Pharmacokinetics of Human Chorionic Gonadotropin Injection in Obese and Normal-Weight Women

Shah, Divya; Missmer, Stacey A.; Correia, Katharine F.; Ginsburg, Elizabeth S.

doi:10.1210/jc.2013-4086

Cited by 41 publications

(47 citation statements)

References 22 publications

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“…Literature identifies medications such as risperidone, epinephrine, Depo-Provera, human chorionic gonadotropin (hCG), and Hepatitis A and B, rabies, and tetanus vaccines that if given into the subcutaneous tissue do not reach therapeutic effectiveness. [1][2][3] Instructions for IM injection technique vary in literature and in nursing texts, including guidelines for weight and gender, injection site, needle gauge and length, bunching or stretching the skin, aspiration, and z-track method. [4,5] As an example, educational texts offer inconsistencies in IM injection practices pertaining to z-track technique.…”

Section: Practice Variationmentioning

confidence: 99%

“…Current evidence guides practice to consider gender when administering an IM injection. [2,3,[11][12][13] Recent evidence recommends ventrogluteal site be the preferred site for IM injections. [14,15] Evidence shows the ventrogluteal site is far from major vascular and nerve structures and has a relatively low subcutaneous thickness in comparison with the traditionally used dorsogluteal site.…”

Section: Practice Variationmentioning

confidence: 99%

“…[4,5,30,34] Even though worldwide injection practices are based on these guidelines, there is increasing evidence validating IM injections with a 1.5-inch long needle may not be reaching muscle, especially in females exceeding a BMI of 30. [2,11,35] Additionally, educational texts may vary in their instructional information related to injection practices.…”

Section: Injection Depthmentioning

confidence: 99%

“…[2,11,13,43] Continuous education based on current evidence is vital to providing safe quality care.…”

Section: Practice Variationmentioning

confidence: 99%

“…[2,11,[44][45][46] Critical assessments of patient weight, BMI, gender and injection site, needle length, volume of medication before administering IM injections is important and therefore should drive practice change.…”

Section: Injection Depthmentioning

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: Practice Variationmentioning

confidence: 99%

Section: Practice Variationmentioning

confidence: 99%

Section: Injection Depthmentioning

confidence: 99%

“…[2,11,13,43] Continuous education based on current evidence is vital to providing safe quality care.…”

Section: Practice Variationmentioning

confidence: 99%

Section: Injection Depthmentioning

confidence: 99%

See 3 more Smart Citations

Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

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Adverse effects of dorsogluteal intramuscular injection versus ventrogluteal intramuscular injection: A systematic review and meta‐analysis

et al. 2023

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AimsTo determine adverse effects of ventrogluteal intramuscular injections versus dorsogluteal intramuscular injections.DesignA systematic review and meta‐analysis.MethodsMEDLINE, EMBASE, CINHAL, CENTRAL, LILACS(BVS), BDENF (BVS), WoS, IRCTP(WHO), ClinicalsTrials.gov and PROSPERO databases were searched with no restriction on year or language. Preferred Reporting items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed.ResultsA total of 1429 participants from 17 studies were included. The meta‐analysis found that ventrogluteal injection site had significant relation to lower pain in 9 studies (SMD = −0.63, 95% CI = −0.87, −0.39), bleeding in 4 studies (SMD = −3.46, 95% CI = −6.07, –0.86) and hematoma in 2 studies; after 48 h (SMD = −0.25, 95% CI = −0.39, −0.11), and after 72 h (SMD = −0.16, 95% CI = −0.26, –0.06), if it was compared with dorsogluteal site injection. No differences were found when comparing the possibility of intramuscular injections given into de subcutaneous tissue. In three studies, ventrogluteal site did not significantly reduce the risk of subcutaneous injection (OR 0,62, 95% CI = 0.16, 2.41).

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Ovarian hyperstimulation syndrome: pathophysiology, staging, prediction and prevention

Nastri

Teixeira

Moroni

et al. 2015

Ultrasound in Obstet & Gyne

158

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Pharmacokinetics of Human Chorionic Gonadotropin Injection in Obese and Normal-Weight Women

Abstract: Subcutaneous injection yields lower hCG levels in obese women. Standard-length needles are insufficient to administer i.m. injections in many obese women.

Cited by 41 publications

References 22 publications

Evidence calls for practice change in intramuscular injection techniques

Evidence calls for practice change in intramuscular injection techniques

Adverse effects of dorsogluteal intramuscular injection versus ventrogluteal intramuscular injection: A systematic review and meta‐analysis

Ovarian hyperstimulation syndrome: pathophysiology, staging, prediction and prevention

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