Development and Simulation of Measurement Tool for Intramuscular Drug Application in Ventrogluteal Site

Abstract

Objective: In this study aimed to design and simulate a measurement tool that can facilitate the detection of a safe area in the ventrogluteal site. Methods: First of all, in the research, measurements were performed on healthy individuals (N = 135) in the ventrogluteal site in accordance to the body mass index. The data obtained from these measurements were analyzed, and the dimensions required for designing the measurement apparatus were determined. The measurement tool was designed using a 3D modeling program. Results: We found that the thickest point of muscle mass was different from that measured by V and G methods and the thickest point of muscle mass was found to be located more to the right and below as compared. Results showed that the method used does not lead to a difference in the measurements of hip length in the right and left sites, distance of the muscle, thickness of the thickest part of the minimus muscle, and the total muscle thickness at the thickest point of the muscle. Conclusions: According to the obtained data and simulation results, there is no obstacle in the production of the measurement tool. The measurement tool was planned to have two different parts, namely, right and left. However, in order to ensure its reliability, it is necessary to carry out controlled safety tests on real patients after the production of the measurement tool.

Keywords

• Safe area detection
• intramuscular injection
• measurement tool
• simulation
• ventrogluteal site
• nurse

Ventrogluteal Bölgeye İntramüsküler İlaç Uygulamada Ölçüm Aracı Geliştirme ve Simülasyonu

Abstract

Amaç: Çalışmada, ventrogluteal bölgede güvenli bir alan tespitini kolaylaştırabilecek bir ölçüm aracı tasarlanması ve simüle edilmesi amaçlanmıştır. Yöntem: Çalışmada öncelikle sağlıklı bireylerde (N=135) vücut kitle indeksine göre ventrogluteal bölgeden ölçümler yapıldı. Bu ölçümlerden elde edilen veriler analiz edildi ve ölçüm aparatının tasarımı için gerekli olan boyutlar belirlendi. Ölçme aracı, 3D modelleme programı kullanılarak tasarlandı. Bulgular: Kas kütlesinin en kalın noktasının V ve G yöntemleriyle ölçülenden farklı olduğu ve kas kütlesinin en kalın noktasının karşılaştırıldığında daha sağda ve aşağıda yer aldığı tespit edildi. Sonuçlar, kullanılan yöntemin sağ ve sol bölgedeki kalça uzunluğu, kas mesafesi, gluteus minimus kasının en kalın kısmının kalınlığı ve en kalın yerdeki toplam kas kalınlığı ölçümlerinde farklılığa yol açmadığını göstermiştir. Sonuç: Elde edilen veriler ve simülasyon sonuçlarına göre ölçme aracının üretilmesinde herhangi bir engel bulunmamaktadır. Ölçme aracı sağ ve sol olmak üzere iki farklı bölümden oluşacak şekilde planlanmıştır. Ancak güvenilirliğini sağlamak için ölçme aracının üretilmesinden sonra gerçek hastalar üzerinde kontrollü güvenlik testlerinin yapılması gerekmektedir.

Keywords

• Güvenli alan tespiti
• kas içi enjeksiyon
• ölçüm aracı
• simülasyon
• ventrogluteal
• hemşire.

References

1. Burbridge, B.E. (2007). Computed tomographic measurement of gluteal subcutaneous fat thickness in reference to failure of gluteal intramuscular injections. Journal Canadian Association of Radiologists, 58 (2), 72-75. PMID: 17521050.
2. Chan, V.O., Colville, J., Persaud, T., Buckley, O., Hamilton, S., & Torreggiani, W.C. (2006). Intramuscular injections into the buttocks: Are they truly intramuscular? European Journal of Radiology, 58, 480–484. doi: 10.1016/j.ejrad.2006.01.008
3. Cocoman, A., & Murray J. (2010). Recognizing the evidence and changing practice on injection sites. British Journal of Nursing, 19 (18), 1170-1174. doi: 10.12968/bjon.2010.19.18.79050
4. Coşkun, H., Kılıç, C., & Şenture, C. (2016). The evaluation of dorsogluteal and ventrogluteal injectionsites: a cadaver study. Journal of Clinical Nursing, 25, 1112–1119. doi: 10.1111/jocn.13171
5. Doğu, Ö., Atasoy, I., Yılmaz Coşkun, E., Karacan, A., Cengiz, C., Karabacak, Ü. Injection Site Detection Apparatus in the Ventrogluteal Region”. Turkish Patent Institute, TR 2016 04323 B, Application Date 04.04.2016, Patent Certificate Issue Date 21.12.2020
6. Doğu, Ö. (2016). The invisible side of the iceberg: How much is the ventrogluteal area used? Journal of Nursing Education and Research, 13 (1), 7-10. doi:10.5222/HEAD.2016.239
7. Gülnar, E., & Çalışkan N. (2014). Determining the knowledge level of nurses about intramuscular injection application to the ventrogluteal region. Dokuz Eylul University School of Nursing Electronic Journal, 7, 70-77.
8. Güneş, Y.Ü., Zaybak A., & Tamsel S. (2008). Investigation of the reliability of the method used in the detection of the ventrogluteal region. Cumhuriyet University School of Nursing Journal, 12 (2), 1-8.

