Hemşirelerin İntramusküler Enjeksiyon Bölgesi Seçimini Etkileyen Faktörler: Kesitsel Bir Çalışma

Öz

Amaç: Bu çalışma hemşirelerin intramusküler ilaç uygulamalarında seçtiği enjeksiyon bölgeleri ile bölge seçimini etkileyen faktörleri belirlemek amacıyla yapıldı. 

Yöntem: Tanımlayıcı ve kesitsel türdeki bu araştırmanın evreni İstanbul’daki iki hastanede çalışan 250 hemşire; örneklemini ise tabakalı rastgele örnekleme yöntemi ile seçilen 171 hemşire oluşturdu. Veriler, ‘Yapılandırılmış Soru Formu’ ile toplandı. 

Bulgular: Hemşirelerin yaş ortalamasının 26,27±7,46 yıl olduğu, %40,4’ünün çok sık intramusküler enjeksiyon uyguladıkları, intramusküler enjeksiyon için %83,6 oranla öncelikli olarak dorsogluteal bölgeyi tercih ettikleri belirlendi. Hemşirelerin intramusküler enjeksiyon bölgesine göre gelişebilecek komplikasyonlar hakkında bilgi düzeyleri incelendiğinde; bazı hemşirelerin ağrı, deltoid bölgede sinir, kemik ve damar yaralanması, enfeksiyon, nekroz, doku tahrişi, nodül veya sertlik, apse ve hematom gibi komplikasyonları bir risk olarak görmedikleri öte yandan ventrogluteal bölgede siyatik sinir hasarı gelişme riskinin bulunduğunu ifade ettikleri görüldü. Hemşirelerin çalıştıkları ünite ve ünitedeki deneyim süresi intramusküler enjeksiyon uygulamasında bölge seçimini etkilemektedir. Sonuç olarak, hemşireler intramusküler enjeksiyon uygulamasında sıklıkla dorsogluteal bölgeyi tercih etmektedir. 

Sonuç: İntramusküler enjeksiyon için seçtikleri bölgelerde gelişebilecek komplikasyonlar konusundaki bilgileri yetersizdir ve bölge seçimini etkileyen faktörler bulunmaktadır. 

Anahtar Kelimeler

• İntramusküler enjeksiyon,ventrogluteal bölge,dorsogluteal bölge,deltoid bölge,laterofemoral bölge

Selection of Site for Administration of Intramuscular Injection to Adult Patients by Nurses: A Cross-Sectional Study

Öz

Objective: This study was carried out to determine the sites which are selected by nurses to use in the intramuscular medicine applications and the factors affecting the selection of the injection sites.

Methods: The population of this descriptive and cross-sectional type of study was composed of 250 nurses working in two hospitals in Istanbul, the sample was composed of 171 nurses selected by stratified random sampling method. Data were collected with ‘Structured Questionnaire Form’.

Results: The average age of the nurses was found to be 26.27±7.46 years, it was determined that 40.4% of them applied injection very often and they preferred dorsogluteal site to apply injection with a ratio of 83.6%. When the knowledge level of nurses about the complications that may occur depending  injection site, it was seen that some nurses did not consider complications such as pain, nerve, bone and vascular injury, infection, necrosis, tissue irritation, nodules or stiffness, abscess and hematoma in the deltoid site. On the other hand, it was learnt that they had a risk of developing sciatic nerve damage in the ventrogluteal site. The unit, which the nurses work and the experience period in that unit affects the site selection in injection application. As a result, nurses often prefer the dorsogluteal site in injection.

Conclusion: The nurses’ knowledge about the complications that may ocur in the sites chosen for injection by them is insufficient and there are factors affecting the selection of the site.

Anahtar Kelimeler

• Intramuscular injections,ventrogluteal site,dorsogluteal site,deltoid site,laterofemoral site

Kaynakça

1. Kaya N, Palloş A. Parenteral drug management. In: Atabek Aştı T, Karadağ A, editors. Nursing Science and Art, Istanbul, TR: Akademi Basın ve Yayıncılık; 2012:761-809.
2. Kaya N, Salmaslıoğlu A, Terzi B, Turan N, Acunaş B. The reliability of site determination methods in ventrogluteal area injection: A cross-sectional study. Int J Nurs Stud. 2015;52(1):355-360. doi:10.1016/j.ijnurstu.2014.07.002.
3. Kaya N, Turan N, Özdemir Aydın G. Intramuscular injection to ventrogluteal site: A systematic review. International Journal of Caring Sciences. 2016;9(3):1168-1176. doi:10.7748/ns2004.03.18.25.39.c3560.
4. Potter PA, Perry AG, Stockert P, Hall A. Fundamentals of Nursing. 9th ed. Philadelphia, PA: Elsevier Health Sciences; 2016; p. 647-652.
5. Yıldız D, Kızıler E, Fidancı BE, Suluhan D. Çocuklara intramusküler enjeksiyon uygulamasında doğrular nelerdir? J Nurs Sci. 2017;9(2):144-152. doi:10.5336/nurses.2016-51005.
6. Kim HJ, Park SH. Sciatic nerve injection injury. J Int Med Res. 2014;42(4):887-897. doi:10.1177/0300060514531924.
7. Boyd AE, DeFord LL, Mares JE, et al. Improving the Success Rate of Gluteal Intramuscular Injections. Pancreas. 2013;42:878-882. doi:10.1097/MPA.0b013e318279d552.
8. Sarı D, Şahin M, Yaşar E, Taşkıran N, Telli S. Investigation of Turkish nurses frequency and knowledge of administration of intramuscular injections to the ventrogluteal site: Results from questionnaires. Nurse Educ Today. 2017;56(9):47-51. doi:10.1016/j.nedt.2017.06.005.

