? about giving shots

kwagner_51 · Oct 17, 2004

Well, I remember sub c as 45 degree angle and IM as 90 dergrees or staight. The shoulder is the deltoid, NEVER give a child a shot there.

Give a child a shot IM in the upper thigh vastus lateralis [sp?]

NEVER give shots in the butt, could hit the siactic nerve and cause permanent damage to the leg.

Give instead in the hip between the illac crest and the trocontor[sp?] of the femur.

I found this site:

http://patienteducation.upmc.com/Pdf/ShotGenInstructions.pdf

Hope it helps!!

RedSox33RN · Oct 17, 2004

Just an FYI, I was given a shot of Phenergan (or Demerol) in the shoulder once, and the RN hit something. Not only did it hurt like a SOB (not just the regular burning from the Phenergan), but my shoulder area had an 4" round area that was completely numb for more than 6 months.

And go figure, I have frozen shoulder in that shoulder now also. Not that it's related, but that poor shoulder has been through ENOUGH! LOL

I've seen a lot of variation in how nurses give injections. Some pinch the skin up, some push it flat with fingers on either side of injection site. I've asked each why they do what they do, and all were taught differently.

When I was taking injection for my diabetes, I always shot at a 90 degree angle, not pinching skin at all after cleaning it. After 6 years of MDI, I only had 2 bruises.

Also, I don't know if this is true for other meds, but tell pt's not to rub the "owie" away after an insulin injection. It can alter the course of the absorption of the insulin (ie. long acting could be absorbed faster, or fast-acting not absorbed quickly) and it breaks down the insulin too quickly. Anyone know if this is true for other meds?

Christina_NICU · Oct 18, 2004

I was told that you are not supposed to rub the area after a heprine shot.

mavnurse · Oct 18, 2004

We learned 90 degree angles for all types of shots. I guess everyone learns it differently. Oh, but DON'T stick yourself accidentally during check offs like I did.:imbar

All_Smiles_RN · Oct 18, 2004

I just checked off on this skill last week. We learned:

* 15 degree for intradermal; only in the inner foreman

* 45 degree for subq; outer upper arm, scapula region, abdomen, outer thigh, or above gluteals

* 90 degree for intramuscular; deltoid, rectus femoris, vastus lateralis, dorsogluteal and ventrogluteal

...Jennifer...

enfermeraSG · Oct 18, 2004

....... Oh, but DON'T stick yourself accidentally during check offs like I did.:imbar

That is the only reason I do not care for the technique that involves spreading your fingers (or finger and thumb apart) like a "V" and giving the injection in the middle of the "V". I am so afraid of stabbing myself. Saw a nurse go right through the webbing of her thumb.........eeeeeowch! I feel more comfortable squeezing up a chunk of flesh to aim at! he he . SG

mavnurse · Oct 18, 2004

^^This was on a mannequin and he was slippery after I wiped him off with alcohol, so my hand kinda...slid. It hurts just thinking about the webbing thing. :stone

enfermeraSG · Oct 18, 2004

^^This was on a mannequin and he was slippery after I wiped him off with alcohol, so my hand kinda...slid. It hurts just thinking about the webbing thing. :stone

Gotta love those mannequins! In my scenario, I had to give an insulin shot also and I chose the abdomen. Our mannequins have these "sites" that you should aim for because you can really insert the needle and inject. Well, it is a rather smallish soft circle area. I hit a spot right next to it so my needle did not go in. I tried to play it cool and laugh it off by saying, Oh, that's no good - I've hit bone! My instructor cracked up at that since I was in the abdomen area. I still passed check offs! BTW, I gave my first real injection yesterday - an IM flu shot in the deltoid. Wow, didn't feel like the mannequin! SG

purplekath · Oct 19, 2004

Just do what YOU have been taught in school to do. I found that what we are taught in school is not necessarily what you do in the hospital (eg: at school we were told 45 deg for subcut, in hospital, it's 90 for ALL injections)....so learn what you need to learn for school and then relearn it all for your clinicals.

I think that that the advice to "not rub after giving heparin" is pretty universal...just make sure at your check-offs you give rationale for everything (eg: don't want to cause bleeding at the site of giving an anti-coagulant), and most instructors will respect that.

In my check-offs if I'm not sure what the protocol is, I'll give two conflicting rationales and just say "there are two schools of thought on this...here are the two ways and the two rationales...here is what I will demonstrate (and why). Let me know if you'd like to give a demo of the other one".

Eg: when I was demonstrating IM's, I demonstrated the usual palm on greater trochanter, pointy finger to iliac crest, splaying fingers and injecting in the "V", but also told the instructor that I would use another method and check with muscle palpation if my client was larger as I have little hands and often in a larger client that won't give me the correct location. He seemed to appreciate that.

coreopsis · Jun 15, 2010

This is going to sound ridiculous, but have been a nurse for over two decades but in areas where I did not have to give any kind of shots (i.e. case managment, school nursing etc). I am now in a setting that may require me to give shots and am having to learn all over again and am scared to death! Any words of wisdom, websites or ideas on how to handle this as i am in a setting where I am the only nurse. Thanks.

turnforthenurse, MSN, NP · Jun 15, 2010

I always go in at 90 for all injections, unless I'm giving a SQ on a little old lady where I would have to go in at 45. 15 is for intradermal always always always (Mantoux).

And DON'T FORGET TO ASPIRATE with IM's!!! It's to tell you if you're in a vein or not. IM meds are not meant to go into circulation! I know at my school if you didn't aspirate when giving an IM you would automatically fail your competency. You do not have to aspirate with SQ injections.