Injection in buttocks: 1" vs. 1 1/2" needle

In a small person with little padding for an IM injection I'd opt for a 1 inch needle (elderly, child). In those with extra padding, I'd go for 1 1/2 inch. If there is more tissue, you have to make sure you get through it into the muscle, so a bigger person will need a longer needle.

In the deltoid muscle I think that 1 inch is probably sufficient. It all depends on where you're sticking. As to giving phenergan in the arm....I don't think I'd opt for that as phenergan has some nasty side effects. But maybe I'm wrong. I don't give shots all that often, and I wouldn't argue with a nurse who's been a nurse for 30 years :)

tencat said:

In a small person with little padding for an IM injection I'd opt for a 1 inch needle (elderly, child). In those with extra padding, I'd go for 1 1/2 inch. If there is more tissue, you have to make sure you get through it into the muscle, so a bigger person will need a longer needle.

Suddenly, I am inspired to lose a few pounds...

I, too, am one who needs a longer needle, especially if I'm getting shot in the rear-end :)

I believe that Promethazine is supposed to be given deep in a sturdy muscle (your long needle). Your supposed to avoid SC due to pot. tissue damage.

azilliRN said:

Last week I had to give a Phenergan injection to a dehydrated patient who came into our clinic for an office visit (I work in Family Practice). I started her IV and once she was settled I gave her anti-nausea medication in her bottom using a 1" needle. Another nurse (20 year verteran) who was working with me told I should have used a 1 and half inch needle instead of a one inch needle. :uhoh21:Then yet another nurse (30+) told me I should have given injection in the arm with 1 inch. Who is right? Please help!

phenergan, i'd want deep muscle so deltoid would be out.

however, deltoid should be absolutely fine with 1" needle.

as tencat said, kids and (frail) elderly should be fine with 1" as well, with 1.5" being reserved for those with an 'abundance" of adipose tissue.:)

bottom line is, it's supposed to be a nsg judgment re length and site.

leslie

leslie ? said:

phenergan, i'd want deep muscle so deltoid would be out.

however, deltoid should be absolutely fine with 1" needle.

as tencat said, kids and (frail) elderly should be fine with 1" as well, with 1.5" being reserved for those with an 'abundance" of adipose tissue.:)

bottom line is, it's supposed to be a nsg judgment re length and site.

leslie

I was just about to say the same thing. I had some abd surgery a few years ago and somebody in OR or RR gave me some Phenergan in the top of my right thigh. My incision didn't hurt as bad as that leg did! And it continued to hurt for almost 6 months!

I have always used 1-1/2" needles for gluteal injections, unless the person receiving it is very small or has underdeveloped muscles.

Yes to all, you have to use your eyes and common sense, thinner patients, 1 inch; medium to heavier patients 1-1/2 inch. Maybe even really obese, 2 inch (do they make them?)

Agree with all of the above advice re: site and decision making re: length of needle. My question is -- why didn't you just give the phenergan IV if you had to put one in (assumably for fluids?) Is this not allowed in a clinic setting?

CNL2B said:

Agree with all of the above advice re: site and decision making re: length of needle. My question is -- why didn't you just give the phenergan IV if you had to put one in (assumably for fluids?) Is this not allowed in a clinic setting?

Phenergan is a vesicant, many facilities are moving towards administering it through central lines only. It is very harsh on veins and can cause tissue damage/necrosis, to be honest I have never seen it given IM, would imagine it to be very painful.

P.S. Personally I never give gluteal injections. There are easier, safer, less painful, more dignified places to give injections.

Asystole RN said:

Phenergan is a vesicant, many facilities are moving towards administering it through central lines only. It is very harsh on veins and can cause tissue damage/necrosis, to be honest I have never seen it given IM, would imagine it to be very painful.

P.S. Personally I never give gluteal injections. There are easier, safer, less painful, more dignified places to give injections.

Hmmmm....by that rationale, I am not sure why it would be given IM at all, unless it's just old practice. Seems to me like diluted in a 50cc bag and given in a large bore IV along with the fluids would be the way to go. IDK, interesting.

Wow. Those were some icky pictures.

I guess I'm not sure how IM would be any better --- to have THAT directly into muscle?

I don't remember the last time I gave phenergan...it's definitely been awhile, and was likely central as most of my patients where I work have central lines. Our docs seem to prefer other drugs for nausea (perhaps for this reason?)