Long Acting Injectable (LAI) medications for patients with schizophrenia is commonly administered to relieve their symptoms. Through shared decision-making and clinical evidence-based, psychiatrists should systematically offer LAIs to all patients requiring long-term antipsychotic treatment as a first-line treatment. Gluteal intramuscular (IM) injection requires accurate insertion of needles into the specific muscle area, often the outer upper quadrant of the buttocks, in order to achieve the required blood concentration. The purposes of this study were to compare the "Distance from the Epidermis to the Under-Fascia (DEUF)" and "Distance from the Epidermis to the Iliac Bone (DEB)" of the buttocks IM injection sites at the dorsogluteal and ventrogluteal sites among healthy Japanese volunteer subjects, and to identify the optimal insertion injection needle length. The DEUF and DEB at the gluteal regions were measured by ultrasonography. Welch's one-way analysis of variance was used to compare the DEUF and the DEB at the gluteal IM injection regions. There was no statistically significant difference observed between the right and left mean values of DEUF for Hochstetter and Clark's point at the ventrogluteal sites, and the Four and Three-way split or Double Cross point at the dorsogluteal sites. However in the DEB, the Hochstetter's point (P < 0.01) at ventrogluteal site on the right side, and Clark's point (P < 0.05) were significantly shorter than the Double Cross point at dorsogluteal sites (F = 4.38). The left buttocks S. Masuda et al. 204 Hochstetter's point was significantly shorter than the Double Cross point (F = 4.38, P < 0.01). These results, however, did not establish a statistically significant difference in the DEUF among injection sites. It was considered that the difference in the DEB depended on muscle volume and thickness in the gluteal injection sites.
The multiple regression equations for BMI and fat percentages (upper extremity estimation) of DEUF, and for BMI and injection site circumference of estimated DEB, successfully value the DEUF and DEB. By using these multiple regression equations for IM injection to the deltoid-muscle, DEUF can better ensure accurate LAI into the muscle through body monitor, DEB, and measured values of the deltoid-muscle injection site circumference.
Gluteal intramuscular injection requires accurate needle insertion into the specific muscle area for accurate, safe, and efficacious delivery of medication for long-acting anti-psychiatric drugs. With ultrasonography, accurate evaluation of the "Distance from the Epidermis to the Under-Fascia (DEUF)" can be determined. However, a nurse in the clinical settings, ultrasonographic measurements during intramuscular injection is impractical and difficult. The purpose of this study was to estimate the thickness of subcutaneous fat by using a near-infrared ray measuring device.This study was approved by the Ethics Committee of Tokushima University Hospital. There were 39 subjects (21 men and 18 women) aged 20 to 60 years (Mean ± SD: 44.97 ± 15.20 years old). Bilateral DEUF at Ventrogluteal and Dorsogluteal sites (AVIUS: Hitachi-Aloka Medical Co.) were evaluated on B-mode scan as the gold standard. At the same sites, the thickness of the subcutaneous fatty tissue was measured using the PoccoStick (HORIC: smallsize instrument measuring the thickness of the subcutaneous fat with a near-infrared ray device). The right Ventrogluteal site thickness of the fatty tissue was significantly overestimated by PoccoStick (15.18 ± 8.77 mm) measurements, as compared to the ultrasonography (12.42 ± 5.26 mm) (p<0.01) results. The left-side Ventrogluteal site and both the right and left Dorsogluteal sites measurements did not show significant differences. This illustrated and supported the credible use of inexpensive devices such as the PoccoStick in estimating the DEUF. The development of a more highly accurate small-sized instrument is recommended.
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