title: Improving the success rate of gluteal intramuscular injections.
abstract: OBJECTIVE
  This study aimed to improve the success rate of gluteal intramuscular (IM) injection.
  
  
  METHODS
  The outcomes of 328 intended gluteal IM injections in 115 patients receiving depot octreotide were evaluated using computed tomography performed in routine clinical practice. Patient-, nursing-, and technique-dependent factors were correlated with successful delivery of medication. Techniques associated with successful injection were taught to center nurses.
  
  
  RESULTS
  At baseline, 52% of injections were successfully delivered (66% men, 36% women; P = 0.001). Factors associated with successful delivery included nurses' frequency of injections (P = 0.008), landmarks use to select injection site (P < 0.001), quick needle insertion (P < 0.001), and use of nonsyringe hand to compress injection site (P < 0.001). Patient-related factors included male sex (P < 0.001), lower body mass index (P < 0.001), and lower skin-to-muscle depth at injection site (P < 0.001). Techniques associated with successful injections were then taught to center nurses. After instruction, the success rate increased from 52% to 75% (P = 0.001). Importantly, improvements were observed in both men (66%-75%; P = 0.43) and women (38%-75%; P < 0.001). Successful injection was associated with better control of flushing among those with carcinoid syndrome (P = 0.005).
  
  
  CONCLUSIONS
  Intended gluteal IM injections often are given into the subcutaneous space. Education in techniques associated with successful injections improves IM delivery rates.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: April E
authors.initials: AE
authors.lastname: Boyd
authors.forename: Linda L
authors.initials: LL
authors.lastname: DeFord
authors.forename: Jeannette E
authors.initials: JE
authors.lastname: Mares
authors.forename: Colleen C
authors.initials: CC
authors.lastname: Leary
authors.forename: Jeana L
authors.initials: JL
authors.lastname: Garris
authors.forename: Cecile G
authors.initials: CG
authors.lastname: Dagohoy
authors.forename: Valentine G
authors.initials: VG
authors.lastname: Boving
authors.forename: James P
authors.initials: JP
authors.lastname: Brook
authors.forename: Alexandria
authors.initials: A
authors.lastname: Phan
authors.forename: James C
authors.initials: JC
authors.lastname: Yao
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D015992:Body Mass Index; D002081:Buttocks; D016503:Drug Delivery Systems / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed
chemical_list: D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide