march 3/vol18/no25/2004 nursing standard 39 Greenway K (2004) Using the ventrogluteal site for intramuscular injection. Nursing Standard. 18, 25, 39-42. Date of acceptance: September 8 2003. Using the ventrogluteal site for intramuscular injection T HE EXTENT to which the ventrogluteal site is used in the UK for administering intramus- cular (IM) injections is unknown (Rodger and King 2000). It is important that practitioners con- stantly re-evaluate and update the care they give and embrace the latest research findings, by apply- ing evidence-based practice. Hamer and Collinson (1999) view this as: ‘Finding, appraising and apply- ing scientific evidence to the treatment and man- agement of healthcare. Its ultimate goal is to support practitioners in their decision-making to eliminate the use of ineffective, inappropriate, too expensive and potentially dangerous practices.’ Nurses in the UK tend to use the dorsogluteal site as the site of choice for IM injections, despite the fact that this choice of site is ineffective, inappro- priate and potentially dangerous (Table 1). A study by Farley et al (1986) identified that only 12 per cent of the nursing staff in a teaching hospital in the United States used the ventrogluteal site. Whether it is better to use the ventrogluteal or the dorso- gluteal site has not yet been debated in the UK. The administration of injections is one of the skills that nurses use regularly in clinical practice. The objective of an IM injection is to deliver the drug into the muscle layer beneath the subcutaneous tissue. This route of administration provides rapid systemic action and absorption of the drug in rel- atively large doses (up to 5ml in most sites) (Campbell 1995). As muscle tissue has relatively few sensory nerves, IM injections allow less painful administra- tion of concentrated or irritating drugs, and also avoid such drugs damaging the subcutaneous tissue (Campbell 1995). The dorsogluteal site or the ‘upper outer quadrant’ as it is known colloquially, is traditionally the IM injection site of choice. However, when this injection site is used there is a significant risk that the drug will not reach the muscle, but will be injected into the subcutaneous tissue layer, as this area is covered with subcutaneous tissue in many people. A study by Cockshott et al (1982) identified that of 213 adults who were injected in the dorsogluteal site by nurses, less than 5 per cent of women and 15 per cent of men would have received an IM injec- tion into the glutei. These results support earlier work by Lachman (1963), who reported that sub- cutaneous fat in adults in the dorsogluteal area varies from 1cm to 9cm. This means that the absorp- tion rate of the drug will be adversely affected, or the tissue may become irritated when the drug does not reach the intended target muscle. This is not the only problem associated with using the dorsogluteal site. Rodger and King (2000) state that the system of visually bisecting the buttocks horizontally and vertically has been used for many years. Yet the threat of injury remains significant as the sciatic nerve and the superior gluteal artery lie only a few centimetres distal to the dorsogluteal injection site. Injecting into the sciatic nerve (Figure 1) could cause pain and temporary or permanent paralysis (Covington and Trattler 1997). The ventrogluteal site is relatively free of major nerves and blood vessels, the muscle is large and well defined, and the landmarks for administration are easy to locate (Wong 2002). The ventrogluteal site consists of the gluteus medius muscle, which is located on top of the gluteus minimus muscle. Colloquially, it is also called the ‘hip site’ (Figure 2). Zelman (1961) reported that this location provides the greatest thickness of gluteal muscle – the glu- teus medius and gluteus minimus. The site is sealed off by bone and there is a narrower layer of fat of consistent thinness than is present in the posterior buttock. Michaels and Poole (1970) concluded that Ventrogluteal injection site Dorsogluteal injection site The dorsogluteal versus ventrogluteal injection sites Kathleen Greenway MEd, BSc(Hons), RN, Cert HE, is senior lecturer, School of Health and Social Care, Oxford Brookes University, John Radcliffe Hospital, Oxford. Email: kgreenway@brookes.ac.uk ■ Injections ■ Intramuscular injection sites ■ Nursing practice These key words are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review. Key words The administration of intramuscular injections is a common nursing intervention in clinical practice. This article aims to raise awareness of the use of the ventrogluteal site for administering intramuscular injections. It describes the main reasons for using this site and outlines the complications associated with the dorsogluteal site. It is hoped that this review of the literature will shift everyday practice in favour of the ventrogluteal site. Summary For related articles and author guidelines visit our online archive at: www.nursing-standard.co.uk and search using the key words below. Online archive art & science policy and practice