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

Nurses General Nursing

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I am a new LVN and just started working at a flu shot clinic. When I was giving someone their flu shot today- I only got about half the dose injected when I got resistance- I couldnt push the plunger anymore. Why did that happen? I talked with the other nurse and she said that had never happened to her before. This is the second time its happened to me. It happened yesterday too. She said that maybe they were too tense. Is that a possibility? What could have caused that? I was worried I did something wrong.

Specializes in jack of all trades.
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.

Good point as I see so many nurses put it to the skin then push :eek: I always hold mine like a dart and administer. Pt's shouldnt feel the needle insert as it's usually the medication that stings.

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Specializes in Progressive Care, Home Health.

I never do a countdown or a signal that I'm going to give it. They already know they're getting the shot, and the anticipation can make people tense up, causing a sore muscle later on. I always have them wiggle their fingers and have their arm dangling. I've probably given 100 deltoid injections, and not one person has ever said "ow" or "oh that really hurt"- the typical response is "oh, that's it?" I encourage people to rub the area and move the extremity....

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Specializes in Psychiatric.

I do a LOOOOTTTT of shots because I do a weekly injection clinic for my guys who receive long-acting antipsychotics such as Haldol, Prolixin, and Risperdal Consta, and we give about 20 shots a week, usually in either the deltoid or dorsogluteal (as much as I've tried to switch to ventrogluteal, they've flatly refused! lol)...anyhow, for the deltoid shots, I have them sit while I chat with them for a few minutes, and then I tell them to make 'spaghetti arms' for me...they shake their arm a bit to loosen it up, and then relax it on the arm of the chair. I then do the usual stuff (finding placement, cleaning, etc), and use the dart method...virtually painless.

For the dorsogluteal shots, I have them stand at my desk (we have no exam tables) with their toes pointed inward slightly, and bend the knee on the side they're gonna get the shot...we then chat about whatever while I do my thing...again, virtually painless, and I have yet to have an adverse event. I've tried to talk them into trying the ventrogluteal site but they all say 'no' and for me, as long as they get their meds, we're all happy! :)

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Specializes in Management, Emergency, Psych, Med Surg.

Is this patient diabetic or on some other medication that they are chronically injecting into that muscle? If a site is used for injection for a long period of time, the tissue becomes hard and you will not be able to inject into it.

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Specializes in Med Surg, Ortho.

I know this is an older thread but this happened to me today. I was giving haldol in the deltoid and met major resistance. Never seen anything like this before in my entire nursing career, it made me feel very uncomfortable. I ended up not giving all the med due to so much resistance.

And, I know for a fact it WAS NOT due to the pt tensing up. I could tell that this patient was very relaxed. The only thing I can think of is maybe there had been many shots in this area in the past (psych drugs) and it has caused some sort of hardening of the muscle. I checked the site before I left and it looked fine, but I'm still very concerned. I'll be researching/ googling this to try and learn more. But has anybody else had this issue? Thanks.

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Specializes in Medical Assistant, Peds.

There is always a chance you got a faulty syringe.

But as far as tensing up goes, I usually give the injection site a quick flick before I administer the meds. This catches the pt offguard and they instinctively untense because of the distraction.

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Those of you mentioning anti-psychotic dec shots-- do you always give them using Z-Track? We are required to and I am not sure if this helps with this problem.

The other thing is many,many of the IMs I have given have been during a restraint in psych and so the patient is fighting the staff and generally very tense. I never had a problem like this so I don't know about the whole tense muscles thing..........maybe but maybe there is something else.......?

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Specializes in Med Surg, Ortho.
Those of you mentioning anti-psychotic dec shots-- do you always give them using Z-Track? We are required to and I am not sure if this helps with this problem.

The other thing is many,many of the IMs I have given have been during a restraint in psych and so the patient is fighting the staff and generally very tense. I never had a problem like this so I don't know about the whole tense muscles thing..........maybe but maybe there is something else.......?

It has to be something else because my pt did not appear tense. I didn't use the z track.

I'm thinking that the muscle is prob with scar tissue or something due to so many injections.

I really have no idea. There wasn't any thing wrong with my syringe either, so it's baffling me.

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Some vaccines are also thicker in consistency than others, aren't they?

In nursing school, they taught us that IM injections are given over 10 seconds, this might seem painfully slow.. but I can see the rationale... giving it TOO fast, especially to a smaller muscle might cause the muscle to tense or spasm, making the rest of the med more difficult to go in.

If you do meet complete resistance again, can you change out the needle and give the rest of the med in the other arm as long as there is not contraindication to giving it in the other arm?

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Could mean you placed the needle in to far.

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