Subcutaneous and IM injections.

OB-nurse2013, BSN, RN · Jul 13, 2012

Well I don't think I've ever worried about this. I mean we were taught if you're giving a subq, then you use common sense. If its a skinny person (where maybe this could happen) then you pinch and change your angle so you're not going 90 degrees. You can always use an even shorter needle too. I think its all about judgement. I had a pt. once that literaly ahd no fat so it was very difficult but I did it, carefully. I've had very overweight patients where I barely had to pinch if at all.

KatePasa · Jul 13, 2012

You can also decrease the angle of the injection. Instead of popping it in at 90 degrees, you can decrease the angle to 45 degrees.

Capp · Jul 13, 2012

Yeah, I always pinch an inch so I'm sure there's not much chance of going into the muscle. It's just that I've never really worried about it before, and now I'm realizing it's a possibility.

I guess it's not much of a worry. One of the two mentions of this was somebody that put heparin in the deltoid so they obviously didn't know what they were doing.

KelRN215, BSN, RN · Jul 13, 2012

Yeah, I always pinch an inch so I'm sure there's not much chance of going into the muscle. It's just that I've never really worried about it before, and now I'm realizing it's a possibility.
I guess it's not much of a worry. One of the two mentions of this was somebody that put heparin in the deltoid so they obviously didn't know what they were doing.

If you are injecting in the correct spot, you should not "accidentally" end up in the muscle. Subq injections in the arm are given in the back of the arm, not near the deltoid at all. Subq injections- other than insulin and heparin which I believe are supposed to be given at 90 degrees- are given at a 45 degree angle. Subcutaneous injections in the thigh are given in the upper thigh whereas to hit the vastus lateralis or rectus femoris, you'd be in the middle 1/3rd of the thigh. The size of a needle you use for subq is also about 1/2 the size of an IM needle. With the correct angle and the correct needle, accidentally giving a subq shot IM shouldn't be a worry. I can't say it's something I've ever worried about and I've been giving subq medications for a long time....

Rogana · Mar 14, 2018

I am a very cautious and careful person. I'm a perfectionist and I'm a but obsessive. That's why it was so difficult for me when I did accidentally inject an allergy shot into the muscle on one patient. I have been giving these for 2.5 years and it's never happened before. I didn't realize it could happen, because I'm so careful. It was on a school aged child who had virtually no fat. I pinched an inch but it didn't seem to work thats time. It was 1/2 a CC which already seems like a lot. It didn't all go in the muscle, because once I started to inject, I realized what happened so I backed out. She said it felt like it went in the muscle and that confirmed my suspicion. I reported it to my physician right away. I feel so bad, because I know it had to hurt. I was informed that it'll make them a bit more sure, but won't ultimately cause any problems.

Though I am very disappointed in myself, I'm not going to let it stop me from doing my job. Instead, I'm using this as a "learn from my own mistakes" experience. Its extremely unlikely it would ever happen again, but just to be sure, I phoned the ENT office who provides the medication and asked for additiinal training on how to prevent it in the future. They happily obliged.

OhioBPH · Mar 14, 2018

In my expeince any time this happens its due to lack of knowledge about the proper placement of the injection, not an accedent due to slightly flawed technique. For example, subq vaccines given in the deltoid are due to not knowing which should be given subq or giving the wrong vaccine at the wrong site, not a bad job injecting into the subq area on the back of the arm.

My best advice for preventing this is to slow down. Know what you are doing and how to do it and be focused.