IM Injection, Hitting Bone?

Nurses General Nursing Nursing Q/A

IM Injection, Hitting Bone?

I was giving my mother an IM injection for the Flu Vaccine at the hospital, I did the injection and felt that I hit a bone or something. I did aspirate and received no blood return and went ahead and inject the medication. The injection was a little high up, not where I received mine.

Is hitting the bone bad or something... will it cause any negative effects. I asked her if there was pain afterwards and she said not really?

37 Answers

Specializes in Med Surg/Ortho.

I have personally had it happen to me. Got a shot once in the hip/butt area, and it hit bone (yes, I am pretty skinny!). And it did hurt. Little soreness afterward, but not much more than any other shot.

Specializes in Community Health, Med-Surg, Home Health.

It's happened to me on occasion. Nothing happened. What I have done since having it happen a few times is to really look at the arm and decide whether or not to administer the IM with a 25 gauge needle instead of a 22 or 23. I've had some really emaciated patients that can only handle a 25 gauge IM.

Specializes in LTC, MDS, Education.

FYI, gauge is the diameter of the needle. Length is measured in inches. Most IM needles are 1" to 1 1/2 " for adults. Flu shots are usually given with 1 inch since they are given in deltoid... If you do hit the bone, just pull back a tad. :)

Have done it before. Pt didn't really react. I did pull back a little. If I am in a situation where all I have is a long needle or a really skinny person I don't put the needle all the way in just enough to make sure I am in the muscle

I have a couple of times hit bone lightly and as posted above, just pull back but these are recommended sizes of needles.

Quote

The intramuscular route is recommended for TIV. Adults and older children should be vaccinated in the deltoid muscle. A needle length of 1 inch or greater (>25 mm) should be considered for persons in these age groups because needles of

Infants and young children should be vaccinated in the anterolateral aspect of the thigh. A needle length of 7/8--1 inch should be used for children aged

https://www.CDC.gov/mmwr/preview/mmwrhtml/rr5606a1.ht

 

I also have never given a flu shot subq. Always IM. At the health dept we use 1" 25G needles... pinch up for smaller people, smooth out for bigger people. Like someone else said, if you stop abruptly at the bone, pull back a tad and inject.

I personally think people miscalculate needle size too small most of the time. At a pediatrician's office I worked at, we rarely used anything less than 1" for IM immunizations. And giving usually 50+ shots a day, never hit bone in a kid. I think it was 5/8" only if the kids were

Specializes in Ortho, Case Management, blabla.

The first time I ever gave an IM shot, I went for someone's deltoid and hit the bone. I think it was more jarring for me, because the patient didn't even blink.

Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

I did it once on a skinny teenager. She didn't even flinch. I was a new grad and was absolutely horrified. I tugged a little to retrieve the needle from the bone :eek: and then aspirated and gave the injection. She was completely unfazed and didn't notice anything. I, on the other hand, have been extremely careful about giving scrawny folks injections after that. Be sure that your needle length is appropriate for the size of the person you are injecting.

Specializes in Med/Surg.
pagandeva2000 said:
It's happened to me on occasion. Nothing happened. What I have done since having it happen a few times is to really look at the arm and decide whether or not to administer the IM with a 25 gauge needle instead of a 22 or 23. I've had some really emaciated patients that can only handle a 25 gauge IM.

Gauge does not equal length. I typically use a 1" needle for an IM injection in the arm. Little or elderly people a 5/8".

Specializes in Have a niche for pysch.

In nursing school we were instructed to use 1-1 and a half inch needles IM, depending on the patient's chubbiness. But now on the floor, some nurses actually use five-eigths needles on skinny adolescents for deltoid injections. My colleagues also insert 1 and a half inch needles only half way when administering IM. I question this.

Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.

Flu shots are given IM, most times you can get away with a 5/8" in the deltoid on someone who is fairly lean, and yeh I've hit bone a couple of times, just pulled back a smidge before injecting, no problems but I HATED the feeling

Specializes in Community Health Nurse, School Nursing,.
chelynn said:
Measles vaccines is in the MMR. I never knew that to be subq?

in my area of assignment we do not give MMR (all in one), instead we have it on a separate doses with measles vaccine administered subcutaneously.

mumps and rubella vaccines are available only in private institutions, so you have to take your kids to some private hospital if you want your kids to be immunized.

the vaccines that we give to babys for free are DPT, BCG, HEP B, Measles, and OPV

DPT (IM)

BCG (Intradermal)

HEP B (IM)

Measles (Subcu)

OPV (oral drops)

(Philippines)

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