IM Injection Tips

ann945n, RN · Sep 16, 2008

I find I hit bone when the pt has very small arms. I always use 1inch in the arm. If the pt is really small I make an effort to not go as deep to avoid that but sometimes you hit bone anyways. I wouldnt worry if you do, simply pull back a bit, aspirate, give the med and then check the tip of the needle to make sure its intact.

BinkieRN, BSN, RN · Sep 16, 2008

Hi There,
I am starting to work some immunization clinics in a few weeks. I really dislike giving IM's as I fear I am going to tap the bone. I am wondering if you have any tips for giving an IM to people with tiny arms? We use a 1 inch needle for all ages/arm size.
Thanks

You can use a 5/8" guage needle for those people with small arms. You can also use the 1 inch needle just don't insert as far as you would with a person with a nice deltoid muscle.

Never give more than 1cc of medication into the deltoid muscle of a person with a very small arm.

If you do hit the bone, it won't hurt the person, as long as you're not injecting with alot of force (which you shouldn't be doing anyway) it won't hurt the person and will not cause any harm. Make sure to aspirate for blood before injecting :nurse:

mpccrn, BSN, RN · Sep 16, 2008

you could always use the hip......much more muscle between bone and the outside. it also hurts less IMO. :smokin:

FlowerbuddRN · Sep 16, 2008

giving IM's into anywhere but the deltoid, or Vastus lateralis make's me nervous, because most of the people I had in clinicals were very overweight, and we were unable to palp the bony landmarks, and just went by where the preceptor showed us.

Any great easy tips on finding these places even on overweight people, and everyone in general? I'm always nervous about hitting a nerve so I have always avoided them.

kmoonshine, RN · Sep 16, 2008

As someone else said, use 5/8" needle if needed for the deltoid. You can also try to "gather" the muscle and bunch it up between your thumb and forefinger. If the muscle is small, its best to use another site.

Dayla · Sep 16, 2008

Imagine working in a detox (like me) going from PO thiamine to IM injection of thiamine on all of our ETOH pt.... The only benefit is that when they are still intoxicated they think it's Ativan even thou I tell them what it is. LOL

RN007 · Sep 17, 2008

giving IM's into anywhere but the deltoid, or Vastus lateralis make's me nervous, because most of the people I had in clinicals were very overweight, and we were unable to palp the bony landmarks, and just went by where the preceptor showed us.
Any great easy tips on finding these places even on overweight people, and everyone in general? I'm always nervous about hitting a nerve so I have always avoided them.

:yeahthat:

Flu shots are just around the corner and I'm working in a new clinic now with the high likelihood of dispensing rocephin injections. I would love some pointers, too.

kmoonshine, RN · Sep 17, 2008

:yeahthat:
Flu shots are just around the corner and I'm working in a new clinic now with the high likelihood of dispensing rocephin injections. I would love some pointers, too.

What specifically do you want to know about rocephin?

Patients complain that it hurts/burns pretty bad. We have pharmacy mix it with lidocaine to help with the pain, but it doesn't kick in right away (and it doesn't take away all the discomfort). However, its not the most painful med that I've given. I've always administered it in the vastus lateralis or dorsal gluteal, using a 21g needle that is 1 1/2 inches long (the needle is a bit big, but that's the longest one we carry). I've never hit bone, and the volume is usually under 1 mL.

For little kids, we papoose them and divide the volume in half (2 syringes, both under 0.5 mL each). We then have 2 nurses administer the injection simultaneously in each thigh using a 5/8" needle - half goes into one thigh, and the other half goes into the other thigh. I tell parents that their child is going to cry even before we give the med because they are scared and we're holding them down. I tell them that papoosing them is necessary because we want to get the job done right the first time. I try to reassure them that there is lidocaine in it which will help to take away some of the pain (sadly, its more false reassurance than anything). I also give them the option of leaving the room, and tell them that most parents choose to leave because its hard to see their child crying.

RN007 · Sep 17, 2008

Yeah, like flowerbuddLPN, I was hoping to get some tips on finding alternate injection sites, knowing I probably won't want to give rocephin in the deltoid.

FlowerbuddRN · Sep 17, 2008

i hate rocephin, working on peds at my main job.. we always use the thigh on our lil ones, and it goes smoothly, except i hate how hard it is to push.. but it is mixed with lidocaine.

I have a prn job with adults however, and have always used the deltoid or thigh on them, since i get nervous trying to LM the ventral glut or side when the pts are sometimes overweight and its hard to dig and find their iliac crest etc. Also some of the lil ladies are so damn small.. it just doesn't seem anywhere has muscle..

kinda like when you have to give heparin or lovenox to one of those 78 lbers with noooooo fatty tissue anywhere

RN007 · Sep 17, 2008

Flowerbudd, tell me how you LM the grown-up thigh. I did one once -- inner third of the outer third (if that makes sense) -- and felt for the tough meat, but didn't feel confident. It was a hep vaccine.