Trying to give a less painful IM gluteal injection

[NurseBoy1983]

Hi. I'm in need of your help and experience. I am a recent nurse and i'm having difficulties in selecting the best method to give an IM gluteal injection.

Most of all my work collegues do this technique: they separate the needle from the siryngue and with the back of the hand they tap around 3 times de injection site; then in a quick movement they round the hand and dart with the needle. It seems the way the patient almost feels nothing but everytime i try to do it i cant have the sincronicity to tap-tap-tap-dart. and a pair of times the needle didn't stand perfectly in 90 degrees... When i search for this technique i don't see any text suporting this. Is this a common technique? Is it correct in terms of assepsia? this patients are used to the "beating" before darting. I personally think it would be easier for me if i do with the syringue and needle in one, without "beating" and rounding the hand . Can you help me?

Any of you know of any technique that reduces the pain? Usualy this patients ask for a standing position. Should i pinch, separate the skin? Is there a technique with wrist so i can dart more quickly? Please i need your help. Thank you very, very much.

[Maerzie]

I have never heard of separating the needle from the syringe. I usually just assess the site in the upper outer quadrant of the gluteus, spread the skin taut with your thumb and forefinger of your non-dominant hand, eye up your target spot, as you "dart" (holding the syringe securely) the needle of that syringe into your selected spot, aspirate for blood, and if none, inject the medicine at the most comfortable rate suggested in the flyer. The insertion is less painful when it's done instantaneously. Hesitating/going slowly for injection is more painful. Sometimes the medicine itself is painful, so slowly injecting helps a little.

[Trixie13, BSN, RN]

Aside from the "dart" technique others mention, I ask a question and administer the injection while they are answering. Works like a charm--even on dramatic teenagers.

[matthdrn]

I've had clients tell me sometimes it is just the medicine that hurts. People have told me that risperdal IM's hurt the most.

[quazar]

The oddest thing I learned after being a patient who had to receive a very thick, viscous med as an IM injection was that a small gauge needle works wonders. My nurse used a 1.25 inch 25 ga. needle to give me the injection in my ventrogluteal (also my injection site of choice), and I am telling you, it worked wonders. I had been using a 19 ga. because of the viscosity of the medication, thinking faster was better, but I'm telling you, that teeny tiny needle was great. I stole her idea and ever since my patients don't complain when I give that particular injection.

I also hold the skin tight, dart, and use the ventrogluteal whenever possible.

[RestlessHeart]

I've given myself lots of IM injections. They hurt least when they're fast, steady and straight (sometimes difficult when you're self administering). It's also best to let the alcohol dry completely before piercing the skin. I have no technique beyond that, and patients frequently tell me that my IM injections are pleasant compared to other people's.

I too have given myself many many IM injections. I believe the single most painful medicine for injection is Phenergan. OMGunness, that stuff burns to he!! and back. The last run I had with that stuff was when I had to mix it with Demerol (might have been Nubain, it was a long time ago)

Ive had 31 surgeries over the last 25 years or so and Ive had lots of pain meds....almost always given with Phenergan or Compazine (I throw up a LOT when Im in severe pain). I have come to hate the injections and will do whatever I can dream up to avoid them.

I had one RN many years ago who was a super person, woman, Mom, Friend, et al and she gave the most awesome PAINLESS shots...even with Phenergan included. Im a big ol' girl and have extra padding we'll say Anyway, this Nurse would have me lay flat on my back, legs out straight....then she'd tell me to roll only my hips ever so slightly and she alcohol the spot on my ...I dont know what you Nurses call it....its in the crease of the leg where the "panty line" is...right smack on that crease if you were to bend there. It never mattered what the injection was for...I never felt it. She was such a sweetheart and from that day on, if I needed a shot for pain, the nurse would always ask where I wanted it and Id show her and she'd smile and ask who taught me that.

Anyway Ladies and Gents...keep up the good work, keep caring for your patients in all the ways you'd want to be cared for. You're a treasure that not enough people are aware of and you're way underpaid and "under-cared" for and about. But some of us who are "frequent" fliers in some of your hospitals and clinics care a lot and would do anything to make your job / life easier.

Have an awesome rest of the week and weekend.