IM Injection, Hitting Bone?

  1. 0
    So I was giving my mother an IM injection for the Flu Vaccine at the hospital, I did the injection and went the whole needle inside and felt that I hit a bone or something. I did aspirate and received no blood return and went ahead and inject the medication. The injection was a little high up, not where I received mine.

    Is hitting the bone bad or something... will it cause any negative effects. I asked her if there was pain afterwards and she said not really.

    Um...
    Last edit by etep1209 on Nov 1, '08
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  3. 36 Comments so far...

  4. 0
    It's happened to me on occasion. Nothing happened. What I have done since having it happen a few times is to really look at the arm and decide whether or not to administer the IM with a 25 gauge needle instead of a 22 or 23. I've had some really emaciated patients that can only handle a 25 gauge IM.
  5. 8
    FYI, gauge is the diameter of the needle. Length is measured in inches. Most IM needles are 1" to 1 1/2 " for adults. Flu shots are usually given with 1 inch since they are given in deltoid... If you do hit the bone, just pull back a tad.
    StayLost, MomRN0913, Ginger80, and 5 others like this.
  6. 0
    have done it before. Pt didn't really react. I did pull back a little. If I am in a situation where all I have is a long needle or a really skinny person I don't put the needle all the way in just enough to make sure I am in the muscle
  7. 1
    if there is limited underlying adipose tissue pull up a pinch..flu vaccines are usually given sub q
    hitting the bone can cause some site pain
    fiveofpeep likes this.
  8. 0
    http://www.cdc.gov/flu/professionals/acip/dosage.htm

    The intramuscular route is recommended for TIV. Adults and older children should be vaccinated in the deltoid muscle. A needle length of 1 inch or greater (>25 mm) should be considered for persons in these age groups because needles of <1 inch might be of insufficient length to penetrate muscle tissue in certain adults and older children. When injecting into the deltoid muscle among children with adequate deltoid muscle mass, a needle length of 7/8--1.25 inches is recommended.
    Infants and young children should be vaccinated in the anterolateral aspect of the thigh. A needle length of 7/8--1 inch should be used for children aged <12 months.
    I have a couple of times hit bone lightly and as posted above, just pull back but these are recommended sizes of needles.
  9. 4
    Quote from CHATSDALE
    if there is limited underlying adipose tissue pull up a pinch..flu vaccines are usually given sub q
    hitting the bone can cause some site pain

    Flu vaccines aren't given subq....or am I missing something? I've never known of a vaccine that wasn't IM.
    TheSquire, StayLost, netglow, and 1 other like this.
  10. 1
    I also have never given a flu shot subq. Always IM. At the health dept we use 1" 25G needles... pinch up for smaller people, smooth out for bigger people. Like someone else said, if you stop abruptly at the bone, pull back a tad and inject.

    I personally think people miscalculate needle size too small most of the time. At a pediatrician's office I worked at, we rarely used anything less than 1" for IM immunizations. And giving usually 50+ shots a day, never hit bone in a kid. I think it was 5/8" only if the kids were <6mos? Something like that... only the teeny ones. And even some of them weren't at all teeny! I just wish the hospital had more long, skinny needles... like a 25g 1 1/2" for IM's... can't have it all I guess.
    StayLost likes this.
  11. 1
    I've never given a flu shot subQ, am I missing something?
    StayLost likes this.
  12. 0
    The first time I ever gave an IM shot, I went for someone's deltoid and hit the bone. I think it was more jarring for me, because the patient didn't even blink.


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