REPORT: March 2006

Research News You Can Use: Base Your Practice on Evidence

Give your IM injections based on evidence, not tradition!

by Joanne K. Singleton, PhD, RN, APRN, BC, FNAP, professor and co-director, Pace University, Lienhard School of Nursing; Council on Nursing Research

When giving an intramuscular (IM) injection to an adult patient, are you concerned about damaging the sciatic nerve? Do you know what the preferred adult IM injection site is to avoid sciatic nerve damage? The aim of Small’s review of the literature is to identify factors that contribute to this iatrogenic injury and establish what preventive measures nurses can take in their own practice. This article brings to light the importance of evidence for our day-to-day practice. Intramuscular injections via the ventrogluteal site prevent sciatic nerve injury.

Method

Small searched the English language databases for relevant research articles and information on injection procedures. Additionally, legal databases were searched for relevant court decisions in Canada and the United States from 1970 to 2003.

What was found?

Sciatic nerve injury is one of the most serious complications of this common nursing procedure. Yet, there are few relevant databased research studies on this topic. Small did find an overwhelming number of commentaries, practice guidelines, and opinion pieces on IM injections. In addition to these articles, Small reviewed textbook descriptions on IM injections, as well as results from the search of legal databases for cases of IM injection injury of the sciatic nerve.

Site selection and injection technique appear to be contributing factors to sciatic nerve injury from IM injection. From the literature four common sites for adult IM injection were identified: dorsogluteal (DG), ventrogluteal (VG), vastus lateralis (VL), and deltoid. The DG site, which is close to the sciatic nerve and the superior gluteal nerve and artery, has lost favor over time due to the potential for injection related injury. The VG was introduced in the early 1950s in response to DG injection site complications. Although anatomic advantages to the VG site have been identified, the DG site remains the preferred site in practice. This is a clear example where current practice is not consistent with the best evidence.

What does this mean for you?

Check your IM injection site! Small, describes the VG site as consisting of the “gluteus medius and minimus muscles, located at the hip in an inverted triangle formed by the iliac crest, the anterior superior iliac spine, and the greater trocanter of the femur” (p.290). Not only can the patient have poor outcomes, damage to the sciatic nerve from IM injection can lead to nursing negligence suits.

According to Small, in the case of this common nursing procedure, “because of the limited research base, practice guidelines are largely founded on opinion rather than on sound research evidence.” Your choice of IM site must be based on the best available evidence and on your individual assessment of your patient. So, check your IM injection site. The best available evidence points to the VG site for your best practice and defense.

For illustrated guides to proper procedures, visit http://flightline.highline.edu/drydberg/balckboard/ventrogluteal_injection_site.htm or www. nursesdrughandbook com/safe_drug_admin/identifying_injection_sites/IdentifyingInjectionSites.cfm.

Reference

Small, S. P. (2004). Preventing sciatic nerve injury from intramuscular injections: Literature review. “Journal of Advanced Nursing” 47(3), 287-296.