How do YOU give a great injection?

GingerSue · Jan 11, 2005

I remember as a student learning injection technique - we practiced giving sc injections of sterile saline to each other - discovered that the injections did not hurt.

gwenith, BSN, RN · Jan 11, 2005

Flick the skin first or tap it with your finger - seems to stop SOME of the pain - especially with those rotten Enoxaparin injections.

leslie :-D · Jan 11, 2005

i don't know specifically what i do, but have been told i give great injections.

not all sc injections are painless; even though the needle is smaller the med can be irritating to inject.

for im injections after drawing the med, i always change the needle because the original needle penetrating the rubber stopper can blunt the needle.

when i do the im, i always pull the skin to the side, making the area taut and that seems to help with the pain. if i know that a specific med is very irritating (rocephin), i swab the area with lidocaine, as well as mixing the powder with lidocain solution. it still hurts. i hate giving those injections.

but just remember if you have to penetrate a rubber stopper, change the needle afterwards.

leslie

Antikigirl, ASN, RN · Jan 11, 2005

Watch your needle lengths! I can't tell you how many times I have seen a 1 1/2 come at some little old lady with an average arm radius of about that! LOL! Put that up to a small arm and it send shivers even for me...so I became really good at judging where muscles are for IM and really using the proper length (and no more). That helps!

Being confident and look confident! People sense fear..LOL, they will know you are new and tense up and feel EVERYTHING! Be confident, and don't look worried..they DO pick up on that!

I tend to get people into conversation as I am drawing up and prepping for the shot..also a sign of confidence and a nice ice breaker. I find some humor helps dependant on the person, and try to keep their mind and eyes on something else when I inject.

When I was dealing with people in the ED, I normally guaged how they responded by the way they looked at the needle! Then I knew if I was up for someone that may be overly sensitive..and in that case I would have them breath in and out the mouth three times...and on the third blow out I would inject (and told them this is what I was going to do). That really seemed to help..that and have them not look!

And as a student...try to get some shots in on Peds! If you can do peds...you can do about anyone! LOL, or try doing it in a moving ambulance as my hubby says..LOL!

I learned the MOST from peds with insulin shots though..they were so great at telling where a shot hurts more or less...proper technique..and they really seemed to know their stuff (far more than most adults!). It really helped me to work with them and have them show me...gives me a view from the pt standpoint and worth seeking that avenue to learn! :)

Watch what you are giving...some meds burn or hurt more...so be nice in picking your spots! I don't like giving heavy burn meds in the old deltoid as much as the hip or glute...doesn't feel good anyway frankly..but you don't go around moving your toosh as much as your arm if you can help it...so it is a bit more user friendly! And with diabetics and insulin...I find if you can use the fatty part of the back near the shoulders..it is less painful (less nerve receptors in that area) and a spot they will not be using so you don't use up their injection sites they can reach! :) Gotten lots of thank yous for that little pearl!

Practice is key, and I will say without doubt that my first shot was given as I barely breathed because I was so nervous..but the patient said "did you give it already? Darn I didn't feel that at all!" (hip IM too!)..I felt so confident after that that they are a breeze now!~ Hope you and the rest of your class get that same encouragement..sure helped me!

kellyo, LPN · Jan 11, 2005

Today in lab we began learning about injections, needles, syringes, etc.......We are all afraid to inflict pain on the poor oranges we practice on, much less the real patients we'll see in a few weeks.
How do you give a great injection? What are your tips and suggestions? :)

Hey girl, from one JCC SN to another, HELLO! I saw your post and thought "We did injections in lab today, too!"

nurscee · Jan 12, 2005

I'm a new grad...but when it comes to Neupogen shots (which can really sting) I'm an expert. My hubby had them for a year b/c of cancer.

Warm the neupogen up in your hand first! (it comes from the fridge)

Give it subq in the most fatty area you can...and give it SLOWLY.

cancer nurses told him this after much pain had been inflicted. He said it works.

Nurscee

Antikigirl, ASN, RN · Jan 12, 2005

Awesome Nurscee great advice!!! I haven't had to give that shot in forever..but may have to soon...I will remember that tip! :)

meownsmile, BSN, RN · Jan 12, 2005

Getting the patient to relax the muscle you are injecting as much as possible is one key. Also, dont think speed is everything. Getting it "over with" just plain hurts. A nice even injection into a relaxed muscle wont hurt(granted some medications have their own capacity to sting). If the muscle isnt relaxed and you give it quickly, the fluid being injected will tear the muscle fibers as it displaces them and that makes it sting/hurt. So relaxation and injecting more slowly so not to tear the muscle fibers is important, remember the muscle will stretch with the fluid to a certain extent, but if the muscle is rigid and tight,, there isnt much ability to expand.

I usually poke (not hard, just enough to get the feel of their muscle) the patient just above the injection site till i feel the muscle relax, insert the needle using a dart throw approach and then start poking the muscle again while injecting. If i feel them stiffen the muscle i stop injecting until they loosen the muscle up again. The needle doesnt hurt once its in place so stopping the injection and leaving the needle in place till they relax the muscle again is no big deal. I have never had anyone tell me my shots hurt. They usually ask me why that other nurses shot hurt so much but mine didnt.

Long Term Care Columnist / Guide · Jan 12, 2005

In four words: let the alcohol dry .

If you inject through alcohol, it tracks through the tissue and makes the sting even worse. You would not believe how much easier it is on the patient if you just wait the 30 seconds after swabbing the site......I swear by this technique, as do my patients. :)

Also.....for IMs, make sure the muscle is as relaxed as possible, and when you inject, do it quickly and assertively. Then, push the medication in slooooowly and steadily.......the faster you push down on that plunger, the more painful the shot.

I also agree with the posters who advised careful selection of the needle and changing it after drawing up the medication. Your average LOL who weighs 80# wringing wet does NOT need a 1 1/4 inch, 21 gauge needle anywhere near her! (Conversely, you may need a 2-incher to reach the muscle on someone who's 350#.)

Here's another consideration.........the amount of medication to be injected. You don't want to put more than 2-3 ml in any one spot; if the dose is, say, 5 ml, divide it into two injections. Yes, you have to poke twice, but it's less painful than having all that solution go into one small area, and is less likely to damage the tissues. :)

pmchap · Apr 10, 2005

Here's another consideration.........the amount of medication to be injected. You don't want to put more than 2-3 ml in any one spot; if the dose is, say, 5 ml, divide it into two injections. Yes, you have to poke twice, but it's less painful than having all that solution go into one small area, and is less likely to damage the tissues. :)

How often are you all giving 5ml + for an injection? Most I have needed to give in ages is 2.5ml.

I find that all the above works - but I do use a pinks finger as a distractor. As I am injecting the pinki of the hand on the skin lighty moves - this caures the patients to notice that sensation and they hardly ever even realise that the needle has entered. Give the injection steady enough and often I have taken the syringe aware and the patient is still wondering when I am going to give the injection. Please note that there are some medications that no matter what you do a sting will occur - until the chemists can come up with a way to make all medications of a similar osmotic property of muscle then we will always have some medications that sting a little.

Cheers

mugwump · Apr 10, 2005

When I start IV's or give injections I try to have the patient sing. Yes I know it sounds stupid but it gets their mind off of what I am doing for a little and there consentration is somewhere else (remembering words to a song) granted most are embarrased to do this but every person who has done this says it was the best injection/ IV start they have recieved