I got resistance when giving IM injection in deltoid. What does that mean?

**NickiLaughs, ADN, BSN, RN** · Sep 24, 2009

They tensed up their muscle severely. It's happened to me twice in my career. I'm not really sure what you're supposed to do about it either. Any advice?

Lacie, BSN, RN · Sep 24, 2009

I usually ask them to sit if possible and to have them put thier arm resting across thier lap. Encourage them to look the other way or keep them in conversation to keep thier mind off the injection for that moment. Lot of people will watch and tense up soon as they see that needle coming anticipating pain. Normal reaction. Also be sure if it's someone small stature that your not going too deep. Thats a nasty feeling when you do hit bone eww. I also massage the area very well with the etoh which helps to relax that muscle.

voneek, ADN, BSN, LVN · Sep 24, 2009

yes that happened to me to i just started working flu clinic also. scared me cause she was so tiny and felt like i met the bone.

bluebird123 · Sep 24, 2009

got me thinking....are there any negative consequences that result from actually hitting the bone in a smaller patient? (I'm a bsn student and have not administered many shots yet)

waggykeeper · Sep 24, 2009

I agree, to make them relaxed I do all the above ( massage with etoh, engage in conversation, make them look away and tell them to dangle the hand instead resting on the table/lap). I did hit the bone once and that taught me to pinch big chunk of the muscle( esp. in skinny clients), which gives more room.

We've been told there is no really harm to hit the bone, unless the needle breaks of course, because the needle is sterile and the bone too hard to be injured.

Hope everyone is enjoying their flu clinic experience, its my first job

(new grad ) and I'm happy to have one

msu2011 · Sep 24, 2009

Find placement, pinch the muscle up, inject.

Midwest4me · Sep 24, 2009

I agree, to make them relaxed I do all the above ( massage with etoh, engage in conversation, make them look away and tell them to dangle the hand instead resting on the table/lap). I did hit the bone once and that taught me to pinch big chunk of the muscle( esp. in skinny clients), which gives more room.
We've been told there is no really harm to hit the bone, unless the needle breaks of course, because the needle is sterile and the bone too hard to be injured.
Hope everyone is enjoying their flu clinic experience, its my first job
(new grad ) and I'm happy to have one

Yep, have the person dangle his/her arm--that'll relax the arm.

Also, we use the syringes with the retractable needles(the needle retracts into the syringe once the med to fully delivered), called VanishPoint Syringes. They are oh so very nice---my only problem with them is drawing up thick, viscous meds--you really need a large gauge needle for such thick substances and there of course is no way to remove the needles to place a larger gauge needle on(due to their retractibility).

Freedom42 · Sep 24, 2009

I gave flu shots for the first time this week at a clinic. I had the same problem. The managing nurse told me to aim a little lower on the arm. She was right. Make sure you aim at least two full finger widths below the edge of the acromion process.

saigelily · Sep 24, 2009

One more question about giving flu shots- Do you count first? I dont know how I started this, but I keep saying- 1..2..3- then give it. Maybe thats making it worse for people? How do you give a shot?

Lacie, BSN, RN · Sep 24, 2009

One more question about giving flu shots- Do you count first? I dont know how I started this, but I keep saying- 1..2..3- then give it. Maybe thats making it worse for people? How do you give a shot?

I dont count but I always tell them "You will feel alittle stick" as my mental countdown. Works for me and them. Majority of time I'm told "didnt feel that one at all ". :clown:

Orca, ADN, ASN, RN · Sep 24, 2009

It is also less painful if you dart the needle in quickly rather than slowly pushing it in. That way you are piercing the underlying tissue rather than tearing it as the needle goes in.