Abstract
To the Editor
There is a trend in some mental health services towards using the ventrogluteal (VG) rather than the traditional dorsogluteal (DG) site for the injection of intramuscular depot antipsychotic medication. This is consistent with recent nursing practice guidelines (Cocoman and Murray, 2008) and nursing students at some universities are now preferentially trained in the VG site. The DG site has been associated with sciatic nerve injury (Small, 2004); the VG site is recommended due to the lack of major nerves in this region. It has also been proposed that intramuscular delivery of medication is more likely to occur in obese patients with use of the ventrogluteal site, however research on this is equivocal (Zaybak et al., 2007). Current mental health nursing practice does not reflect recommendations to use the VG site (Walsh and Brophy, 2010; Wynaden et al., 2006) likely due to lack of training and staff perceptions of risks to themselves through assault or needle stick injury. Mental health nursing guidelines from 2006 supported the continued use of dorsogluteal injection (Wynaden et al., 2006).
Widespread change of injection sites for depot antipsychotic medication involves several challenges including training of staff, education of patients and carers, and addressing potential changes in medication bioavailability with the change of site. Theoretically, bioavailability may be different with a change of sites, although evidence in this area is lacking. It is also important to consider recommendations from the manufacturer of the medication as to the appropriate site of injection, as well as consumer preferences, in deciding on an injection site. Adopting one standard site may not be a realistic option.
Although nursing practice guidelines (Cocoman and Murray, 2008) recommend the use of the VG site, there is an absence of evidence to support this change. We suggest that further research is required to firstly quantify the magnitude of the problem with the current practice of DG injection, and secondly to demonstrate that changing to the VG site would provide actual benefits for patients. Finally, further research is required to measure any change in bioavailability of antipsychotic medication and any associated change in safety and efficacy that occurs with a change in injection site. In the absence of further research, we see no compelling reason to change practice in mental health services. In the interim, psychiatrists should check with their nursing colleagues as to which site is being used for the administration of antipsychotic medication.