9. Kaya, N., Turan, N., & Palloş, A.Ö. (2012). Shouldn't the dorsogluteal area be used for intramuscular injection? Florence Nightingale Journal of Nursing, 20(2), 146-153.
10. Kaya, N., & Palloş A. (2014). Parenteral drug applications. Nursing Fundamentals. Editors: Aştı T.A, Karadağ A. İstanbul; Akademi Publishing.
11. Kaya, N., Salmaslıoğlu A., Terzi B., Turan N., & Acunaş B. (2015). The reliability of site determination methods in ventrogluteal area injection: A cross-sectional study. International Journal of Nursing Studies, 52 (1): 355-360. doi: 10.1016/j.ijnurstu.2014.07.002
12. Kilic, E., Kalay R., & Kilic C. (2014). Comparing applications of intramuscular injections to dorsogluteal or ventrogluteal regions. Journal of Experimental and Integrative Medicine, 4 (3), 171-174. doi: 10.5455/jeim.220514.rw.009
13. Kikuchi, K., Takahashi, Y., Oyama, N., & Ishida, Y. (2009). Needle length required for intramuscular injection skills: Evidence-based nursing. Japanese Journal of Nursing Art and Science, 8, 66-75.
14. Korkmaz, E., Karagözoğlu, Ş., Çerik, B.K., & Yıldırım, G. (2015). Information status and application preferences of nurses about intramuscular injection sites. Journal of Nursing Research Development, 20 (1), 1-10.
15. Larkin, T.A., Elgellaie, A., & Ashcroft, E. (2018). Comparison of the G and V methods for ventrogluteal site identification: Muscle and subcutaneous fat thicknesses and considerations for successful intramuscular injection. International Journal of Mental Health Nursing, 27, 631-641. doi: 10.1111/inm.12346
16. Masuda, S.,Yasuhara, Y., Tanioka, T., Atsuta, A., Motoki, K., &Takase, K. (2016). Comparison of gluteal muscle intramuscular injection sites of japanese healthy subjects: Considerations for optimal insertion of injection needle length. Open Journal of Psychiatry, 6, 203-212. doi: 10.4236/ojpsych.2016.62025
17. Palma, S., & Strofhus, P. (2013). Are IM injections IM in obese and overweight females? A study in injection technique. Applied Nursing Research, 26: e1–e4. doi: 10.1016/j.apnr.2013.09.002
18. Sahebkar, M., Khosrojerdi, A., Rad, M., Stewart, J. J., Rastaghi, S., & Assarroudi, A. (2021). Evaluation of the effect of selecting gluteal injection site on the pain injection based on anthropometric indices and body shape pattern. A randomized controlled trial study. Journal of Clinical Nursing, 30(11-12), 1556-1563. doi: 10.1111/jocn.15703
19. Sakamaki, S., Yasuhara Y., Motoki K., Takase K., Tanioka T., & Locsin, R. (2013). The relationship between body mass index, thickness of subcutaneous fat, and the gluteus muscle as the intramuscular injection site, Health, 5 (9), 1443-1448. doi:10.4236/health.2013.59196
20. Salari, M., Estaji, Z., Akrami, R., Rad, M. (2018). Comparison of skin traction, pressure, and rapid muscle release with conventional method on intramuscular injection pain: A randomized clinical trial. Journal of Education and Health Promotion, 7(172), 1-6. doi: 10.4103/jehp.jehp_216_18
21. Strohfus, P., Palma, S., & Wallace, C. T. (2022). Dorsogluteal intramuscular injection depth needed to reach muscle tissue according to body mass index and gender: A systematic review. Journal of Clinical Nursing, 31(19-20), 2943-2958. doi: 10.1111/jocn.16126
22. Su, S., & Bekmezci, E. (2020). Reasons for nurses not using the ventrogluteal area in intramuscular injection. Koç University Nursing Education and Research Journal, 17 (1), 46-50. doi:10.5222/HEAD.2020.046 Tanioka, T., Ta-kase, K., Yasuhara, Y., Zhao, Y.R., Noda, C., Hisashige, S., & Locsin, R. (2018). Efficacy and safety in intramuscular injection techniques using ultrasonographic data. Health, 10: 334-350. doi: 10.4236/health.2018.103027
23. Walsh, L., & Brophy K. (2011). Staff nurses' sites of choice for administering intramuscular injections to adult patients in the acute care setting. Journal of Advanced Nursing, 67 (5), 1034–1040. doi: 10.1111/j.1365 2648.2010.05527.x
24. Zaybak, A., Gunes, Y., Tamsel, S., Khorshid, L. & Eser, I. (2007). Does obesity prevent the needle from reaching muscle in intramuscular injections? Journal of Advanced Nursing. 58(6): 552 556. doi: 10.1111/j.1365-2648.2007.04264.x