IM Injection, Hitting Bone?

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.

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

If there is limited underlying adipose tissue pull up a pinch..flu vaccines are usually given sub q

Hitting the bone can cause some site pain.

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

CHATSDALE said:

if there is limited underlying adipose tissue pull up a pinch..flu vaccines are usually given sub q

hitting the bone can cause some site pain

Flu vaccines aren't given subq....or am I missing something? I've never known of a vaccine that wasn't IM.

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

I've never given a flu shot subQ, am I missing something?

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.

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 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.

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".