Hitting bone/nerve with IM injection

Aurora77 · Nov 21, 2011

I did once on an LOL. Scared me, but my pt didn't react at all.

Esme12, ASN, BSN, RN · Nov 21, 2011

Got the last of my 4 rabies vaccines last Saturday. The first 3 shots made my arm hurt the night I got them really bad but were fine the next day. This 4th shot has made my arm hurt TERRIBLY for the past week and has not gotten any better. (to the point it hurts to sleep on it and get dressed.)
My question is not asking for medical advice in anyway..I'm not worried about this from a medical standpoint. My question is have you ever hit a bone/nerve while giving an IM injection and if so, how did the patient react? My arm is super skinny and I'm always afraid someone will hit bone. As a nurse, I'm also always so scared to give IMs to skinny older patients.

If you arm is hurting you need to seek medical care. We can not give medical advice here whether or not you say you aren't asking for medical advice. It is possible to hit the bone or nerve but you would know that immediately. Callyour PCP for evaluation....I hope you feel better

http://www.medscape.com/viewarticle/551320

nerdtonurse?, BSN, RN · Nov 21, 2011

I've hit bone twice, in extremely emaciated patients despite my best efforts not to. Neither one of them seemed to be able to tell, but it freaked me out. Since Aurora said the same thing, now I wonder if the bone's that sensitive? I know when I've broken bones that as long as they were in place they didn't hurt if I wasn't putting pressure on the site (foot) or taking a deep breath (ribs).

I've never done an I/O or had one; anyone did one and the pt react?

2011nursetobe · Nov 21, 2011

My sister who is extremely skinny (78lbs) had an IM once and she said it felt like a knife stabbed her arm and she was in tears within seconds. I assumed they hit her bone, but from what I'm hearing, most people don't flinch. Thats why I'm thinking maybe when it hurts like heck, its a nerve that has been hit, not a bone.

I've heard I/O's hurt so they use lidocaine for conscious individuals. But this is going into the marrow, not just hitting the outside of the bone.

Double-Helix, BSN, RN · Nov 21, 2011

I've done it twice. The first time the patient winced and said "ouch"! The second time the patient didn't even seem to notice. Of course, I don't know how they felt the next day compared to my other patients.

Did you get all the injections in the same arm?

turnforthenurse, MSN, NP · Nov 21, 2011

I hit the bone on a tiny LOL while giving a flu shot...I reacted lol but the patient was looking away and didn't even notice!

MurseyMe · Nov 21, 2011

When I helped give flu shots at the hospital where I was taking my clinicals in nursing school, I gave a shot to a classmate who was very skinny, and struck bone. I remembered my clinical instructor telling us that the patient wouldn't feel it if this happened, and to go ahead and give the shot. So I did. Not only did she not feel it, the next time I saw her in class, she told me she was the only one in her group that did not get a sore arm the day after shots were given. I'm not saying striking bone prevents soreness or advocating hitting bone. Just relating the experience I had. :twocents:

divaRN* · Nov 21, 2011

with IOs it is the infusion of fluid/ medication that hurts. not the actual drilling part. that is why lidocaine is pushed prior to using the line in conscious patients. i have hit bone with IM injection before and my patient didnt notice. i think it is worse on the RN than the patient!

2011nursetobe · Nov 21, 2011

I've done it twice. The first time the patient winced and said "ouch"! The second time the patient didn't even seem to notice. Of course, I don't know how they felt the next day compared to my other patients.
Did you get all the injections in the same arm?

Yes got all of them in the same arm. If it still hurts in a few days I will go see my PCP although not really sure what they would be able to tell me...

christina1614 · Nov 22, 2011

I did it once... the patient didn't even notice. She was skinny, but I was giving a RHoGam, and those needs are so short. Oh well, haven't had it happen since!

NursingStudent17 · Nov 22, 2011

I hit bone working at a flu vaccine clinic last week. The girl didn't even notice. Then another girl who shouldn't have felt it at all flinched, so I think I hit a nerve on her. My instructor was watching when I gave that one and said I did it perfectly so I don't think I could have screwed it up.