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?

Specializes in NICU.
It seems as though I was wrong about my perceived increased risk of infection for diabetics injecting routinely through skin.

Sorry....that just made me giggle. I totally know what you meant to say, but :chuckle.

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Specializes in Med/Surg.
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'm glad to know I was right, thanks for the information :nurse:

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Specializes in ER, ICU, Infusion, peds, 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:

i retract my previously ill-informed statement.

i wonder about the characteristics of that population.

it takes a certain amount of responsibility to participate in most research studies like this (where the patient is at home, and has to do something consistently, and record it). it really isn't easy to do -- i know, i participated in the side effect trials for allegra when i was in college. it is frankly a pain in the butt to keep that "side effect diary" every day.

outside of the hospital, there is a certain "self-selection" in patients that choose to participate in medical research. you aren't going to sign someone up for a study if you don't think they will be capable of following the rules/guidelines.

what i'm getting at is that the patients in that study were probably ones that take their insulin on a regular basis, work at keeping their blood sugars under control, and bathe/wash their clothes regularly.

they probably aren't the ones that tend to have diabetic complications -- amputations, etc.

i wonder if the study would get different results if they used the non-compliant patients. they are probably at higher risk of infection because of higher blood sugars. but then, how would you ever study this population?

it is kind of like teaching diabetics to re-use insulin needles. ok for certain people -- those who can maintain "clean" technique. others really need to get a new needle each time.

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Specializes in district nurse, ccu, geriatric.

I would agree with critterlover, I have searched the web and have found countless articles and extracts that support the research that has been cited by DonaldJ, however, every single one of these articles have also cited the exact same research that DonaldJ has. The problem I have with this study is the population used, (age 23-63), totally omitting elderly and young children, who can be non-compliant. A population of 50 people is very small for a study like this, and it was pointed out that of this 50 people, only 42 finished the study. I could not find any article that had updated this study since 1997 when it was originally conducted. Not very current, and a very biased study.

The diabetic population, especially the elderly, are more prone to infections and not knowing the hygiene practices of my clients, I would never inject through the clothes.

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Specializes in Urology.

u know it's not ok...plus, it's not that hard to pull off your clothing in an emergency situation..you just need to do it right even in an emergency situation.

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i wonder if the study would get different results if they used the non-compliant patients. they are probably at higher risk of infection because of higher blood sugars. but then, how would you ever study this population?

but if it was something that made things easier for them, as said above it's easier for some diabetics to inject through the clothes, then maybe they'd be more compliant. the less compliant a person is, the easier we should try to make it for them to be compliant. then they can be more compliant, have more stable blood sugars, and be less at risk for infection.

i think insulin needles and im needles are entirely different though. insulin needles are so tiny, they're unlikely to break off fibers of fabric (they're instead going to bend between them), and there's so little surface area to carry germs on before it breaks the skin in such a small spot. im needles are big enough they could actually take part of the fabric with them, they're making a bigger and deeper injection. if it's a wild enough patient, i could see it possibly being worth the risk in certain situations. not a routine habit i'd get into though like i think is safe for diabetics with their insulin needles.

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Specializes in med/surg, snf, some psych.

expose skin... skin...skin....unless you can tell that if you take time taking clothing off will cause death, then i guess you could go through a thin layer of clothing, other than that expose that epidermis.

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NO ! Hi risk of infection, no site visulization, never OK . ( the only exception I can possibly think of is in the military (antidote) injections, or epi injections.

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I guess I'm not creative, but it would have never occurred to me to give a shot through clothing. Come to think of it, though, it sounds like bad practice.

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No, you cannot give an IM through clothing.

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Specializes in Oncology.

I injected through my clothing countless times when I took insulin shots. I also never used alcohol for injections or fingersticks, licked my fingers to stop the bleeding, and reused syringes and lancets endlessly.

As for bathrooms- ewww, gross. As for privacy and worrying about people thinking your a drug addict? Yeah, got over that after my 100th injection or so. As for laziness, try exposing any area in a dress.

That being said, I would never do any of those things in practice as a nurse. I know they're wrong. It's a mild risk in my opinion, and one I'm willing to take with myself (also knowing I have a perfectly fine immune system) but one I would NOT be willing to take with someone else.

In an emergency situation where exposing a site would truly delay urgent treatment, I would probably inject through clothes, but definitely not on a regular basis.

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No, it's not acceptable.

The only IM that comes to mind where seconds matter that much is for an Epi-Pen. And that's it. It only takes seconds to bare a bit of skin for any other IM, when it can be swiped fast with alcohol and a site can be found. Even if you're skipping that alcohol because of the immediacy of the crisis (going with that), there's no reason to drag lord-knows-what into an injection site by taking whatever's on or in the clothing into it.

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