Evidence calls for practice change in intramuscular injection techniques

Abstract

Background and Objective: Intramuscular (IM) injections are administered to patients in all health care settings. Even though this procedure is invasive and the evidence supporting the process of administration is extensive, techniques and procedures vary throughout the literature and in practice. The purpose of this descriptive correlational study was to 1) investigate the literature on current evidence-based IM injection procedures pertaining to gender, patient weight, injection site, needle length, and technique, 2) compare surveyed healthcare personnel self-reported IM injection practices, and 3) query respondents on informational resources they access, continuing education they receive, and their years of healthcare experience and higher education. Methods: The Intramuscular Injection Questionnaire (IIQ) was sent via email to various professional healthcare facilities and their respective social media sites. Two hundred and six (206) healthcare personnel of various healthcare backgrounds and educational levels accessed the IIQ via a link to Qualtrics software. SPSS Version 24 was used for data analysis. Results: Most respondents were registered nurses with 4 -15+ years of experience. Seventy-eight percent of respondents considered their IM injection knowledge at above average or expert levels. Gender was not considered an important factor when selecting an injection needle among 75% of participants. Of all respondents, 61% use z-track technique, 59% use the ventrogluteal site and 34% always bunch or stretch the skin during injection. IM injection education was not provided in 75% of healthcare facilities. Conclusions: IM injection practices vary among respondents and in the literature; some reported practices are contrary to current evidence-based practice. While the evidence provides some sound recommendations, some procedures are not well-documented or supported including in nursing texts. Nurses and other healthcare personnel must critically analyze the site, depth, needle, volume, medication, vaccine, and whether to bunch or stretch, according to evidence-based practice. Healthcare facilities should provide IM injection education routinely to ensure safe practices. Future studies (Level 1 and 2) are needed to further demonstrate the best evidence leading to safe and effective IM injections.

Selection of Site for Administration of Intramuscular Injection to Adult Patients by Nurses: A Cross-Sectional Study

“…24 Strohfus et al state that it is more challenging for nurses with inexperience and newstarters to spot and use VG site. 25 To sum up, the present study and other studies emphasize that nurses feel confident about themselves in identifying DG site and thereby, they favor this site. However, alternative methods have been developed to determine VG site and reliability of these methods have been…”

“…It is important to choose a site away from large blood vessels, nerve and bone structures. 25 Although VG site is advocated as the first preference in clinical environment, the DG site, vastus lateralis, and deltoid muscle are used despite their well-known potential risks. 4,7 It is a known fact that nurses face a variety of problems in selecting the VG site and administration despite the updated nursing curriculum.…”

Best practice for deltoid intramuscular injections in older adults: Study in cadavers

“…Nurses who consider themselves experts in performing deltoid IMI may also believe they no longer need to physically landmark because they can eyeball the client's arm to select the best injection site. [5] Our study demonstrates the hubris of this belief. Physically landmarking the intended injection site is critical for the safety of the client receiving deltoid intramuscular injection.…”

“…However, it is unlikely that the nurse was taught to consider these variables when administering deltoid intramuscular injection (IMI), and contemporary nursing fundamentals textbooks do not cite empirical evidence to support recommended practices for deltoid IMI. [4,5] Guidelines provided by government agencies are vague with respect to specific practice techniques for deltoid IMI. [3,6] Nursing textbooks and entry-to-practice nursing education programs likely do not include best practice evidence for deltoid IMI because little evidence exists.…”

“…Therefore, many nurses have a ritualistic, routinized approach to administering injections and consider themselves to be experts. [5,10] As well, nurses fear striking bone when giving injections, described by Wilkoff as a "fingernails-on-the-blackboard experience" for the nurse (p. 20), [11] although the patient is unlikely to feel it. [12] "You don't want to hit bone" is a frequently-given rationale for the universal use of 25 mm needles, employing bunching technique and leaving a few millimetres of the needle out of the skin.…”