Is it okay to give an IM through clothing?

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In the past I've had diabetic patients who injected themselves through their clothing. Is this ok with IM injections as well? In psych we have so many traumatized patients who are resistive to injection it seems more traumatic to expose a site than just go through the cloth. Doing it with alcohol wipes and saying "there will be a little prick" etc. is fine with cooperative people in a calm setting, but what is acceptable in crises?

In an absolute psychotic crisis, I think it would be acceptable to go through clothing to give the injection. I have never done this, but wouldn't rule it out in an extreme emergency. While it's poor practice and a risk for infection, you have to weigh the danger to staff/pt against the danger of infection.

In an ideal world, you would have plenty of staff to assist you in completely restraining the pt to allow time to remove clothing and expose a site. In the real world, it just doesn't always happen that way, especially in a small facility.

Don't forget in a perfect world, we're swiping the site with CHG and waiting for it to completely dry too!

I think the weighing the dangers is the important thing there. That's why we're paid the "big bucks" for our knowledge and experience.

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Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

Injecting through anything could cause an abcess, a small piece of fiber could be embedded in the flesh and this could cause a nasty infection.

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Specializes in Day program consultant DD/MR.

My aunt is a diabetic & always injects her insulin discreetly right at the table- she just lifts the bottom of her shirt or sleeve & gives it. Nobody in the restaurant ever seems to notice- the fact is other people just aren't THAT interested in other diners!! Call 911?? PULEEZE!!!! (not like she's sitting there holding a tourniquet on her arm injecting into a vein like some junkie!!!!) :chuckle

Gee sometimes I take my vitamins or an aspirin in a restaurant- I suppose I could be taking "illegal" drugs and some well meaning (aka psycho) nosey busybody could call 911........... not to mention how much emergency personnel LOVES to be called for NOTHING!!! Sheesh!! That IS a little far-fetched! (& that pipe you're smoking........ it could be illegal too!!) :chuckle

I worked ER admitting for 5 yrs you would be surprised at what calls 911 brings in. I had a few ppl excorted by the police via for things that turned out to be nothing at all. I did happen to have one person brought in by the police becuase they did administer insulin out in public, it was from a prefilled syringe they did not have the insulin bottle or prescription with them so the police brought them in for a drug screen.

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Specializes in Emergency, Case Management, Informatics.
Well you can quite discreetly inject under a table cloth in a restaurant just before your meal,straight through pants into leg and nobody is the wiser!

Couldn't the diabetic just as easily do the same thing by going underneath the bottom of their shirt and not opening themself up to infection? Again, it's just laziness.

If I met a nurse who treated him/herself with such disregard as to not even take proper precautions when giving themselves routine insulin injections several times a day, I don't think I would want them working with me, let alone taking care of me as a patient. :no:

Again, an emergency is one thing, but to practice with such carelessness in routine circumstances is just sheer stupidity. :twocents:

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I worked ER admitting for 5 yrs you would be surprised at what calls 911 brings in. I had a few ppl excorted by the police via for things that turned out to be nothing at all. I did happen to have one person brought in by the police becuase they did administer insulin out in public, it was from a prefilled syringe they did not have the insulin bottle or prescription with them so the police brought them in for a drug screen.

that is ludicrous! I worked a Level I trauma center for many yrs, and my husband was a police officer -- they got some crazy calls for sure, but I never saw anything like that brought in!!! (I suppose those types of calls might have been taken to a smaller hospital in the area?) I can't imagine being hauled out of a restaurant & drug tested! Can you say "lawsuit"??? (and who carries their prescription w/them??) My mother just carries her syringes & insulin when traveling and it's never even been questioned!! People certainly need to get a life! WOW. :no:

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An IM injection through clothing would be very poor technique- I find it hard to believe that anyone would actually do this! My mother is also an insulin dep. diabetic, and just injects at the table in restaurants. It's never been questioned, and as another poster said, I doubt anyone's even noticed. It would be very offensive & degrading to be hauled off for a drug test b/c of someone's ignorance too-- in fact, it's hard to imagine a policeman who wouldn't believe my neatly dressed articulate mom when questioned about her "illegal drug use"!! People really DO need to MYOB!! :twocents:

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Specializes in Day program consultant DD/MR.

that is ludicrous! I worked a Level I trauma center for many yrs, and my husband was a police officer -- they got some crazy calls for sure, but I never saw anything like that brought in!!! (I suppose those types of calls might have been taken to a smaller hospital in the area?) I can't imagine being hauled out of a restaurant & drug tested! Can you say "lawsuit"??? (and who carries their prescription w/them??) My mother just carries her syringes & insulin when traveling and it's never even been questioned!! People certainly need to get a life! WOW. :no:

I never said it was right. I just registered them. I think the police where in the wrong. I do know that the person was not taken into custody upon discharge, but not sure if a lawsuit was filed. This was not a trauma center, we only had 14 beds in er, so yes it was considered a smaller hospital. I agree there are ppl out there that that need to get a life and not call 911 for non-emergent reasons. But that is another thread in it of its self.

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Specializes in Med/Surg.

It's doubtful you could get more than a local infection by giving an injection through clothing unless you hit a vein, still the chances would be very very low. Think about how many nurses touch the patients skin after cleaning it with alcohol and then palpate the vein before inserting an IV. I've seen it a million times. I've also seen many nurses who miss the vein and use the same intercath to re-stick. I personally would never do it but it is done "all" the time.

However, I would never give an IM through clothing unless it was an epi-pen or some other medication that meant the difference between life and death. A sedative to a combative patient is not life or death.

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An Epi-Pen is the only injection acceptable to be given thru clothing.

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Specializes in Maternal - Child Health.

The manufacturer of the eip-pen indicates that it is acceptable to inject thru clothing in an emergency.

Other than an immediately life-threatening circumstance, such as a first-responder at an accident scene, I don't see any other situation where it would be acceptable to inject thru clothing.

Besides the infection-control issue, I don't know how one can accurately ID anatomic landmarks over clothing.

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Specializes in Emergency, Case Management, Informatics.

It seems as though I was wrong about my perceived increased risk of infection for diabetics injecting routinely through skin. This page cites a scientific study published in Diabetes Care that discovered the following in a test group of 50 participants:

Over the 20-week period, approximately 13,720 injections were performed by the participants. None of the subjects experienced erythema, induration, or abscess at injection sites. Neither the glycosylated hemoglobin levels nor the leucocyte count differed between the conventional or the experimental (through clothing) injection regimens. During the injection-through-clothing phase of the study, participants' logbooks recorded only minor problems, such as small bloodstains or bruising. Subjects reported that insulin injection through clothing offered benefits such as convenience and saving time.

I retract my previously ill-informed statement.

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It seems as though I was wrong about my perceived increased risk of infection for diabetics injecting routinely through skin. This page cites a scientific study published in Diabetes Care that discovered the following in a test group of 50 participants:

I retract my previously ill-informed statement.

I had no idea either.

Gosh, just seems like such a bad idea, huh?

Interesting.

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