IM for infants - skin bunch or taut?

[nursequestions852]

I had worked in a flu vaccination clinic for 3 days (Injected 200+ shots). I had to inject a flu vaccine with 5/8 (16mm) needle to a infant aged ~1-2 years old.

I chose anteriolateral thigh as the IM injection site. Before injection, her parents had asked why I didn't use bunch up method. I explained and used Z-track method with making taut. It was because I've been taught that we always stick with Z-track method with IM injection. I darted the needle at 90 degree with spreading the skin taut. Then I felt like I've hit something hard like the bone. She cried out loud. So I pulled back a little and finished the injection. After that, her parents still concerned whether the needle will hit the bone if the skin is not bunched up.

I've read the online articles. The articles said the skin should be taut with 5/8 (16mm) needle in IM injection to anteriolateral thigh of infants. It is because the needle cannot reach to muscle layer with this length of needle if the skin is bunched up.

Now I feel worried and concerned about the whole things. Can't sleep well....

Here are some questions :

1. With 5/8 (16mm) needle IM injection, should the skin bunch up or taut in anteriolateral thigh for infants?

2. If the skin should be made taut and flat, why would I feel like hit the bone with this length of needle? Is it possible to hit the bone in this situation?

3. If I did really hit the bone, would it cause any harmful effects to the infant? (The most concerned questions for me....)

Thank you very much.

[LovingLife123]

Any IM injection should be taut. I pinch the skin for a subQ injection.

I've never seen anything but taut when IM injections were given to my kiddos.

[bugya90, ASN, BSN, LVN, RN]

I work in pediatrics. 5/8" with skin taut is correct. If you were to hit the bone you would know. I've only done it once (on a little old lady with no muscle mass). It is fairly unmistakable. The patient normally doesn't realize you hit a bone (just feels like any other injection to them). Baby was most likely crying because they were being held down and given a shot, not because you may have hit bone.

[KelRN215, BSN, RN]

Parents have probably seen skin pinched for subq injections before. That is not proper technique for an IM injection.

[OldDude]

I've given several thousand IMs to infants. You use what method fits the anatomy. If the baby is premature or otherwise has a skinny little leg you'll want to bunch the meat up to get into the muscle without hitting the bone. If you have a fat leg you can pull it taut to lessen the distance between the skin and the muscle so, again, you get into the muscle and not the subcutaneous fat. What you describe sounds like hitting the bone but no big deal; you withdrew and finished the injection. So, don't worry about it. Anyone who has given IMs to skinny leg infants on a regular basis has hit the bone.

I don't use either of those techniques now...I've developed the OldDude method of IM injections for infants over the years. I have the parent hug over the baby's chest while holding their hands. I grasp both legs at the knees with one hand and inject with the other hand. I rest my hand on the thigh for stability so I can adjust the depth of the needle according to the thickness of the thigh; I aspirate the syringe with my thumb...then flip the needle safety cover, drop the syringe, swab the site, and apply the bandaid, have mom or dad swoop the little sweet potato up for comforting and bam - done!

[nursequestions852]

I work in pediatrics. 5/8" with skin taut is correct. If you were to hit the bone you would know. I've only done it once (on a little old lady with no muscle mass). It is fairly unmistakable. The patient normally doesn't realize you hit a bone (just feels like any other injection to them). Baby was most likely crying because they were being held down and given a shot, not because you may have hit bone.

So it was unlikely I hit the bone with 5/8 needle to the infant?

I was concerned whether her bone would be injured by the needle and cause harmful effects to her....

[nursequestions852]

I've given several thousand IMs to infants. You use what method fits the anatomy. If the baby is premature or otherwise has a skinny little leg you'll want to bunch the meat up to get into the muscle without hitting the bone. If you have a fat leg you can pull it taut to lessen the distance between the skin and the muscle so, again, you get into the muscle and not the subcutaneous fat. What you describe sounds like hitting the bone but no big deal; you withdrew and finished the injection. So, don't worry about it. Anyone who has given IMs to skinny leg infants on a regular basis has hit the bone.

I don't use either of those techniques now...I've developed the OldDude method of IM injections for infants over the years. I have the parent hug over the baby's chest while holding their hands. I grasp both legs at the knees with one hand and inject with the other hand. I rest my hand on the thigh for stability so I can adjust the depth of the needle according to the thickness of the thigh; I aspirate the syringe with my thumb...then flip the needle safety cover, drop the syringe, swab the site, and apply the bandaid, have mom or dad swoop the little sweet potato up for comforting and bam - done!

It means I was kind of fail to identify the best method to use for this infant.... Maybe she was a bit skinny for me to pull the skin taut....

I can't stop thinking whether I've made any wrong decision in this case....

[OldDude]

It means I was kind of fail to identify the best method to use for this infant.... Maybe she was a bit skinny for me to pull the skin taut....

I can't stop thinking whether I've made any wrong decision in this case....

You've beat yourself up enough already...the medicine was delivered so mission accomplished. Put it in your "experience" locker for future reference and move forward:up: