The nurse is preparing to give an IM injection. Which of the following sites has maximum chance to damage of major nerves?

Appeared in: AIIMS CRE SNO - 2023

Explanation

The dorsogluteal site carries the highest risk of nerve damage because of its close proximity to the large and critical sciatic nerve.
An injection that inadvertently hits the sciatic nerve can cause severe and permanent complications, including chronic pain, muscle weakness, and paralysis of the lower limb (foot drop).
Due to this well-documented and significant risk, the dorsogluteal site is no longer recommended or considered a standard of care for IM injections in modern nursing practice.

Option A: The deltoid site has a low risk of nerve injury. While the radial nerve is in the vicinity, proper landmarking (two to three finger-widths below the acromion process) makes injury unlikely. The risk is significantly lower than the sciatic nerve risk at the dorsogluteal site.
Option C: The ventrogluteal site is considered the safest site for IM injections because it is free of major nerves and blood vessels. It is the preferred site for adults.
Option D: The vastus lateralis site is also very safe and has a very low risk of nerve injury. The muscle is thick and located away from any major nerves.

Clinical Relevance

Nursing practice connection: Knowing Anatomical safety and risks of intramuscular (IM) injection sites helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Patient safety is paramount. Routinely using the ventrogluteal site instead of the dorsogluteal site is a critical practice change that prevents life-altering nerve injuries.
A nurse's legal and ethical responsibility includes using current, evidence-based practices. Choosing the dorsogluteal site could be considered negligent if an injury occurs, as it deviates from the current standard of care.
What if? If a patient has a hip prosthesis or compromised skin at the ventrogluteal site, the next safest alternative for a large volume injection would be the vastus lateralis, not the dorsogluteal site.

How to Approach the Question

First, identify the core of the question: which injection site is the most dangerous regarding nerve damage.
Recall the basic anatomy associated with each of the four listed muscle sites.
Specifically, bring to mind the location of major nerves: the sciatic nerve in the gluteal region and the radial nerve in the upper arm.
Compare the proximity of these nerves to the injection sites. The sciatic nerve runs directly under the gluteus maximus, making the traditional dorsogluteal site extremely risky.
Contrast this with the ventrogluteal and vastus lateralis sites, which are known to be free of major nerves.
Conclude that the dorsogluteal site poses the highest and most significant risk of major nerve injury.

Concept Tested & Keywords

Concept Tested: Anatomical safety and risks of intramuscular (IM) injection sites.
Stem keywords: IM injection, damage, major nerves
Lead-in keywords: maximum chance
Negative lead-in flag: false

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E6 Nursing Fundamentals Taylor p. 861-863

E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 174-176

Practise the full AIIMS CRE SNO - 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.