gives med aspiration fr injektion", "Intramuskulr injektion p brn og voksne", "Needle size for vaccination procedures in children and adolescents", "ACIP Vaccine Administration Guidelines for Immunization | Recommendations | CDC", "Lessons learned and applied: what the 20th century vaccine experience can teach us about vaccines in the 21st century", https://ouv.vt.edu/content/dam/ouv_vt_edu/sops/small-animal/sop-dogs-and-cats-injections.pdf, Prevention and Control of Influenza, Recommendations of ACIP, https://en.wikipedia.org/w/index.php?title=Intramuscular_injection&oldid=1095140638, All articles with bare URLs for citations, Articles with bare URLs for citations from March 2022, Articles with PDF format bare URLs for citations, Pages using multiple image with auto scaled images, Creative Commons Attribution-ShareAlike License 3.0, This page was last edited on 26 June 2022, at 16:42. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. [23], The deltoid muscle in the outer portion of the upper arm is used for injections of small volume, usually equal to or less than 2 ml. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Sitting May Raise Risk of Heart Failure Nearly 50%, Broccoli Reigns Supreme as Americas Favorite Veggie, Vaccinations for Youngest Kids Gets Final CDC Approval, Dr. Whyte's Book: Take Control of Your Diabetes Risk, The Future of Food: What You Need to Know, Health News and Information, Delivered to Your Inbox. Two portals were generally applied to most patients, with one portal at the apex of the greater trochanter and the other at 2cm or 4cm above the apex of the greater trochanter, but in the current case with a severe GMC, an additional portal which was at 2cm or 4cm below the apex of the greater trochanter was used. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. d The photograph on the first day after surgery shows that the patient is able to walk independently in a straight line in the absence of his feet external rotation. Scully WF, White KK, Song KM, et al. [16], In some populations, a change in injection site, needle length, or technique is necessary. The patient could walk in a straight line without external rotation of both feet (Fig. The authors declare no competing interests. The study patient had moderate arthrokatadysis. Intramuscular injections: a review of nursing practice for adults. [5][9]:372, Injections into the deltoid site in the arm can result in unintentional damage to the radial and axillary nerves. The postoperative incision was distributed as shown in the figure (Fig. The thumb should always be pointed toward the front of the leg. ", International Journal of Caring Sciences: "Using Ventrogluteal Site in Intramuscular Injections is a Priority or an Alternative? [17], The vastus lateralis site is used for infants less than 7 months old and people who are unable to walk or who have loss of muscular tone. Terms and Conditions, Dr. Ebraheims educational animated video illustrates injection methods of the Gluteal region or the buttock.Gluteal injection, buttock injection or Glute injection is common but it can injure the sciatic nerve.INTRAMUSCULAR INJECTION OF THE BUTTOCK SHOULD BE SAFE.Glute (buttock) injection is a universal procedure that is commonly used around the world.The injection has to be safe.Selecting the proper site that avoids injury to the neurovascular structures is important.The sciatic nerve could be at risk for the injury during buttock injection.Buttock is divided into quadrants.Divide the buttock halfway down the middle and halfway across.Injection is given in the center of the upper, outer quadrant.Injection into the other quadrants may cause injury to the neurovascular structures.Another helpful method could confirm a safe site for injection is to draw a line from the posterior superior edge of the iliac spine to the greater trochanter.The area above the line is considered to be the safe zone for intramuscular injection.This corresponds with the upper outer quadrant of the buttock and is the exact safe site for the buttock injection.Follow me on twitter:https://twitter.com/#!