The ventrogluteal is a site of administration of injections located on the upper side of the hip, at the gluteus medius muscle. The capacity of the area to absorb injected substances with a high speed makes it the preferred site for intramuscular injections of a volume larger than 1 ml.
It is also opted for injecting irritating, oily, or viscous medications as well as narcotics, antibiotics, anti-emetics, and sedatives.
In this article, you can find information about the ventrogluteal site, its location, and its advantages as an injection administration site.
Where Is The Ventrogluteal Located?
The ventrogluteal site belongs to the muscle Gluteus medius. This muscle is thick, broad, and radiating. It is located on the exterior of the pelvis.
The Gluteus medius is one of the three muscles that form the gluteus. It is posteriorly covered by the gluteus maximum and anteriorly by the gluteal aponeurosis.
The origin of the gluteus medius is at the ilium’s outer surface, between the iliac crest and the posterior gluteal line upwards and the anterior gluteal line downwards. It can also originate from its anterior covering muscle, the gluteal aponeurosis.
The function of this muscle is to combine with the gluteus minimums to abduct the thigh, pulling it away from the midline in a neutral position.
These two muscles also help in rotating the thigh internally when the hip is flexed and rotating it externally when the hip is extended.
This external rotation takes place in order to prevent internal rotation, and thus the creation of strain on the foot, knee, and hip due to the inward migration of the knee.
In addition, the gluteus medius and the gluteus minimus have the function of supporting the body while standing on one leg, and they prevent the lateral drift of the pelvis along with the fasciae latae tensor.
Now that we have a basic idea of the location of the ventrogluteal site, let’s get to know why is it used as an intramuscular injection site.
A. Intramuscular Injections
Not all the medications are suitable to be taken orally. The main reasons are that the gastric juices may alter their properties or that they are too strong and irritating to travel through the veins and fatty tissues.
Most of the times, these types of injections are preferred to be inserted directly into the muscles. They are known as intramuscular injections.
Intramuscular injections, or IM injections are those that are administered into the tissue of the muscle. The amount of blood supply that is present deep into the muscles eases the absorption of a medicine and makes its outcome quicker and more effective.
Intramuscular injections are mainly administered on five locations. The choice of the location depends on the medication type, the age of the patient and their body mass.
Care should be taken to avoid inflamed, swollen, tender, or scarred points. The locations include:
1. The Dorsogluteal Site
This is the upper and exterior quadrant of the buttock. If the accurate location is missed, it can affect the sciatic nerve and cause permanent damage to the system. The use of this site is not recommended as it could cause tissue trauma, muscle fibrosis, hematoma, nerve paralysis, abscess, and gangrene.
For the injection on this site, it is recommended to draw back the syringe before administration due to the high risk of accidental intravenous administration.
2. The Ventrogluteal Site
This is the most preferred site for administration of injections to adults. It is located on the upper hip and it is recommended for administering medication of volumes larger than one milliliter, itchy, viscous, or oily. Narcotics, antibiotics, sedatives, and anti-emetics are administered through this site.
3. The Deltoid Site
This is located on the upper the arm, approximately two inches below the shoulder. It is recommended for the administration of small volumes (less than 1 milliliter) of medication or vaccines. Repeated injections are not recommended for this site.
4. The Vastuslateralis
This is located on the outer mid-thigh. It is a common injection site for infants of up to 7 months of age and patients with a decreasing muscular tone.
5. The Rectus Femoris
This site is also common in the case of injections of children and it is in the anterior mid-thigh.
The administration of intramuscular injections is done by needles of variable size, depending on the body mass of the recipient. An appropriate needle length ensures that the tissue of the muscle is reached.
It may be from one to one and a half more for those with a large body mass or half to one inch less for those that have a lower body mass.
The injection device into which the medication is added is the syringe. Its volume varies from one to five milliliters in proportion to the size of the patient’s muscles.
Muscles that are large, like the ventrogluteal and the dorsogluteal sites, are usually administered with four milliliters of medication.
To push the medication through the needle the plunger is pressed. The needle should be covered with a needle cap before the administration of the fluid in order to prevent accidents or contamination.
The medicines that are administered through an intramuscular route include codeine, lorazepam, olanzapine, diazepam, penicillin, streptomycin, morphine, testosterone, and Vitamin B12 to name a few. Hepatitis A, rabies, and influenza vaccines are also administered intramuscularly.
The procedure for intramuscular injections has the following steps:
- Cleansing of the selected site with an antimicrobial substance and letting it dry.
- Injection of the medication with a quick, darting motion of the dominant hand. A quick injection will painless.
- The injection should be administered perpendicularly to the body of the patient, with an angle from 72 to 90 degrees.
- Stabilization of the needle with the non-dominant hand and simultaneously sliding the plunger to with a slow motion of the dominant hand to avoid the discomfort of the patient.
- Withdrawal of the needle at the same angle as insertion.
- The zigzag technique or “Z track” is recommended to follow.
B. The Z-Track
The Z-track consists in pulling the skin and holding it around one inch down to one side with the non-dominant hand. This is followed by withdrawing the displaced skin and letting it go back to its normal position.
A gentle pressure may be applied but massages are not performed to prevent the forceful administration of the medicine into the subcutaneous tissue. The technique ensures that the administered medication does not leak back into the needle track.
The Ventrogluteal Injection Site
The ventrogluteal site is located on the hip and it is the most recommended site for the administration of large volumes of medicine (more than 1 ml) that are irritating, oily, or viscous.
