Abstract
Background: Medications and vaccines are delivered via intramuscular injection throughout the world to improve health and to prevent or treat illness. Intramuscular injections are an essential nursing and pharmacist skill which includes choosing an appropriate injection site and selecting needle lengths and gages based on weight and muscle mass. Scientific evidence suggests changes in current practice and national guidelines to fully reach medication and vaccine efficacy.
Results: There is a direct relationship between medication/vaccine efficacy and health outcomes. The variance in weight provides vital information on the needle length and site of injection. Body mass index, age, sex, and skin to muscle depth are important measures when choosing the right needle length and site for an intramuscular injection.
The literature draws attention to deltoid injection concerns. The standard 25 mm needles may not be appropriate for small or large and obese populations as there can be reduced efficacy if the medication or vaccine is not deposited into the muscle. Other concerns include medications and vaccines deposited in the shoulder bursa in some patients instead of the deltoid pad causing pain, limited range of motion, and long-lasting disabilities.
Dorsogluteal and ventrogluteal sites are used for deep gluteal muscle injections. The ventrogluteal is the most appropriate site for deep muscle injections yet many nurses prefer the dorsogluteal site because of preference/comfort with the procedure. Deep gluteal injections often require longer needles to reach the muscle mass in large or obese patients, especially women.
Intramuscular injection guidelines are followed by clinicians worldwide. Agencies/centers such as the Centers for Disease Control and Prevention update these guidelines as needed but most national guidelines lack specific intramuscular injection instructions. Clinicians usually perform clinical procedures taught in basic training and follow national guidelines rather than performing individual clinical assessments.
Conclusion: Improving public health is vital, especially in various weighted populations that may not be receiving optimal efficacy of medications and vaccines. Updates to guidelines and continuous education and training in injection techniques should be a priority in all health agencies worldwide.