9. Coskun H, Kilic C, Senture C. The evaluation of dorsogluteal and ventrogluteal injection sites: a cadaver study. Journal of Clinical Nursing. 2016;25:1112-1119. doi:10.1111/jocn.13171.
10. Larkin TA, Ashcroft E, Elgellaieb A, Hickey BA. Ventrogluteal versus dorsogluteal site selection: A cross-sectional study of muscle and subcutaneous fat thicknesses and an algorithm incorporating demographic and anthropometric data to predict injection outcome. Int J Nurs Stud. 2017;71:1-7. doi:10.1016/j.ijnurstu.2017.02.017.
11. Bağış S, Adam M, Leblebici ÜB, Karataş M, Güven AZ, Çeliker AR. Sciatic nerve injury due to intramuscular injection: electrophysiological findings and one-year follow-up. Turk J Med Sci. 2012;42(5):913-7.
12. Craven RF, Hirnle CJ. Fundamentals of Nursing: Human Health and Function. 8th ed. Philadelphia, PA: Lippincott Williams&Wilkins; 2016, p. 529-530.
13. Taylor C, Lillis C, LeMone P, Lynn P. Fundamentals of Nursing the Art and Science of Nursing Care. 7th ed. China: Wolters Kluwer, Lippincott Williams&Wilkins; 2011, p. 797- 2842.
14. Min HJ, Kim YJ. Analysis of gluteal subcutaneous and muscle thickness in infants and children for application to intramuscular injection, autologous fat grafting, and gluteal artery perforator flaps. Arch Plast Surg. 2018;45(6):550-556. https://doi.org/10.5999/aps.2017.01760.
15. Greenway K. Rituals in nursing: intramuscular injections. J Clin Nurs. 2014;23:3583-3588. doi:10.1111/jocn.12627.
16. Masuda S, Yasuhara Y, Tanioka T, et al. Comparison of gluteal muscle intramuscular injection sites of Japanese healthy subjects: considerations for optimal insertion of injection needle length. Open Journal of Psychiatry. 2016;6(2):203-212. doi:10.4236/ojpsych.2016.62025.
17. Cocoman A, Murray J. Recognizing the evidence and changing practice on injection site. Br J Nurs. 2010;19(18):1170-1174. doi:10.12968/bjon.2010.19.18.79050.
18. Berman A, Snyder S, Frandsen G. Kozier&Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 10th ed. New Jersey, NJ: Pearson; 2015; p. 797-803.
19. Smith SF, Duell D, Martin BC, et al. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. Upper Saddle River, NJ: Pearson Prentice Hall; 2016.
20. Kaya N, Turan N, Palloş AÖ. Dorsogluteal bölge intramusküler enjeksiyon uygulamak amacıyla kullanılmamalı mı? İ.Ü.F.N. Hem. Derg. 2012;20(2):146-53.
21. Sherri, Ogston-Sherri. Intramuscular injection technique: an evidence-based approach. Nursing Standard. 2014;29(4):52-63. doi:10.7748/ns.29.4.52.e9183.
22. Doğu, Ö. The invisible tip of the iceberg; How often is the ventrogluteal area used? Journal of Education and Research in Nursing. 2016;13(1):7-10.
23. Walsh L, Brophy K. Staff nurses’ sites of choice for administering intramuscular injections toadult patients in the acute care setting. J Adv Nurs. 2010;67(5):1034-1040. doi:10.1111/j.13652648.2010.05527.x.
24. Wynaden D, Tohotoa J, Omari OA, et al. Administering intramuscular injections: How does research translate into practice over time in the mental health setting? Nurse Educ Today. 2015;35:620-624. doi:10.1016/j.nedt.2014.12.008.
25. Strohfus PK, Paugh O, Tindell C, Molina-Shaver P. Evidence calls for practice change in intramuscular injection techniques. J Nurs Educ Pract. 2018;8(2):83-92. doi:10.5430/jnep.v8n2p83.
26. Larkin TA, Elgellaie A, Ashcroft E. Comparison of the G and V methods for ventrogluteal site identification: Muscle and subcutaneous fat thicknesses and considerations for successful intramuscular injection. Int J Ment Health Nurs. 2018;27:631-641. doi:10.1111/inm.12346.
27. Cook IF. Best vaccination practice and medically attended injection site events following deltoid intramuscular injection. Hum Vaccines Immunother. 2015;11(5):1184-91. doi:10.1080/21645515.2015.1017694.
28. Hensel D, Springmyer J. Do perinatal nurses still check for blood return when administering the hepatitis B vaccine? J Obstet Gynecol Neonatal Nurs. 2011;40(5):589-594. doi:10.1111/j.1552-6909.2011.01277.x.
29. Mclaws ML, Palenik CJ, Askarian M. Assessment of injection practice in primary health care facilities of Shiraz, Iran. Am J Infect Control. 2014;42:300-304. doi:10.1016/j.ajic.2013.09.006.