questions about IM injections

[IngyRN]

I know the usual needle length for IM is 1-1 1/2 inch needle. I was taught in NS to hold skin taut ( ?sp), inject at 90 degree angle, withrdraw to assure no blood return, if no blood return>inject medication.

2 questions>

what if you inject and the needle is long enough that part of it is still outside the skin-obviously it is deep in the muscle, but can it be too deep or too close to bone???

When injecting into deltoid, specifically flu vaccine, I see that some actually pinch the skin instead of holding taut-is this a new technique?

Thanks

[TopazLover, BSN, RN]

There are times when the needle can hit the bone. Pick the size needle for the size pt. Many elders have no fat to go through. In those cases you might use shorter needle same as you do with infants. I may be wrong but I think there is no- too far into muscle- as long as it is in muscle.

[MadisonsMomRN, BSN, RN]

There are times when the needle can hit the bone. Pick the size needle for the size pt. Many elders have no fat to go through. In those cases you might use shorter needle same as you do with infants. I may be wrong but I think there is no- too far into muscle- as long as it is in muscle.

I agree. This is what I do.

As far as pinching (grabbing a pretty good size area) ... I do this when I give an IM injection. This is what I learned in NS. I can't remember the rationale but I have heard comments from the patient that pinching the area makes it hurt less.

[Bean79]

I know the usual needle length for IM is 1-1 1/2 inch needle. I was taught in NS to hold skin taut ( ?sp), inject at 90 degree angle, withrdraw to assure no blood return, if no blood return>inject medication.

2 questions>

what if you inject and the needle is long enough that part of it is still outside the skin-obviously it is deep in the muscle, but can it be too deep or too close to bone???

When injecting into deltoid, specifically flu vaccine, I see that some actually pinch the skin instead of holding taut-is this a new technique?

Thanks

From what I understand you are supposed to pinch or hold the deltoid muscle when giving an IM injection. In a sense you are isolating muscle and pulling it away from the bone. Less risk of hitting bone this way. The only site I have learned where you hold the skin taut are IM injections in the Gluteal muscles. Granted I am not a nurse yet (working on it) but an RMA but this portion of my course was taght by an RN. So this is what I was taught and they way I was graded in clinicals. Even on my recent yearly competency test at the hospital I work, the review materials were written this way. Hope this helps.

[ShiftyRN]

Recently I started a new job in a clinic and was rusty in the IM department, so I found this:

http://www.cdc.gov/vaccines/Pubs/pinkbook/downloads/appendices/D/vacc_admin.pdf

Scroll down past page 9 and you will see the paragraph about bunching for geriatric and pediatric patients.

Or, you can Google "IM injection techniques."

[smstar1996]

I was shown to hold skin taunt when giving IM. However I was getting my tetnus booster and the nurse was intermittenly squeezing and releasing real fast while injecting. She said by doing this it is less pain after and less bruising. Sure enough, no bruise but sore.

[Turtle in scrubs]

hmmm.... I haven't heard anyone out there mention the z-track technique. The concept is by moving the skin to one side prior to inserting the needle, injecting (attempting to aspirate first), then releasing the skin so that the intact tissue goes over the injected muscle, this will seal medication into the muscle. This is what I was taught in NS, but find that few nurses actually do this.

A few times I have hit bone. It makes the hair on the back of my neck stand up, but I've never had a patient seem to even notice. I just draw back a tiny bit to make sure I'm in the muscle, and then inject. :wink2:

[MadisonsMomRN, BSN, RN]

hmmm.... I haven't heard anyone out there mention the z-track technique. The concept is by moving the skin to one side prior to inserting the needle, injecting (attempting to aspirate first), then releasing the skin so that the intact tissue goes over the injected muscle, this will seal medication into the muscle. This is what I was taught in NS, but find that few nurses actually do this.

A few times I have hit bone. It makes the hair on the back of my neck stand up, but I've never had a patient seem to even notice. I just draw back a tiny bit to make sure I'm in the muscle, and then inject. :wink2:

Its funny you mention the z-track technique... I thought about that when I first read this thread. I have done that a few times too. I had to do Rocephin shots (for 7 days!!!) on this older lady (98 yrs) and I was thinking "yea right... where is the muscle" She was in assisted living because that is where the family wanted her, where she wanted to be, and we ALL loved her... anyway. I put it in her gluts... using the z-track. We mixed it with lidocaine which seemed to help a little I guess (Rocephin is hard to push... its THICK) The first injection was not ztrack and more than enough leaked out... so we used the z-track and it did the trick!

[rubystar]

I was taught to always z-track an IM. At no time have I been taught to pinch anything and my school seems to pride itself on being up to date with best practice. They're loving their ventro-gluteal site for IM, followed by gluteal and the thigh related ones but deltoid I believe we just brushed over because it's not a very good site.

[MadisonsMomRN, BSN, RN]

Our school taught us the z track too. I use the pinch with the deltoid mainly.