Larkin Theresa A, Ashcroft Elfriede, Elgellaie Asmahan, Hickey Blake A
Illawarra Health and Medical Research Institute (IHMRI), NSW, 2522, Australia; School of Medicine, University of Wollongong, NSW, 2522, Australia.
School of Medicine, University of Wollongong, NSW, 2522, Australia.
Int J Nurs Stud. 2017 Jun;71:1-7. doi: 10.1016/j.ijnurstu.2017.02.017. Epub 2017 Feb 22.
The dorsogluteal and ventrogluteal intramuscular injection sites both have their use in clinical practice; however, it has not been established in whom one or the other should be preferentially targeted or avoided. There is a need for an evidence-based approach towards site selection for a successful intramuscular injection outcome and to avoid unwanted injection outcomes of inadvertent subcutaneous injection or bone contact. Injection outcome is dependent on injection site subcutaneous fat thickness and muscle thickness; these are likely influenced by gender and anthropometry.
To determine whether subcutaneous fat, muscle, and total tissue thicknesses differ between the dorsogluteal and ventrogluteal sites, and whether theoretical injection outcome (intramuscular, subcutaneous, or bone contact) can be predicted by demographic and anthropometric data and described by an algorithm.
Cross-sectional study design.
University in Australia.
145 volunteers (57% female) of at least 18 years of age recruited through the university community.
Anthropometric data was collected and subcutaneous fat and muscle thicknesses were quantified by ultrasonography. Anthropometric differences between theoretical injection outcome groups (bone contact versus intramuscular versus subcutaneous at the ventrogluteal and dorsogluteal sites) was determined for each gender (ANOVA). Multiple regression analysis was conducted to determine the influence of demographic and anthropometric data on theoretical intramuscular injection outcome. An algorithm to guide site selection was developed for each gender, based on the anthropometric measures that best discriminated between injection outcomes.
Subcutaneous fat, muscle and total tissue were significantly thicker at the dorsogluteal site than the ventrogluteal site, and subcutaneous fat was significantly thicker in females than males at both sites (all p<0.001); there was no gender difference for muscle or total tissue thickness at either site. Female gender, and waist and hip circumference were significant predictors of subcutaneous fat thickness at both sites; male gender was a significant predictor of dorsogluteal site muscle thickness (all p<0.05). In the algorithm developed for site selection based on theoretical injection outcome, the best discriminators were: weight, BMI and waist circumference for females, and weight and distance between the iliac tubercle and anterior superior iliac spine for males.
The algorithm describes when each of the ventrogluteal and dorsogluteal sites is appropriate or should be avoided, based on easily obtained anthropometric data. This has direct relevance in clinical practice in evidence-based site selection for gluteal intramuscular injections for optimal medication and health outcomes.
臀大肌和臀中肌肌内注射部位在临床实践中均有应用；然而，尚未明确何种情况下应优先选择其中一个部位或避免使用某个部位。需要一种基于证据的方法来选择注射部位，以实现成功的肌内注射效果，并避免意外皮下注射或触及骨头等不良注射后果。注射效果取决于注射部位的皮下脂肪厚度和肌肉厚度；而这些可能受到性别和人体测量学因素的影响。
确定臀大肌和臀中肌部位的皮下脂肪、肌肉及总组织厚度是否存在差异，以及人口统计学和人体测量学数据能否预测理论注射效果（肌内、皮下或触及骨头），并通过算法进行描述。
横断面研究设计。
澳大利亚一所大学。
通过大学社区招募的145名年龄至少18岁的志愿者（57%为女性）。
收集人体测量学数据，通过超声测量皮下脂肪和肌肉厚度。针对每个性别，确定理论注射效果组（臀中肌和臀大肌部位的触及骨头与肌内注射与皮下注射）之间的人体测量学差异（方差分析）。进行多元回归分析，以确定人口统计学和人体测量学数据对理论肌内注射效果的影响。根据最能区分注射效果的人体测量指标，为每个性别开发一种指导部位选择的算法。
臀大肌部位的皮下脂肪、肌肉和总组织厚度显著厚于臀中肌部位，且两个部位的皮下脂肪在女性中均显著厚于男性（所有p<0.001）；两个部位的肌肉或总组织厚度均无性别差异。女性性别、腰围和臀围是两个部位皮下脂肪厚度的显著预测因素；男性性别是臀大肌部位肌肉厚度的显著预测因素（所有p<0.05）。在基于理论注射效果开发的部位选择算法中，最佳区分指标为：女性的体重、体重指数和腰围，男性的体重以及髂结节与髂前上棘之间的距离。
该算法根据易于获取的人体测量学数据，描述了何时臀中肌和臀大肌部位适合或应避免使用。这在临床实践中对于基于证据选择臀肌肌内注射部位以实现最佳用药和健康结果具有直接相关性。
