Optimal needle insertion length for intramuscular injection of risperidone long-acting injectable (RLAI)

Tanioka, Tetsuya; Sakamaki, Sakiko; Yasuhara, Yuko; Tomotake, Masahito; Takase, Kensaku; Watari, Chie; Makiguchi, K; Locsin, Rozzano C.; Motoki, Kazushi; Inui, Tatsuya

doi:10.4236/health.2013.512262

Cited by 10 publications

(33 citation statements)

References 19 publications

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“…Recent studies show the need for longer needles but our survey shows longer needles are seldom available in the United States. [12,20,25] Autoinjectors supplied with standard-sized needles are too short for obese patients and overweight women, which can lead to unfortunate consequences, especially with epinephrine autoinjectors. [11,19] Again, practice change would occur if manufacturers utilize current evidence to produce autoinjectors with varied sized needles based on weight or BMI.…”

Section: Injection Depthmentioning

confidence: 99%

“…[20,21] Even with documented concern in the literature, populations such as asthma patients, women, and overweight and obese children and adults continue to be impacted by needles not reaching muscle. [3,12,17,[22][23][24][25] Subcutaneous fat distribution differs by gender, age, and ethnicity and determines the thickness of subcutaneous tissue at the IM injection site. For a male with a BMI of 25, a 1-inch needle may be sufficient for an IM injection at the deltoid, but a female with a BMI of 25 and above will most likely require a 1.5-inch-long needle to reach the deltoid muscle due to a thicker fat pad.…”

Section: Injection Depthmentioning

confidence: 99%

“…[3,21,27] Healthcare facilities should provide a variety of needles with different lengths and gauges, including 2+ inch safety needles. [25] In addition, requiring a clinical assessment of morbidly obese patients by a clinical nurse specialist, nurse practitioner or other specialized nurse before IM injections are given should be a standard within all healthcare facilities. This may require an assessment of patient mobility status and ultrasound guidance to determine the appropriate needle length at the injection site.…”

Section: Implications For Nursing Practicementioning

confidence: 99%

“…[18] Longer needles with safety locks should be available in all healthcare facilities and nurses/other personnel must be trained to use longer needles. [12,20,25] Patients weighing greater than 260-pounds or 30+ BMI may require a muscle depth assessment prior to IM injection.…”

Section: Implications For Nursing Practicementioning

confidence: 99%

“…Additionally, we recommend adopting BMI as a standard to determine appropriate needle length throughout the United States comparable to other countries conducting similar research. [6,11,12,24,25] We recommend the CDC and WHO update IM injection recommendations to include BMI and needle length based on various sized populations. [33,52] Lastly, additional research on thickness of subcutaneous tissue (fat pad) is needed similar to Poland's study in 1997.…”

Section: Future Studymentioning

confidence: 99%

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Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

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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.

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Section: Injection Depthmentioning

confidence: 99%

Section: Injection Depthmentioning

confidence: 99%

Section: Implications For Nursing Practicementioning

confidence: 99%

Section: Implications For Nursing Practicementioning

confidence: 99%

Section: Future Studymentioning

confidence: 99%

See 3 more Smart Citations

Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

View full text Add to dashboard Cite

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Dorsogluteal intramuscular injection depth needed to reach muscle tissue according to body mass index and gender: A systematic review

Strohfus

Palma

Wallace

2021

Journal of Clinical Nursing

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Aims and objective(s):The objective of this systematic review was to determine the needle length required to reach the dorsogluteal muscle based on body mass index and sex. Our aim was to provide evidence-based recommendations to current intramuscular injection guidelines from the result(s) of this review. Background: Studies worldwide are documenting reduced medication effectiveness due to improperly placed dorsogluteal intramuscular injections because of incorrect needle length, wrong site selection and/or obesity. Current intramuscular injection guidelines lack specific instructions according to weight or sex. While there are similar concerns with other injectable sites, this review focuses solely on adult dorsogluteal intramuscular injections. Design: A systematic review of relevant literature of dorsogluteal intramuscular injections based on body mass index and sex.Methods: This systematic review was reported using the PRISMA checklist 2020. The review protocol was registered with Center for Open Science (OSF). We analysed 1,412 articles from nine databases. We compared twelve studies that utilised computerised tomography or ultrasonography using The Johns Hopkins Evidence-Based Practice Model and Guidelines. Results: A significant number of dorsogluteal intramuscular injections are administered into subcutaneous tissue rather than muscle because needles are too short for populations with body mass indexes over 25, especially women. Poor landmarking often results in improperly placed injections. Conclusions: To prevent administering a dorsogluteal intramuscular injection into subcutaneous tissue, women with a BMI of 25 and over require needles longer than 38 mm (1.5 inches). Men have less subcutaneous tissue in the dorsogluteal area and only require longer needles if BMI is 35 and over. If skin-to-muscle depth is questionable in either sex, an ultrasound-guided intramuscular injection is warranted for accurate dorsogluteal placement. Landmarking and needle length are key to appropriately placed IM injections. Relevance to clinical practice: Dorsogluteal injections are often injected into subcutaneous tissue rather than muscle because needles are not long enough to reach

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Assessment rate of true dorsogluteal intramuscular drug injection using ultrasonography

Özen¹,

Günaydın²,

Tosun³

et al. 2019

Pak J Med Sci

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Objective: Medications are generally administered by either the enteric or parenteral route. With parenteral administration, intramuscular (IM) is the preferred approach because it increases the bioavailability of the drug, acts more quickly than the enteric route. The aim of this study was to determine the rate of true dorsogluteal intramuscular drug injection and to determine the causes for application failures in practice by ultrasonography (US). Methods: The study was conducted from May 1 to May 30, 2017 in Giresun University Education and Research Hospital, Giresun, Turkey. We examined 60 patients who were administered dorsogluteal IM injection with a 38.1mm length needle. After the injection, localization of medications (whether intramuscular or subcutaneous adipose tissue [SAT]) was evaluated by Ultrasound. Results: Female/male ratio of the patients was 27/33, with a mean age of 39.78±2.16 years. Obese/normal weight ratio was 20/40. The mean dorsogluteal area SAT thickness of obese and normal weight patients were 32.34±2.17 mm and 20.85±1.20 mm, respectively. In 23 of the patients, IM injected drug was observed in the SAT, while it was observed in the IM area in 37 patients. Medication was observed in IM area in 37 of 50 patients who dorsogluteal region SAT thickness was appropriate (SAT thickness lower than 33.1mm) for IM injection while it was seen in SAT area in 13 patients. Conclusions: SAT thickness values are important if IM drug injection is to be administered correctly. Unsuccessful IM injections may be seen even in patients with appropriate SAT thicknesses. doi: https://doi.org/10.12669/pjms.35.4.313 How to cite this:Ozen O, Gunaydin M, Tosun A, Coskun ZU, Aytekin K, Takir S. Assessment rate of true dorsogluteal intramuscular drug injection using ultrasonography. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.313 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Optimal needle insertion length for intramuscular injection of risperidone long-acting injectable (RLAI)

Cited by 10 publications

References 19 publications

Evidence calls for practice change in intramuscular injection techniques

Evidence calls for practice change in intramuscular injection techniques

Dorsogluteal intramuscular injection depth needed to reach muscle tissue according to body mass index and gender: A systematic review

Assessment rate of true dorsogluteal intramuscular drug injection using ultrasonography

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