What is the maximum volume in milliliters (mL) for injection into the gluteal muscle?

Maximum Volume for Gluteal Intramuscular Injection

For adults, the maximum recommended volume for gluteal intramuscular injection is 5 mL, while smaller volumes (maximum 2-3 mL) are recommended for routine clinical practice to minimize pain and tissue damage.

Anatomical Considerations

The gluteal muscle is one of the largest muscle groups in the body, making it suitable for larger volume injections compared to other intramuscular injection sites. However, several factors influence the maximum safe volume:

• Muscle mass: The gluteus medius and gluteus maximus muscles are the primary targets for gluteal injections
• Subcutaneous fat thickness: Excessive subcutaneous fat may prevent medication from reaching the muscle
• Patient size: Larger patients may tolerate larger volumes

Site-Specific Recommendations

Ventrogluteal Site (Preferred)

• Maximum volume: 2-3 mL for routine use, up to 5 mL in adults with adequate muscle mass
• Advantages: Greater muscle thickness and lower subcutaneous fat thickness compared to dorsogluteal site 1
• Safety profile: Lower risk of bone contact and subcutaneous injection, particularly in older adults 1

Dorsogluteal Site

• Maximum volume: 2-3 mL for routine use, up to 5 mL in adults with adequate muscle mass
• Caution: Has thicker subcutaneous fat (22.97 ± 7.40 mm) compared to ventrogluteal site (20.07 ± 6.64 mm) 1
• Muscle characteristics: Gluteus maximus is significantly thicker at this site 2

Special Populations

Older Adults

• Both ventrogluteal and dorsogluteal sites can be used safely in older adults 1
• Ventrogluteal site may be safer due to:
  • Lower risk of bone contact
  • Lower risk of subcutaneous injection
  • Greater muscle thickness (40.13 ± 5.59 mm vs. 25.61 ± 4.30 mm for dorsogluteal) 1

Medication-Specific Considerations

For certain medications, specific volume limitations apply:

• Long-acting cabotegravir: Administered as 3 mL (600 mg) by gluteal injection 3
• Intramuscular tumor implantation: Maximum of 50 μL with the finest needle possible (27G or smaller) 3

Clinical Practice Recommendations

1. Use smallest effective volume: Minimize volume to reduce pain and tissue damage
2. Consider needle length: Ensure needle is long enough to reach muscle tissue
3. Injection technique: Use Z-track method for medications that may cause tissue irritation
4. Avoid in patients with gluteal implants/fillers: Use caution with injectable medications in patients with gluteal implants 3

Common Pitfalls to Avoid

• Exceeding maximum volumes: Volumes >5 mL may cause tissue damage and increased pain
• Incorrect site identification: Improper landmark identification may lead to sciatic nerve injury
• Inadequate needle length: Failure to reach muscle tissue results in subcutaneous administration
• Multiple injections at same site: Can cause tissue damage and affect drug absorption

By following these guidelines, clinicians can ensure safe and effective administration of intramuscular injections in the gluteal region while minimizing patient discomfort and potential complications.