Giving IM Injections

[debkimt]

I have a question about how LVN's were taught to give an IM injection. I was trained in 1985 and was taught to pull the skin/muscle taunt. I have been working in clinics for the last 10+ years now and the MA's that I have worked with ( the majority of them), pinch up the skin/muscle to give an IM injection. They tell me they are taught this way in their MA schooling. Which is the correct way?, and has anyone else ever encountered this? Thanks for your info, this has caused a big ruckus at my job.

[nursetobe745]

Hello debkimt

Me too I tought the only way was to pull the skin taunt, but during one of our clinical rotation, the nurse I worked with pinched the skin so I asked our instructor and she said yes you can pinch for IM. The thing is, unlike the small pinch you use for subq, for IM the finger are positionned a bit wider; and this is mostly used for skinny people. Hope this helps a little

[applewhitern, BSN, RN]

It depends on the patient~ are they obese? Thin? In other words, do they have a lot of adipose tissue, or under-developed muscles? The pediatric and geriatric patient may require the "bunching" method, where you are trying to avoid placing an IM injection into the sub-cutaenous tissue. (Some people may require you to bunch up the muscle.) In a normal sized, well developed patient, you may not need to bunch it up, but can give it with the skin spread taut between your thumb and index finger. The most important aspect is proper needle selection, and proper site selection.

[libran1984, ASN, RN]

I always do Z-track. I once saw the skin bunched up and somewhere between the muscle and the SubQ tissue a vessel broke and blood squirted out upon retraction of the needle like a water gun.

[canned_bread]

I was taught in 2006 to give IM injections. We were taught that with people with wrinkly, loose skin, to hold it taunt. With people who don't have that skin, or who are chubby, to pinch and give in that raised area. Ultimately I think it is use your brain, whatever gets it to the muscle is what you do. Interestingly, when I was taught we were also told to slightly draw back to make sure we were not in a vein, however they have since scrapped that from the protocol for some reason.

[Topaz7]

They have not scraped that from the protocol. At least not here, we are still taught to aspirate when giving IM injections.