Why no IM injections??

LJR89 · Jan 18, 2016

My guess is because muscle is more vascularized, but I don't think I've ever been told about that before, interesting.

kistigirl84 · Jan 18, 2016

Yea, I'm confused by that

LJR89 · Jan 18, 2016

Yea, I'm confused by that

Confused by what?

NurseGirl525, ASN, RN · Jan 19, 2016

Because they can bleed to death. They are on bleeding precautions. Think about it, why can a person on bleeding precautions not shave with a regular razor? Think about what goes along with bleeding precautions.

kistigirl84 · Jan 19, 2016

I figured that but was confused as why IM injections were singled out. What about SQ or IV?

ScrappytheCoco · Jan 19, 2016

Think about the route. IV, SQ, and IM are all totally different when you get right down to it. Where is the needle when you give IM vs SQ?

IVRUS, BSN, RN · Jan 20, 2016

If you have a patient who has Thrombocytopenia, ALL needlesticks can become problematic.

Injections should be minimized whenever possible. If an injection is absolutely mandatory, the nurse MUST be observant to assess whether or not the normal blood clotting cascade is occurring. Remember, blood normally clots in 2-6 minutes. Platelets will form at the traumatized site and serotonin will be released causing spasms to occur and narrowing the blood vessel. Then a mesh of thrombocytes etc form to "plug" the injured area. But if Thrombocytes are low, then the whole blood clotting cascade is put into jeopardy.

So, if bleeding is occurring under the tissue, firm and immediate pressure should be applied for 10-15 minutes. Because the muscle is underneath the superficial fascia (SQ) it is harder to detect bleeding.

bgxyrnf, MSN, RN · Jan 20, 2016

I figured that but was confused as why IM injections were singled out. What about SQ or IV?

The subcutaneous tissue has minimal vasculature.

Once an IV is established, it's not an issue. Starting an IV on a patient on bleeding precautions *is* an issue but it's a matter of the benefit-to-risk ratio being high enough to warrant it. When doing so, one must be mindful of the risk of bleeding and choose the site carefully.

The other issue is that a hematoma within the muscle can expand for quite a long time before it's identified; if you miss an IV on a bleeder, you'll see the hematoma very quickly.

IVRUS, BSN, RN · Jan 20, 2016

The subcutaneous tissue has minimal vasculature.
Once an IV is established, it's not an issue. Starting an IV on a patient on bleeding precautions *is* an issue but it's a matter of the benefit-to-risk ratio being high enough to warrant it. When doing so, one must be mindful of the risk of bleeding and choose the site carefully.
The other issue is that a hematoma within the muscle can expand for quite a long time before it's identified; if you miss an IV on a bleeder, you'll see the hematoma very quickly.

Sorry, BUT the veins that are used for Venipunture are found in the SQ tissue. So, to say that it has little "vasculature" is incorrect.

bgxyrnf, MSN, RN · Jan 21, 2016

Sorry, BUT the veins that are used for Venipunture are found in the SQ tissue. So, to say that it has little "vasculature" is incorrect.

Sorry, BUT there is relatively little subcutaneous vasculature by comparison to the total volume of subcutaneous tissue.

Take a look with an ultrasound and see how few veins of any size there are.

IVRUS, BSN, RN · Jan 21, 2016

Sorry, BUT there is relatively little subcutaneous vasculature by comparison to the total volume of subcutaneous tissue.
Take a look with an ultrasound and see how few veins of any size there are.

Use US all the time... Vein anatomy is divided into three systems: Superficial ( In the Superficial Fascia ~ SQ) Deep (Which run alongside arteries) and Perforating veins which communicate between deep and superficial.

What you are seeing, in most cases, with the US is the deep veins, like the Brachial in the inner, upper arm. Superficial veins in the Subcutaneous tissue are numerous and everwhere.