Image courtesy of CDC
Editor’s note: In early August, on our Facebook page, we asked if there were “old nursing habits” that should be killed off. We received a lot of feedback, which we described in a blog post, “Killing Traditional Nursing Duties #1.” We’re back now with feedback from our second question: “When you give IM injections, what site do you most often use—dorsogluteal (upper outer quadrant of
buttocks), ventrogluteal (lateral hip), or deltoid (upper arm)? Why?”
Hands down, the deltoid injection site was preferred for intramuscular (IM) injections, especially for immunizations and if the patient was an adult. (“People don’t have to drop their drawers” was my favorite reason cited.) A few of those who favored that site noted that, if they didn’t use the deltoid (because of the volume of the injection), they would then go to the ventrogluteal site. One person preferred the vastas lateralis (the outer middle third of the thigh), which wasn’t listed as a choice, but is certainly a site that’s used, especially in infants. And several respondents said they prefer the dorsogluteal site. Reasons given were “more comfort” and “more muscle.”
This is actually contrary to current evidence and teaching, which is that the preferred site is the ventrogluteal site. As noted in an article we did in February 2010, evidence indicates we should avoid the dorsogluteal site because “it poses unnecessary and unacceptable risks of injury to the superior gluteal artery and sciatic nerve.” Also, the traditional dorsogluteal site, especially in obese
individuals, may have excess subcutaneous fat that can reduce the chances of having the medication injected into the muscle.
And it’s not just a few nurses who continue using the traditional dorsogluteal site—a recent Canadian study (see our report on the results) showed that only 14% of hospital nurses use the recommended ventrogluteal site. So, for those of you who still prefer the dorsogluteal site, think again.
Our new question is this: “Does your institution routinely follow ‘NPO after midnight’ for preoperative patients?” Give your feedback here or on our Facebook page.—Shawn Kennedy, editor-in-chief
The facility that I work for does routinely follow NPO after midnight guidelines. As someone mentioned in an earlier post, I disagree with this order if the patient is scheduled for a late surgery the next day. If the patient is scheduled for a late surgery I may call the doctor and request that the orders be altered and in most cases the doctor’s are agreeable. I do sometimes run across those doctors that are not agreeable to any change suggested but for the most part they will change the orders. I have also seen some doctors writing NPO after midnight with the exception of clear liquids.
I mentioned this on the other blog about “bad old habits”…..where I last worked in an O.R., most of the younger anesthesiologists/ CRNA’s allowed BLACK COFFEE to be drunk right up until time of surgery. No dairy or sugar in it, obviously. This came from their own journals and seminars, and we never saw a problem w/ it.
Many people are “coffee junkies” who get severe headaches from skipping coffee, others just want something warm and wet during those long hours. I’m all for it…though of course it has to be ok’d by the anesthesiologist in charge of that patient….
My institution does follow the NPO after midnight for preop patients. I sometimes disagree d/t the time patients may be going to surgery. If a patient is not scheduled for the OR until the following day at 5 pm, why should they have to be NPO after midnight the night before? Thoughts…