Intramuscular injection technique tips

[dedicate]

Hi all! One of my Friends stated when giving an I'm injection to a patient- the arm seemed to pulsate once. (an area of the skin depressed in for a second). Why does this happen?

Also I'm starting flu clinics tomorrow. I don't shoot the needle in like a dart bc I get scared of it going all the way in. I just squeeze the muscle, put the needle in a 90 degree angle n inject. I feel I'd hurt the client if I shoot in like a dart- any suggestions?

[msjellybean]

Nothing to say really except on the dart vs the way you described method.

I've gotten IMs done both ways. Dart is faster and hurts less, IMO.

[NamasteNurse, BSN, RN]

dart is way faster and hurts way less. do it the way you were taught

[tyvin, BSN, RN]

By trial and error you will develop you own technique. I've hit bone with an small frail elderly person's deltoid once. Before you shoot look at the arm and access; is there much muscle, are they small etc...

I do the dart method as opposed to (I hate watching nurses do it this way) methodically pushing it straight in waiting; then withdraw, then slowly inject Ahhhhhhhhhhhhhhh! Distraction techniques and having your supplies not directly out in view or covered with a cloth are a couple of things that take practice. Small talk and making people feel at ease. It's generally not a good idea to prepare the injection in front of the person (turning your body to hide it in a flu clinic setting). It truly is an art form IMO.

Knowing where to inject is key for example many meds are only for deep muscle injections therefore not suitable for the deltoid. Know your meds.

[AgentBeast, MSN, RN]

Definitely fire that baby in there like a dart. I recently had vaccines injected in both deltoids and the nurse "darted" me. It didn't hurt one bit. Well other than the immune response after since, my left deltoid received a tetorifice vaccine.

[NoviceRN10]

I've never noticed the muscle pulsate after giving an injection? I always do the dart motion to get the needle in, and I don't squeeze the muscle, I push the skin taut.

[PedsAtHeart, LPN]

I think the pulsating might just be their muscle twitching. I have that happen every now and then. No biggy.

I do not dart. But I am not slow either. I get my needle right next to where I am going to give it and stick that sucker in. I never have complaints on my shots, I actually have people who will request me and will refuse a shot if I am not here to give it. I also have parents who refuse to let anyone but me give their child shots.

Just give it time, you will develop your own technique that you feel comfortable with. If you do not feel comfortable darting, then don't do it. In school we were forced to dart and I was scared to death to even give shots. Once I got out into the real world and started doing it how I felt comfortable, well... I give shots all day long now!

I will also say that I developed my technique while working 4 years in pediatrics. I don't think darting is ever appropriate in an infant or small child. If a nurse were to come at my child like that... well... it wouldn't be a pretty sight. Just me.

[MAISY, RN-ER, BSN, RN]

I give tons of injections, right needle for the size of deltoid is important. I will assume the dart method does not draw back? I landmark, ask the patient to relax their muscle then enter, draw back, then push. I usually have people tell me that it's the best "shot" they ever got. It isn't about speed, but finesse and proper technique.

M

[AgentBeast, MSN, RN]

The real skill to master is phlebotomy. I've had it done where it doesn't hurt nor do I get black and blue after, and I've also had it done where the nurse/phlebotomist had to poke around to find the MCV then left me black and blue after. Not that all skills aren't equally important, some just lend more to the "patient experience" than others.

[MeganG.James]

I just had a hep B booster because my titer was low before NS. The RN did my deltoid and hit a nerve, which caused my muscle to spasm. It hurt alot after. She didn't hit exactly in the center of the deltoid, which is why i think it happened.

Definitely dart! The needle just hurts when it is in. The faster it's in, the less time it's in, the less pain the patient will feel.

[mrmedical, ASN, BSN]

I just got my HepB updated an Tdap in my R and L arms and the lady who did mine was awesome. I made sure my muscles were relaxed, and she darted me and injected the vaccine. Could hardly feel it. Less time in the muscle the better. As long as they're not emaciated I don't see a reason not to dart them. It's not like your inserting the needle to the hub, so I unintentional intrathecal injection is rare.

I would even go as far to say don't even worry about aspirating in the deltoid in a healthy individual if you know your landmarks, because there is no major arterial supply on the lateral deltoid and the gauge of the needle is too small for serious concern of arterial infiltration.

Current evidenced based (CDC's on board with this) practice and IAC (immunization action coalition) actually suggest it is best practice NOT to aspirate for vaccinations: IAC Express Issue 891

[Akeos]

i agree with eveyone else, definatly dart, when i went to get the gardasil vaccine a few years ago the girl doing it went in super slow, then look at least 15-20 sec. to push the vaccine in, I was about to kick her it hurt soo bad.