/DrEbraheim_UTMCDonate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:https://www.utfoundation.org/foundation/home/Give_Online.aspx?sig=29 It has been suggested4 that the following points should be incorporated into clinical guidelines: These measures should ensure optimal nursing care for patients. This is possibly the first reported case of arthrokatadysis that was caused by GMC after repeated intramuscular injections into the buttocks. If single-use or sterilized equipment is not used, there is the risk of transmission of infectious disease between users, or to a practitioner who inadvertently injures themselves with a used needle, termed a needlestick injury. [2]:102103 An intramuscular injection is less invasive than an intravenous injection and also generally takes less time, as the site of injection (a muscle versus a vein) is much larger. gluteal region nerve quizlet sciatic buttock JBJS Case Connect. This site can be used for infants, children and adults. G stands for geometric. [12][14] Sites that are bruised, tender, red, swollen, inflamed or scarred are generally avoided. Gluteal muscle contracture: diagnosis and management options. f The surgical marker diagram illustrates that the vertex of the greater trochanter of the hip joint is denoted 0, parallel lines are made up and down, with an average interval of 2cm between each line. [9]:368369 Specific sites of administration may also be contraindicated if the desired injection site has an infection, swelling, or inflammation. 2d). An intramuscular injection can be administered in multiple different muscles of the body. Am J Med Sc 1961; 241: 47-58, Rodger MA, King L. Drawing up and administering intramuscular injections: a review of literature. J Bone Joint Surg Am. Needle length used is usually 2.5cm or less. [29], In animals common sites for intramuscular injection include the quadriceps, the lumbodorsal muscles, and the triceps muscle. Google Scholar. Place the opposite hand on the person's hip. Zhonghua Liu Xing Bing Xue Za Zhi. [6], However, aspiration is recommended by the Danish Health Authority for COVID-19 vaccines to reduce the potential rare risk of blot clotting and bleeding. Sorenson & Luckmanns Basic Nursing, A Psychophysiological Approach (3rd ed.) Intramuscular injection may be preferred because muscles have larger and more numerous blood vessels than subcutaneous tissue, leading to faster absorption than subcutaneous or intradermal injections. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. 15DZ1941703 and 15441904403). If it's just given under the skin, it can lead to poor absorption of the substance, skin irritations, and more pain during injection. Many people have dimples over this bone, Draw an imaginary line between the two bones, After locating the centre of the imaginary line, find a point one inch toward the head. It is the knobbly top portion of the long bone in the upper leg (femur). a A clinical photograph taken on the first day after the surgery shows two mini incision and mild swelling over the operation area. Hence, we chose release of bilateral gluteus maximus contractures under arthroscopy for this patient. Clinical Practice - IM injections: Hows your technique? a The patient walks with his feet in external rotation. Nursing Standard 2004; 18 (29): 39-42, Small SP. [9]:369 Intramuscular injections may also cause an abscess or gangrene at the injection site, depending on the specific medication and amount administered. In people who are overweight, a 1.5-inch needle may be used to ensure the injection is given below the subcutaneous layer of skin, while a 58-inch needle may be used for people who weigh under 60 kilograms (130lb). There is also a risk of nerve or vascular injury if a nerve or blood vessel is inadvertently hit during injection. In our case, we hypothesized that arthrokatadysis was caused by recurrent gluteal contracture fibrosis resulting from repeated bilateral buttocks injections. Injection: Intramuscular. It should not be forgotten that among potential complications of IM injection are abscess, cellulites, tissue necrosis, granuloma, muscle fibrosis, contractures, haematoma and injury to blood vessels, bones and peripheral nerves.2 Although IM injection is a commonplace nursing practice, there is a dearth of guidelines for nursing staff in this area.3,4 It has been outlined that there are no working policies or procedures on administering injections to which nursing staff can refer.3 Furthermore, the technique and preparation by certain staff may not be substantiated by evidence.4, Sites of the thigh (Rectus femoris and Vastus lateralis)The uptake of drugs from the thigh region is slower than from the arm but faster than from the buttock, thus facilitating better drug serum concentrations than is possible with the gluteal muscles.5, The thigh may be utilised when other sites are contraindicated or by clients who administer their own medication, as it is readily available in the sitting or lying back position.
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