Gluteal Subcutaneous Fat Thickness Measured by Computed Tomography as an Estimate of Proper Gluteal Intramuscular Injections in Korean Adults

Abstract

Purpose:To study the thickness of gluteal subcutaneous fat (SCF) and propose an adequate length for needle for gluteal intramuscular injections based on computed tomography (CT) measurements. Methods: The thickness of gluteal SCF were measured and studied for 568 patients who visited a tertiary hospital in Seoul, Korea between January 2007 and February 2009 for routine health screening and who had abdominopelvic CT. Results: The average thickness of gluteal SCF was 15.92±4.08 mm in males and 24.90±5.47 mm in females. The thickness of gluteal SCF differed significantly according to gender. The gluteal SCF thickness was greater than 20.4 mm for 54 (12.3%) of the 440 male patients and 99 (77.3%) of the 128 female patients. Conclusion: The most common syringe needle used for gluteal intramuscular injections in Korea is a 23 G, 25.4 mm-needle. The SCF thickness must be less than 20.4 mm in order to reach the dorsogluteal muscles to a depth of at least 5 mm if this 25.4 mm needle is used. In many patients, especially in female patients, the 25.4 mm needles will result in improper intramuscular injections with the injection being into the SCF. Therefore an appropriate needle should be selected by considering the gender and SCF thickness of patients receiving gluteal intramuscular injections.

The Appropriateness of the Length of Insulin Needles Based on Determination of Skin and Subcutaneous Fat Thickness in the Abdomen and Upper Arm in Patients with Type 2 Diabetes

“…Here, we showed that, within a certain range, the subcutaneous fat thickness increased by 0.63 and 0.52 mm in the abdomen and upper arm, respectively, per 1 kg/m 2 increase in BMI, which is consistent to the data from Gibney et al [3] who showed that the thickness increased by 0.4 mm per 1 kg/m 2 increase in BMI, as well as the data from Joo and Sohng [4] who reported that the thickness increased by 0.71 and 0.62 mm in males and females, respectively, per 1 kg/m 2 increase in BMI. As expected, the immediate relevance of BMI and subcutaneous fat thickness was very high like the many other domestically conducted studies [16,17].…”

“…As for insulin injections, an intramuscular injection leads to a faster absorption than the desirable rate, while intradermal injection causes insulin leakage and pain, for which reasons insulin must be injected not into the muscles, dermis, and nerves, but into the subcutaneous tissue [1]. However the subcutaneous tissue thickness of patients varies depending on the age, gender, body mass index (BMI), and parts of the body [2,3], and the injected subcutaneous area depends on the length of a needle [4]. Therefore, before an insulin injection, the injection site, the subcutaneous fat thickness, the injection method, the length of the needle, and other psychological factors must be considered.…”

“…Yet, nurses constantly trained patients to inject insulin to diabetic patients with needles of the same length, regardless of the skin and subcutaneous adipose layer thicknesses [4], and most patients inject insulin themselves with the syringes that they were trained with. Currently 8-mm needle syringes are used to inject insulin in clinical settings, and because these needles are long, people are trained to either inject insulin at 45-degree angle or after making skinfolds.…”

“…Many studies regarding the skin and subcutaneous fat thicknesses [3,12] and insulin syringe needle length [3,5,8,13] have already been published not only from abroad, but endemic studies also exist regarding the skin thickness [14,15], subcutaneous fat thickness [4,16,17,18], and needle length [2]. Even so, a major drawback remains that even if it is the same abdomen or upper arm, the subcutaneous fat thickness can vary depending on where it was measured [17].…”

Comment on the New Indian Injection Technique Recommendations: Critical Appraisal of the Real-World Implementation of the Current Guidelines

“…Studies of skin and SCT thicknesses in other Asian populations, such as Filipinos [12], Koreans [13], and Indians [14], yielded comparable results to those obtained for the Chinese population, whereas non-Asian populations had considerably higher BMIs in a major ultrasound-based study [16, 17]. …”