Running head: VENTROGLUTEAL VS DORSOGLUTEAL

Pain in Ventrogluteal vs. Dorsogluteal IM injection sites

Braydon Bird, Jentry Hess
Dixie State University

VENTROGLUTEAL VS DORSOGLUTEAL

Pain in Ventrogluteal vs. Dorsogluteal IM injection sites

Many people are afraid of needles. Maybe its the sight of the needle, maybe its the
blood often associated, or maybe its the pain. This paper addresses the pain associated with IM
injection in the gluteal region. The question is whether the dorsogluteal or ventrogluteal site is
less painful. Five studies which focus on this subject are reviewed. The findings indicate that
the ventrogluteal site for IM injection carries less risk for injury, and may cause less pain than the
dorsogluteal site. Research reveals however, that the ventrogluteal site is used much less by
nurses than the dorsogluteal site. More education about the decreased pain and risk for injury
associated with the ventrogluteal site for IM injection should be provided to nurses. Education
will help nurses learn and follow evidence based practice.
Practice Question
Many nurses use the dorsogluteal site for IM injections, even though evidence based
practice suggests the ventrogluteal site is safer than the dorsogluteal. The question which this
project seeks to answer is whether use of the ventrogluteal site causes adult patients less pain
than use of the dorsogluteal site.
P- Patient Population or Problem
The patient population is adults.
I- Intervention
The intervention of interest is IM injections in the ventrogluteal site.
C- Comparison

VENTROGLUTEAL VS DORSOGLUTEAL

The comparison intervention is IM injections in the dorsogluteal site.

O- Outcomes
Which site for IM injection is associated with less pain.
The Following Question was Developed
Does the ventrogluteal IM injection site cause adult patients less pain than the
dorsogluteal site?
Evidence
This question is a therapy question, as it involves IM injection therapy. The main
resource used to find articles on this subject was Health Source: Nursing/ Academic Edition
hosted by EBSCOhost. This database, as accessed through Dixie State Univertys library page
online, was invaluable in this research.
Search Items and Results of Search
Search terms developed from the PICO question included: ventrogluteal,
dorsogluteal, IM injection sites, and pain, IM injections. Changes made to the search
terms included IM injection complications, dorsogluteal vs ventrogluteal. We found 5
articles that address the differences between dorsogluteal and ventrogluteal IM injection sites.
Three literature reviews, one cohort, and expert article were reviewed for this information.
Study One
Carter-Templeton and McCoy (2008) performed a systematic review of five nursing
fundamentals textbooks. The focus of the review is what the textbooks instruct and recommend

VENTROGLUTEAL VS DORSOGLUTEAL

about IM injections, and several aspects of the injections are considered. The researchers found
many discrepancies between the textbooks in relation to which site they recommended for IM
injection. All five books had instructions on how to find and use the ventrogluteal site, and three
specifically advised against the dorsogluteal site. There were several reasons listed for choosing
the ventrogluteal site over the dorsogluteal site. One reason was that it houses no major nerves
and blood vessels, or excess adipose tissue. Along with the textbook review, the researchers did
a survey of nurses from local clinical institutions. The study found that the dorsogluteal site was
the preferred site for seventy-five percent of the 27 nurses who responded, even though most of
the textbooks and other literature suggest using the ventrogluteal site as the preferred location.
This paper did not exactly answer the question posed by our group, but it did offer some insight
into why the ventrogluteal site might be less painful than the dorsogluteal. The paper also
revealed that many nurses use the dorsogluteal sight for IM injection, despite much research
against such practice.
Study Two
Cocoman and Murray (2008) reviewed many resources in an effort to determine best
practice for IM injection site selection. The researchers reviewed forty-four textbooks and
journal articles written between 1960 and 2007. The literature was mostly from North America
and Europe. Research revealed that the dorsogluteal site for IM injection is the source of more
potential injuries and complications than the ventrogluteal site. With this understanding, the
researchers wanted to find out why so many nurses continue to use the dorsogluteal as the site of
choice. Review of the literature found that ease of locating the dorsogluteal site, and lack of
knowledge concerning the ventrogluteal site were the most likely reasons for this discrepancy.

