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Discussion

IM Injections

I did my first injection at clinical the other day and had a horrible experience. My patient was very thin. I was injecting 1 ml with a 1 inch needle. I asked if I should use a smaller needle, instructer said no. I asked if I should go in at an angle instead of 90 degrees, no again. I also asked if I should still spread the skin. She said yes. :uhoh21: So, I spread the skin, went in at 90 degrees and hit bone. The needle was only halfway in his arm. She had me push the med anyway. I feel like I did something wrong but she insists it was fine. Just curious if it really was ok to do this. I knew I was going to hit the bone before I even filled the syringe. He was just so thin. Is there anyone who uses another technique for thin patients?

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The only thing I can think would be to use a large muscle site like thigh or glute. I'm assuming you went deltoid for the injection? Other than that I would have taken the instructor out of the room and discuss before giving the injection. IMO, the instructor was wrong and you tried to do the right thing.

  • Experts

I have hit bone once or twice in my career giving IM injections. Not to worry. As long as you used a sterile syringe and needle and followed the proper technique it is very unlikely that the patient will suffer any untoward consequences of this.

In the nursing homes we had many patients who were very thin like this. What we did was try to inject into areas (usually the gluteals) where there was more muscle mass. Otherwise, you just don't plunge the needle in so deeply. On the other hand, when you hit bone, you can always pull the needle back a few millimeters, aspirate and if you get no blood return, inject the medication--that is what I have done. There are actually 23g needles that are only 5/8 inches long which we had in the nursing homes for these patients.

Ditto the previous poster, you don't have to stick the needle in the whole way...I've hit bone once or twice; the feel of it makes you cringe, doesn't it?

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