IM injections - divide into 2 or keep as 1?

Nurses Medications

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Okay, I need a bit of good nursing practice know-how. If you have a 2ml IM injection is it better to give it all at once (assuming non-irritating med) or divide it into two, 1ml injections? My thought process is that one injection will only break the skin once but will potentially cause a much larger sore spot, while two injections will be more comfortable for the pt.

I ask because the last pt. I gave 2ml IM to (in the VG) c/o moderate-to-severe pain (non-irritating med). It really scared me how much they were complaining and I went home and looked up all sorts of things about muscle separation, tissue necrosis etc.

Thanks for any help you can give.

Specializes in Chemo.

i have not seen any evidence based information whether to divide the dose or not. think of it this way, if you are the patient how many times do you want to be stabbed with a needle. if the dose is going to be more than three ml consideriv route if it possible.

I've always heard that you can give up to 5mL...maybe the patient was really a weenie...it happens all the time. I've given IM's that "should" cause discomfort and pain and yet some patients don't say a word...while with others...a simple med that should cause no discomfort screams for help. It's pretty subjective to me... I wouldn't divide it into 2...I mean, come on...it's no biggie, right? Why "waste" material and have the patient go through another injection for "no reason"? I dunno...it's just my opinion... I guess people should learn how to bear with it sometimes...

I understand how you feel though...

Specializes in ED.

Whoever complained about a 2cc IM shot is a wimp. Especially in the glute.

If it is 2cc+, it goes in the VL or VG. I have never personally IM'd someone with more than 3cc. I give 2cc deltoid shots all the time on larger pts. You can always rub the IM site (as long as it's not iron or something irritating like phenergen).

As far as I was taught first as a medic and seconly as a nursing student it's 2ml for delt depending on size of patient .It is very subjective and different texts have different opinions on it. and 3ml for gluts....

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
So far, the responses have ranged from simply asking for more information to downright condescending.

Let me clarify that I am looking for an experienced opinion (or even published literature, if there is any, which I haven't been able to find myself) on outcomes for the pt. to have one large injection (infection control) or two small ones (comfort). Is the potential increase in infection outweighed by pt. comfort at injection sites?

It really doesn't matter if I was technically/prudently "right" last time (and I was). You can be "right" and still have a sub-optimal outcome. The pt. reported pain and was very uncomfortable after I gave them 2ml in a large muscle. If I can help a pt by giving them two 1ml injections then I want to be able to do that with good rationale.

I don't think that anyone has been condescending and you have gotten great information. If it burned with one infection it will burn with 2 injections. Anytime you break the body's first line of defense....the skin, you risk complication, infection, or cellulitis. If you give 2 injections, when one would do, you've doubled the chance of complications.

Most treatment will cause discomfort but the therapeutic effect far outweighs the discomfort of the treatment to feel better. How was your outcome sub-optimal? The patient didn't like the shot? If the shot helped you had a good outcome. It goes with...no pain no gain. Some meds really burn,plain and simple.......what was the med? But like I said....if it hurt with one injection it will hurt with 2.

Specializes in Clinical Research, Outpt Women's Health.

The question cannot be answered without knowing the medication. It depends on the med.

Though not evidence-based, per se~ One poke= sore muscle, apply cool pack to affected area and give analgesic, if warranted. Two pokes=only if necessitated by dose. Second poke likely to elicit compounded discomfort due to patient tensing more in anticipation=more pain. Plus now you have two breaks in skin integrity-(though alcohol or cleanser of choice should minimize that risk, especially if you apply a little bandage). Conclusion? I'd "stick" with one stick.

Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.
I don't think that anyone has been condescending and you have gotten great information. If it burned with one infection it will burn with 2 injections. Anytime you break the body's first line of defense....the skin, you risk complication, infection, or cellulitis. If you give 2 injections, when one would do, you've doubled the chance of complications. Most treatment will cause discomfort but the therapeutic effect far outweighs the discomfort of the treatment to feel better. How was your outcome sub-optimal? The patient didn't like the shot? If the shot helped you had a good outcome. It goes with...no pain no gain. Some meds really burn,plain and simple.......what was the med? But like I said....if it hurt with one injection it will hurt with 2.
I know this post older and I hate to open it back up here, but, OP stated that drug/ abx to be given was/ is clindamycim, now clindy is abx, my history with abx deep im is that the majority are generally painfull and usually anywhere from 4 to 6 mls/cc's the best place to give an abx deep im, in one injection, in a glute, well diluted by putting some lidocaine in the syringe after you draw up the abx.Sincerely,Rod, RN, BSN, Cen, Ccrn, tncc, Cfrn, Nurse manager- ed/ sicu
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I know this post older and I hate to open it back up here, but, OP stated that drug/ abx to be given was/ is clindamycin, now clindy is abx, my history with abx deep im is that the majority are generally painful and usually anywhere from 4 to 6 mls/cc's the best place to give an abx deep i'm, in one injection, in a glute, well diluted by putting some lidocaine in the syringe after you draw up the abx.Sincerely,Rod, RN, BSN, Cen, Ccrn, tncc, Ccrn, Nurse manager- ed/ sicu

I see we have similar backgrounds and credentials.......All literature that I can find really says 4cc....max 5cc deep IM can be given. I wouldn't give 6cc....... I'd divide it into 2 IM's. I would, however, be interested in any data you could supply that would support 6cc IM.

Specializes in nursing education.
I see we have similar backgrounds and credentials.......All literature that I can find really says 4cc....max 5cc deep IM can be given. I wouldn't give 6cc....... I'd divide it into 2 IM's. I would, however, be interested in any data you could supply that would support 6cc IM.

Esme12, I'd be interested in your source for 4cc! Please share. Thanks! Especially if it has VG site vs UOQ gluteal.

Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

As far as data goes I got the 4-6 cc/ml estimate out of one of my pharm/med calc books, I also seen it in a med-surg nursing book, I think its just pretty much an estimate to kind of give you an idea of what to expect, as I would never give a full 6 cc's/ml's, I think it was pretty much an estimate, I think they rounded up because of doses like 5.6 cc's/ml's etc. you get the idea, but as far as I go anythimg above 3.5 cc's/ml's and I will split into two (2) injections especially of its deep im, and if its a burning/stinging med I will always try to get an order for me to dilute it with some lido, as far as sites go I prefer the vg site the majority of the time, I will give a drug dg if I have to, but I prefer not to as it could possibly damage th e sciatic nerve.Rod Rn, Bsn, Cen, Tncc, Ccrn, Cfrn, Pals, Nals, Acls, also have med/surg- lol isnt amazing how many letters you can get behind your name- lol

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
As far as data goes I got the 4-6 cc/ml estimate out of one of my pharm/medcalc books, I also seen it in a med-surg nursing book, I think its just pretty much an estimate to kind of give you an idea of what to expect, as I would never give a full 6 cc's/ml s, I think it was pretty much an estimate, I think they rounded up because of doses like 5.6 cc's/ml s etc. you get the idea, but as far as I go anything above 3.5 ccssm and I will split into two (2) injections especially of its deep im, and if its a burning/stinging med I will always try to get an order for me to dilute it with some lido, as far as sites go I prefer the vg site the majority of the time, I will give a drug dg if I have to, but I prefer not to as it could possibly damaged sciatic nerve.Rod Rn, Bsn, Cen, Tncc, Ccrn, Cfrn, Pals, Nals, Acls, also have med/surg- lol isn't amazing how many letters you can get behind your name- lol

RN B.Mus, BSN, BHA. ENPC, EMT-P, CATN, CCNS, CSC, CNML, NRP, ACLS, TNCC, CFRN, CRNI, PALS, NALS,.......and a few more. Man I have blown a ton of cash. I don't use them anymore as I have been ill with a rare autoimmune disorder for the last 2 years and I am not working so, they have lapsed or been retired besides being very expensive to keep.....and some you have to be actively working to keep. I keep my RN active by consulting work Ah....such is life.

Every Time I have to look for this it's a nightmare, everyone is so vague.

Intramuscular Injections: The volume is not to exceed 5 mL in adults of average weight. Volumes in excess of 5 mL will be given in divided doses at different sites. Maximum volume for infants (birth to 1 year): 0.5 mL; for children 1-2 years: 1 mL; children 2-12 years: 2 mL.

Administer Intramuscular, Subcutaneous, and Intradermal Injections

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