VENTROGLUTEAL VS DORSOGLUTEAL

The conclusion that the researchers came to was that even those who are familiar with the EBP
of IM injection site choice, may chose against it in favor of the easier option.
Study Three
Small (2004) presented a literature review on preventing sciatic nerve injury from
intramuscular injections. She reviewed many research studies regarding IM injection procedures
and also legal databases for court decisions in Canada and the United States dating from 1970 to
2007. In her research she found that even though there was a lot of evidence based practice
supporting the use of the ventrogluteal site over the dorsogluteal site, the dorsogluteal site was
still being chosen by many of the nurses. Not only is making the choice of using the
dorsogluteal site putting the patients at risk for sciatic nerve injury, causing them discomfort,
morbidity and lasting disability, but it also provides the basis for nursing negligence suits,
which she covers throughout the article. She goes on to make a point of educating nurses on
how to locate the sites using landmarks, providing the patients with the safe care they deserve.
This paper didnt necessarily answer our question directly, but it was very thorough on the risk of
injury for the patient and the risk of a lawsuit for negligence if injury is caused by a nurse giving
an IM injection in the dorsogluteal site over the ventrogluteal.
Study Four
The Greenway, Merriman, and Statham (2006) study shows that the dorsogluteal site is
not as effective a location as the ventrogluteal site due to the thickness of the subcutaneous fat in
adults on the dorsogluteal area. This means that the absorption rate of the drug will be
adversely affected, or the tissue may become irritated when the drug does not reach the intended
target muscle. The research continues on to say The ventrogluteal site is relatively free of

VENTROGLUTEAL VS DORSOGLUTEAL

major nerves and blood vessels, the muscle is large and well defined, and the landmarks for
administration are easy to locate. In continuing the comparison of these two sites there were
many disadvantages to using the dorsogluteal site, including damage to the sciatic nerve leading
to pain or paralysis; inadvertently administering the drug intravenously; mistakenly injecting into
subcutaneous tissue instead of the muscle causing irritation and improper placement of the drug;
it is also associated with tissue necrosis, gangrene, pain, muscle contraction and fibrosis. The
only disadvantage to using the ventrogluteal site is that it is a new practice that practioners are
unfamiliar with and lack confidence in. This article was a lot more specific in answering our
question and the conclusion we get from this is that the ventrogluteal site is much safer, with less
risk of injury or pain, and that it is time for nurses to start getting more confident in using this
site.
Study Five
Mishra and Stringer (2010) also reviewed many resources in their study for the best
practices in giving IM injections, to determine if sciatic nerve injury is a continuing problem and
determining the availability of published guidelines for the nursing community. Their studies
found that there was still a continuing problem with sciatic nerve injuries from IM injections
given in the dorsogluteal site. They did not determine whether they were given by nurses or
doctors, but they did determine that a majority came from a general practice setting and that most
injuries occurred in younger people, ranging in age from childhood to 40 years old. They were
also unable to find very many published guidelines for nurses although the nursing organizations
claimed to support nurses using the ventrogluteal rather than the dorsogluteal site for IM
injections. This article didnt answer our question regarding which site was less painful, but it did

VENTROGLUTEAL VS DORSOGLUTEAL

cover the risk of injury in using the dorsogluteal site and the need for more published materials
and guidelines for the nursing community.
Summary of Evidence and Practice Recommendation
The articles reviewed all presented information on ventrogluteal injections vs.
dorsogluteal injection. This information included that the dorsogluteal site for IM injection posed
a greater threat of injury than does the ventrogluteal site; that EBP suggest use of the
ventrogluteal site over the dorsogluteal; that nurses can be held legally responsible if accidents
occur with the dorsogluteal site usage; and that nurses use the dorsogluteal site for IM injections
much more often than the ventrogluteal site. Through this information, it was concluded that
there would be less pain associated with ventrogluteal IM injections, although that question was
not specifically addressed.
Conclusion
Whether or not the dorsogluteal site causes more pain initially, it is clear that it carries
more risk to the patients safety and health than the ventrogluteal site. Therefore it is
recommended that the dorsogluteal site should not be used for IM injections, and that the
ventrogluteal site be used in its place. Nurses and nursing students should be taught proper
technique for finding and using the ventrogluteal site, and should be informed on the importance
of this practice.
References

VENTROGLUTEAL VS DORSOGLUTEAL

Carter-Templeton, H., & McCoy, T. (2008). Are we on the same page? a comparison of
intramuscular injection explanations in nursing fundamental texts.MEDSURG
Nursing, 17(4), 237-240.
Cocoman, A., & Murray, J. (2008). Intramuscular injections: a review of best practice for
mental health nurses. Journal Of Psychiatric & Mental Health Nursing, 15(5), 424-434.
doi:10.1111/j.1365-2850.2007.01236.x
Greenway, K., Merriman, C., & Statham, D. (2006). Using the ventrogluteal site for
intramuscular injections. Learning Disability Practice,9(8), 34-37.
Small, S. (2004). Preventing sciatic nerve injury from intramuscular injections: literature
review. Journal Of Advanced Nursing, 47(3), 287-296. doi:10.1111/j.13652648.2004.03092.x
Walsh, L., & Brophy, K. (2011). Staff nurses' sites of choice for administering intramuscular
injections to adult patients in the acute care setting. Journal Of Advanced Nursing, 67(5),
1034-1040. doi:10.1111/j.1365-2648.2010.05527.x