Strong medications like antibiotics, sedatives, narcotics, and anti-emetics are usually administered through this site.
The thickness of the area is determined by the thickness of the muscle gluteus medius, the subcutaneous tissue and the skin-bone margin. This is in turn, influenced by the body mass index and the gender of the patient.
The Ventrogluteal Injection Method
The most frequently used technique for ventrogluteal injections is the Z track or zigzag method. It ensures that the patient experiences a reduced pain and that the medication is properly distributed.
It prevents the leaking of the medication into the subcutaneous tissue and the consequent irritation of the tissue.
The ventrogluteal injection technique consists of the following steps:
i. The patient should be positioned such that the muscles of the gluteus are relaxed. Muscle contraction can enhance the risk of injuries.
ii. It might be necessary to explain the patient why they need to pull off their pants a bit as this could make them feel awkward. It is recommended to briefly indicate the reasons and advantages of the choice of this area.
iii. The site should be checked for the presence of enough muscular tissue before the injection.
iv. Areas that have injuries, scars, lesions, redness, or swelling should be strictly avoided.
v. It starts by aspirating the plunger of the syringe to check for the return of blood. This is done prior to the administration of the medication.
vi. The volume of medication used for well developed muscles is from 1 ml to ml and less than 1 ml for patients below 2 years of age.
vii. The length of the needle used should be sufficient to administer the medication into the muscle without contacting the surrounding tissues. It is usually of 1.5 inches for adults of average size and shorter for individuals with a small body mass and children.
Some patients may require a needle longer than 1.5 inches so that it penetrates through the fat tissue.
viii. If the aspiration process does not result in any bleeding, the needle has been inserted correctly into a muscle and not into a blood vessel.
ix. The Z track technique is followed to administer ventrogluteal injections in all the patients.
x. A gentle pressure is applied on the skin and this is pulled about an inch from the injection site with the non-dominant hand.
xi. The needle is injected at a right angle (90 degrees) with the skin in a slow motion such that each ml takes around 10 seconds.
xii. Once the medication is administered the needle is quickly withdrawn.
xiii. Lastly, the skin will be released and the injection site can be covered with a dry gauge.
xiv. Pressure can be gently applied for a few seconds to mitigate the bleeding, but massaging is forbidden as it can lead to undesirable complications.
xv. For long-term treatments that consist of several injections, the side of the administration should be alternatively changed to prevent tissue damage.
The ventrogluteal site should be preferred over any other intramuscular injection sites, and it should be used whenever it is possible.
It is important to use the ventrogluteal area to ensure a decreased pain experienced by the patient and for a reduced risk of complications. Moreover, the Z track technique ensures an easy process.
Due to the location of this site, it is recommended to explain to the patient about the advantages of the choice of this site over the others for an intramuscular injection.
Locating The Ventrogluteal Site
The ventrogluteal site is located by placing the hand palm on the greater trochanter and forming a triangle in whose center the injection is administered. The fingers should be placed parallel to the head of the patient. The index finger is placed on the iliac spine and the middle finger is run along the iliac crest.
These are the steps to be followed to identify the site correctly:
- Place the palm of the hand on the greater trochanter area of the patient.
- Palpate the anterior superior iliac spine with the index finger.
- If the injection is being administered on the right buttock, use the left hand. If it is being administered on the left buttock, use the right hand.
- Now slide the middle finger making a “V” shape or a “peace sign”.
- A triangle will be formed. Its center is where the injection should be administered.
- Clean the area with alcohol and start the injection process.
Advantages & Complications Of The Ventrogluteal
The ventrogluteal site is preferred for children older than seven months and most adults.
It has a number of advantages for the administration of intramuscular injections. These include:
- The location counts with an adequate amount of muscle mass for deeply penetrating injections administered by the Z track method.
- The site is devoid of major vascular branches and nerves.
- The presence of the greater trochanter and the iliac spine serve as bony landmarks that make it easy to locate the exact injection site.
- The ventrogluteal injection can be administeredfrom numerous positions of the patient including the supine, left or right side, and on the abdomen. However, they should be able to relax the muscles as much as possible to reduce the risk of bruises, pain, and discomfort.
The ventrogluteal site has these advantages but it could prove hazardous in the following conditions:
- The healthcare provider is unfamiliar with the site.
- In the case of hypersensitivity, the absorption of the medication can not be delayed by using a tourniquet.
- Performing the injection by an unexperienced person and damaging the wrong tissue, producing severe pain.
The complications that could arise from ventrogluteal injections are:
- Muscle contracture.
- Harm of the front, side thigh, and sciatic nerve.
Ventrogluteal Vs Dorsogluteal
For many years, the dorsogluteal site was opted for the administration of the intramuscular injections. This is found in the lateral superior part of the gluteus, or its upper outer quadrant.
However, it was proven that the dorsogluteal site carried a larger risk of injury and complications, especially in the case of long treatments. These include muscle fibrosis, granuloma, muscle contracture, blood vessel damage, nerve damage, and hematoma.
There is a great chance of damage to the sciatic nerve and the superior gluteal artery, which may even lead to limb paralysis.
Moreover, the presence of a considerable large amount of fat in the area may not let the needle reach the target muscle. In addition, the dorsogluteal site counts with many subcutaneous receptors that can make this injection more painful and less effective due to the buildup of the medication under the skin.