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 transport,forensics,ED.

"Back in the Day".... When I worked in a busy ED in the hayday of PCP this was common practice with combative patients. Routinely we had 4-5 people lying on top of patients to hold them down for the administration of medication. Through clothing was the safest means of administration for the staff, police, and guards involved. These pt's were moving targets to start with. The safety of myself and fellow staff took precedent and I have no qualms about this. (NEVER heard of a negative consequence)

My brother-in-law is a military medic. They are trained to inject through clothing. Life first.

Back to today. Do I do it now? No. But I can't say I wouldn't in a staff safety situation. As for pt need, I have scissors and know how to use them. I can expose a spot rapidly and if time is that critical I'm cutting off clothes anyway.

It is situation dependent, and as trained medical providers we must utilize critical thinking. There are few black and whites in medicine.

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Specializes in Emergency, Case Management, Informatics.

Since there are so many people who are flat-out saying that it is not okay to inject IM through clothing under any circumstances (outside of epi-pens), I just did a quick Google search and found a notation under a drug info/protocol sheet for Naloxone (Narcan) published by NHS of Greater Glasgow:

http://www.glasgow.gov.uk/NR/rdonlyres/52C950FA-32FE-45FF-BDF9-D4388175943D/0/GASNaloxoneInjection.pdf

It specifically states "Intramuscular injection into the outer thigh. May be

administered through clothing if necessary".

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Specializes in Day program consultant DD/MR.
Since there are so many people who are flat-out saying that it is not okay to inject IM through clothing under any circumstances (outside of epi-pens), I just did a quick Google search and found a notation under a drug info/protocol sheet for Naloxone (Narcan) published by NHS of Greater Glasgow:

http://www.glasgow.gov.uk/NR/rdonlyres/52C950FA-32FE-45FF-BDF9-D4388175943D/0/GASNaloxoneInjection.pdf

It specifically states "Intramuscular injection into the outer thigh. May be

administered through clothing if necessary".

Key word in the above statement is necessary..... Most have stated in an emergent situation or for saftey reasons then they would administer through clothing. From the OP it was my understanding that they wanted to know if im injections could be done through clothing more on a routine basis not an emergent situation.

p.s I know OP was referring to psych pt's, but again not all are emergent situations.

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Since there are so many people who are flat-out saying that it is not okay to inject IM through clothing under any circumstances (outside of epi-pens), I just did a quick Google search and found a notation under a drug info/protocol sheet for Naloxone (Narcan) published by NHS of Greater Glasgow:

http://www.glasgow.gov.uk/NR/rdonlyres/52C950FA-32FE-45FF-BDF9-D4388175943D/0/GASNaloxoneInjection.pdf

It specifically states "Intramuscular injection into the outer thigh. May be

administered through clothing if necessary".

Ah, but Narcan is a 'life-or-death' drug just as the epinephrine in an Epi-Pen is. So that yes, those of us saying "Epi-Pen only" would say, "ok, and of course Narcan too".

It's one thing for it to be a matter of someone DYING if they don't get that med that instant through denim if absolutely necessary. It's quite another for it to be administered that way for sheer convenience, or because they don't want to deal with an unruly patient. The infection to follow won't matter if they're dead.

Good practice still holds: get the fabric moved, get the IM through skin only, not a cotton/poly blend.

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I have never gave an injection through clothing and would hope that no one else would, unless it was a life or death situation.

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Specializes in Emergency, Case Management, Informatics.

Who decides what a life or death situation is? IM Ativan and Haldol can be the difference between life or death if your pt is on a psychotic rampage. Don't try to backpedal and say, "Well, Narcan is one of those emergency drugs like Epi". Before, you all were saying Epi was designed specifically to be used through clothing in an emergency. Well, Narcan is not. So, what is the criteria?

I don't think that the OP was saying that they were interested in doing IM through the clothes as a routine procedure. In fact, by the OP saying the following, I think we're talking about serious psych issues:

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.

Now, I know a lot of you may not have any real psych experience besides the occasional 90-year-old Alzheimer's patient in your nursing home telling you she hasn't eaten in 3 days and threatening to smack you around. But, some of us have been presented with some real life or death scenarios in psych, and the potential for complications from injecting through clothing is heavily outweighed by the potential for a patient putting a fire extinguisher through your skull.

