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Most nurses 'ignore VG site advice'

Intramuscular injections are administered by seven out of 10 hospital nurses in the dorsogluteal (DG) buttock site despite the potential risks of causing sciatic nerve damage, a study found.

The research also discovered that only 14% of nurses applied the injection to using the ventrogluteal (VG) hip site, which is recommended in nursing literature.

Researchers in Canada targeted medical staff through a postal questionnaire, and received responses from 264, or 40% of people.

They found that the recommended VG site advice was more likely to be followed by younger nurses who were newer to the profession than those who had more experience.

The study, published in the May issue of the Journal of Advanced Nursing, also discovered that out of those using the DG site, 25% did not know about the possible nerve damage risks.

“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.

“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.

“Complications can include skin and tissue trauma, muscle fibrosis and contracture, nerve palsies and paralysis, abscesses and gangrene.

“Although three-quarters of the nurses in our study said they were aware of potential nerve damage when using the DG site, this site was used significantly more often than other sites.”

The majority of nurses who took part in the poll were aged between 30 and 49 years and had been working in nursing for more than ten years.

 

 

Readers' comments (3)

  • “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”

    If it is located away from major muscles, what is the point of using it for an IM injection where the whole idea is to inject into a large muscle? I suspect this is meant to say "...major nerves and blood vessels..."

    Another issue with the dorsogluteal site (mentioned in the paper) is the significant layer of fat that covers it, which means you need to use a long needle. The Royal Marsden manual recommends a 5-7.5 cm needle for patients weighing 40.5-90 kg, and a 10-15 cm needle above this weight to ensure that the injection goes into muscle and not fat.

    Part of the problem is that the VG site is more difficult to landmark. Many older nurses don't know how to find it, which can be an issue for students who want to practice using this site.

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  • There is nothing worse than hitting bone for patient or nurse!

    as an older nurse we were taught and have always injected into the upper lateral quadrant of the buttocks in order to avoid the sciatic nerve. is this not accurate enough or no longer appropriate? can anyone give me the answer please.

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  • The evidence against using the DG site isnt as strong as its being made out and the DG site is safe as long as correct technique is being used. Have a read of the studies used to support the shift to the VG site and you will see that many of them are 30- 50 years old

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