IM injections

Boog'sCRRN246, RN · Nov 16, 2009

I was taught to "pinch" for an IM, except in the case of a Z-track injection. which displaces the skin in order to seal the injection so the medication doesn't leak back out or get into surrounding tissue. I don't pinch for a subQ.

KungFuFtr · Nov 16, 2009

When doing an IM don't pinch. Why would you? Pinches are for subq injections. You want the fat concentrated that's why you do I WIDE pinch. You're more likely to get a needle stick (in yourself) if you do a skinny pinch with a subq.

systoly · Nov 16, 2009

The objective is to get the medication into the belly of the muscle. Pinching subcutaneous tissue is therefore not indicated. I've observed the muscle (deltoid) itself being squeezed or pinched, if you will, in an effort to locate the site, however, that is not the appropriate method for locating the injection site. In LTC, dealing with atrophic tissue, I prefer the ventrogluteal site. Unless contraindicated (eg. hep c), this site is less likely to cause pain and can hold more volume as might be necessary when giving Rocephin.

Little Panda RN, ASN, RN · Nov 16, 2009

Never heard of pinching for an IM. In school we were taught to pinch for subq and skin taut for IM. Subq 45 degree angle and IM 90 degree angle. "Anywhoo that is how I was taught".

Fernanda88 · Nov 16, 2009

For me to do an IM injection corecctly you doesn't have to pinch the skin. You only have to hold firm the arm to locate deltoid and then put the injection and aspirate only to confirm that you didn't touch a vein.

meadow85 · Nov 16, 2009

I pinch because the needle is long and I had a bad experience during my first IM injection when the needle actually touched bone.

systoly · Nov 16, 2009

I pinch because the needle is long and I had a bad experience during my first IM injection when the needle actually touched bone.

I know, especially in LTC, you don't always have your choice of needles, but you don't have to bury the needle to the hub. Try to just bury enough needle to get deep into the muscle without going too far.

littleneoRN · Nov 16, 2009

I pinch because the needle is long and I had a bad experience during my first IM injection when the needle actually touched bone.

Working with the small population I do, I have hit bone on more than one occasion. I have been told that the patient should not feel anything different if you hit bone, just to pull back before injecting. (I don't know this from personal experience being on the receiving end). I have not witnessed any different reaction from my patients. And like another poster said, if the needle is long, just know not to bury the needle. Pinching gathers subcutaneous tissue, decreasing the likelihood you are truly in the muscle. Our facility also teaches that it is no longer necessary to aspirate prior to an injection as this does not actually tell you anything. Our policy says you are allowed to do it if you prefer, but there is no known benefit and it is NOT required or recommended. Of course, in nursing school we were taught otherwise. I Z-track all of my IM injections for two reasons. One is the original purpose of the Z-track, to keep the medicine from leaking back out. Two, because with my small patients, it keeps the leg and muscle in place for good aim.

NeecyBSN_RN · Nov 16, 2009

I am only in my first semester of nursing school, but we learned to pinch subq and pull taut for IM. I have since given approximately 100 H1N1 vaccines IM and have NEVER pinched when doing so. We have been taught to aspirate as well. Hope this helps!!

DuluthMike · Nov 16, 2009

The only time I pinch is to give IM to newborns. In this case you must pinch to get the muscle in-between thumb and index finger to insure a muscle stick.

nurseiam08 · Nov 17, 2009

An RN at the MD's office taught me to grasp firmly the deltoid muscle and pull it "away from the bone" while injecting into the muscle. She was a seasoned nurse. That's not the technique I was taught in school. Maybe that's an old-school way?