Nursing school should have taught you a little in the realm of critical thinking. Let's try to use that. :rolleyes:

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Nursing school should have taught you a little in the realm of critical thinking. Let's try to use that. :rolleyes:

And Life should have taught you how avoid antagonizing others with unnecessary rudeness. Let's try to use that.

I was not "backpedaling", I was clarifying. I still stand by what I said. You will do what you think is prudent, as will I.

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Specializes in Day program consultant DD/MR.

A tramatized pt is not one that is facing life or death. And I think talking to them calm and explaining what you are going to do is alot better that coming at them with syring in hand and giving an IM injection through thier clothing...... That should help them alot when the drugs wear off....... They will be even more tramatized and terrified when anyone walks into the room.

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A tramatized pt is not one that is facing life or death. And I think talking to them calm and explaining what you are going to do is alot better that coming at them with syring in hand and giving an IM injection through thier clothing...... That should help them alot when the drugs wear off....... They will be even more tramatized and terrified when anyone walks into the room.

I think the OP's idea of a psych emergency and your idea (and apparently a lot of people posting here) of a psych emergency are very different things. If talking calmly and explaining what they were going to do would work, it wouldn't require a take down team to hold them down. And going through clothing wouldn't be an issue to even think about. We're talking getting a group of big strong people specially trained in take downs to hold the patient down here. Not "I need a second nurse to hold their arm."

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Specializes in Day program consultant DD/MR.
I think the OP's idea of a psych emergency and your idea (and apparently a lot of people posting here) of a psych emergency are very different things. If talking calmly and explaining what they were going to do would work, it wouldn't require a take down team to hold them down. And going through clothing wouldn't be an issue to even think about. We're talking getting a group of big strong people specially trained in take downs to hold the patient down here. Not "I need a second nurse to hold their arm."

The original poster says nothing of requiring a "take down" I have seen many of them. I worked at a hospital that at least 10 people were brought in through the ER on 5150 holds per day as well as many being escorted vial the police needing PET evaluations. I have been through all to many code grey's. NONE required injections through clothes. The mention of the "take down" was by another poster, and if that particular situation escalated and required injection through clothing then so be it(case by case basis), but it should not be the norm. Even in a psych facility IMO if that is happening they need to look at thier policies and procedure again.

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Specializes in Emergency, Case Management, Informatics.
And Life should have taught you how avoid antagonizing others with unnecessary rudeness. Let's try to use that.

If you think that what I said was "antagonizing" and "unnecessary rudeness", you have a hard life ahead of you.

I was not "backpedaling", I was clarifying.

Riiiight. :rolleyes:

A tramatized pt is not one that is facing life or death. And I think talking to them calm and explaining what you are going to do is alot better...

LOL. If talking to a severely delusional schizophrenic who thinks you are a demon trying to carry him off to Hell would work, we wouldn't need Haldol. If you haven't worked true psych, then you have no idea.

Also, when talking about "life and death", I'm not just talking about the patient. When dealing with a psychotic patient, staff safety comes first.

And just to repeat myself, I have never injected through clothing and definitely don't believe it should be a common practice. But for anyone to say that they would *never* consider doing it r/t risk for infection shows that they lack basic logic and problem-solving skills.

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Specializes in Day program consultant DD/MR.

lol. if talking to a severely delusional schizophrenic who thinks you are a demon trying to carry him off to hell would work, we wouldn't need haldol. if you haven't worked true psych, then you have no idea.

op stated tramatized pt, not delusional schizophrenic......... no i have not worked in a true psych ward, but have seen all to much of psych (see myprev post).

also, when talking about "life and death", i'm not just talking about the patient. when dealing with a psychotic patient, staff safety comes first.

every situation is different and should be treated as such, once again op didn't say psychotic patient.

and just to repeat myself, i have never injected through clothing and definitely don't believe it should be a common practice. but for anyone to say that they would *never* consider doing it r/t risk for infection shows that they lack basic logic and problem-solving skills. i 100% agreen with this. each situation needs different logic and problem solving.

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