Ventrogluteal
Definition
The ventrogluteal area is the area in which intramuscular injections are performed. The ventrogluteal muscle area is often preferred for the administration of intramuscular injections, as it allows for the rapid absorption of the injected medication.
Ventrogluteal vs Dorsogluteal
The dorsogluteal approach was used for many years for the administration of the intramuscular injections but recent research has demonstrated an increased risk of injury. Today, it is known that the dorsogluteal approach can lead to a series of complications, especially in patients who receive intramuscular injections for prolonged periods of time. Among these complications, there are: abscess, cellulitis, necrosis at the site of the injection, formation of granuloma, muscle fibrosis, muscle contracture, hematoma, injury of the blood vessels or nerves in the area.
The dorsogluteal area is found in the superior and lateral part of the gluteal muscles, which is known in the medical field as the upper outer quadrant. The area can be more easily identified by dividing the buttock into four imaginary quadrants.
The constant administration of dorsogluteal injections presents an increased risk of damage to the sciatic nerve, as well as to the superior gluteal artery. The damage can cause complications such as the dropping of the foot or even the paralysis of the entire limb. Apart from that, given the fact that there is a lot of fat in the area, there is always the risk of the needle not reaching the muscle. The dorsogluteal injections are also known to be more painful, given that there are many pain receptors in the subcutaneous layer of the skin. There is also a reduced absorption rate of the administered medication and the risk of the drug building up under the skin, causing the effects of an overdose.
The ventrogluteal site is preferred for the administration of intramuscular injections, as there is a lot less fat in the area. Apart from that, the muscular mass is more generous (gluteus medius and gluteus minimus muscles), so the needle can certainly reach the muscle. Another advantage of the ventrogluteal approach is that there are no major blood vessels or nerves in the area, presenting thus a reduced risk of injury. The ventrogluteal site can be found at a half point between the head of the femur and the hip. It is important to remember that up 3 ml of fluid can be administered through the ventrogluteal approach.
Ventrogluteal IM injection site
In order to correctly identify the ventrogluteal IM injection site, there are several steps that have to be followed. First of all, you need to place the heel of the hand on the greater trochanter of the patient’s limb. You will need to palpate the anterior superior iliac spine using the index finger. Keep in mind that the left hand has to be used in case you are planning on administering the injection on the right buttock, while you will be using the right hand in case of the left buttock.
The next step will require that the middle finger slides across, thus making a peace sign and pointing in the direction of the iliac crest. The ventrogluteal IM injection site will be found exactly in the middle of the peace sign. Apply alcohol to the site of the injection and insert the needle at an angle of 90 degrees. Inject the medication without hurry – each ml should take 10 seconds and then remove the needle from the skin, applying pressure to the injection site for about 10 seconds (to stop the bleeding).
Ventrogluteal injection technique
The most common technique for the ventrogluteal injection is represented by the Z-track. The main advantages of this technique are related to the reduced pain experienced by the patient and the correct distribution of the medication (prevent the irritation of the tissues caused by the leaking of the medication into the subcutaneous tissue).
Before injecting the medication, you have to aspirate with the plunger of the syringe and check for blood return. If no blood results from the aspiration process, this means that you have inserted the needle correctly, meaning into a muscle and not into a blood vessel.
In order to administer a correct ventrogluteal injection through the Z-track technique, you will have to start by applying gentle traction on the skin. Pull the skin from the injection site – about two or three cm – using your non-dominant hand. Inject the needle at a 90 degrees angle, in a slow manner. Administer the medication as required and then withdraw the needle rapidly. The last step will be to release the skin. You can cover the injection site with a dry gauge and apply pressure to stop the bleeding. It is strictly forbidden to massage the site of the injection, as this can lead to unnecessary complications.
The clinical guidelines for nurses indicate that the ventrogluteal site should be used whenever it is possible, in preference to the other ones. The medication is recommended with a needle that has a sufficient length in order to reach the said muscles groups and without affecting the surrounding structures. The patient should maintain a position that allows for the gluteal muscles to be relaxed – a contracted musculature increases the risk for injuries. Also, the Z-track technique should be used in all patients.
When administering an injection in the ventrogluteal site, it is recommended that one assesses the site to see whether there is enough muscular tissue or not. Apart from that, it is forbidden to administer intramuscular injections in the areas where there are lesions, healing injuries or bony protuberances. The frequent change of the ventrogluteal site (from one side to the other) is recommended as well, so as to prevent the damaging of the tissues, especially if the patient has to undergo a long-term treatment.
So, you see, it is really important that you always use the ventrogluteal area when administering intramuscular injections. The patient experiences a lot less pain and the risk of complications is genuinely reduced, which is a clear advantage of this method. Plus, the Z-track technique is easy to follow, no matter your experience in the field.
