IM injections!

[smiler2010]

Hi guys!

I have began having to give a lot of IM injections, I am now giving Depo and vaccines. The other day when I gave an IM injection in a patient's deltoid I could feel that the needle wasn't advancing as easily and she said "Ouch, I think you hit a nerve", this has never happened to me before? Can the nurse feel when he/she hits a nerve? Or could it possibly be a tendon or something? This patient was very thin so I tried not to advance it as far as I would have a heavier patient but I wanted to make sure that I advanced it far enough that it would get into the muscle well. Any advice and/or information would be much appreciated.

Thanks!

[Whispera, MSN, RN]

I'm thinking you could pierce or nick a nerve and wouldn't know it. I think you would feel it when you hit ligament, tendon, or bone.

In a very thin patient, if you're using the deltoid for an IM, it's important to scrunch up the deltoid with your other hand so you have enough tissue to inject into. It's easy to hit bone in a thin person's deltoid. Also, use a shorter needle. Or don't push as much of the needle into the site (you did this). While deltoid is the recommended site for many IMs, in a thin person, another site might be better.

[Airidis]

Whispera, I know your in the states and I dont know how to tell where the first poster is from, but best practice guidelines in Canada call for you to pull the skin taunt not scrunch when giving an IM injection..... But I do agree with a shorter needle with thin people

[Tait, MSN, RN]

I think if you hit a nerve the patient wouldn't have simply said "ouch I think you hit a nerve", pretty sure they would have flown off the bed/chair/table.

[Whispera, MSN, RN]

I understand about pulling the skin taut for in IM. However, if the patient is extremely skinny, that just flattens out the little bit of muscle that's there. When I said scrunch, I didn't mean just scrunch the skin. I mean kind of grab the whole muscle so it's a package of skin and muscle between the fingers, so it's kind of lifted from the bone. Then inject deeply into the package. All this is if there's not a shorter needle available or I'm worried I'd be unable to avoid pushing an entire long needle in.

[nursinmama921]

I agree with using a shorter needle with very thin patients if they are available to you. I also believe that depo shots are given in the dorsogluteal area. There are some major nerves that run through your buttocks including the sciatic nerve. To avoid hitting a nerve in this area visually divide the gluteal area (one butt cheek) into 4 equal quadrants. Be sure to only give the injection in the upper outer quadrant to avoid any nerves. But I agree with the above posts in saying that if you hit a nerve they would be flying out of their skin!!

[demylenated, BSN, RN]

JUST and FYI!!! The Dorsogluteal is NOT being taught starting with this years fundamentals books. SOME states have already made it an "illegal" spot due to the sciatic nerve. So, the quarter division should NOT be used!! Now, the best "buttocks" place to give an IM is the ventrogluteal (hip). That is the hand on the greater trochanter, a "V" with fingers, and inject within the "V".

CHECK you protocols and state statutes!!!! Being changed very quickly and THIS YEAR!

I agree with using a shorter needle with very thin patients if they are available to you. I also believe that depo shots are given in the dorsogluteal area. There are some major nerves that run through your buttocks including the sciatic nerve. To avoid hitting a nerve in this area visually divide the gluteal area (one butt cheek) into 4 equal quadrants. Be sure to only give the injection in the upper outer quadrant to avoid any nerves. But I agree with the above posts in saying that if you hit a nerve they would be flying out of their skin!!