NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. The needle should enter the triangles center. If you take one or more of these, a member of your health care team can tell you how and when to stop taking them before the procedure. Heres What That Means, What to Know About Afluria (Influenza Vaccine) Jet Injector, An Overview of the Moderna COVID-19 Vaccine, Epidural Steroid Injections for Back Pain, Monoclonal Antibodies for Arthritis and Other Diseases, Injection site that is tender to the touch, Coughing, wheezing, and shortness of breath, A blueish tinge to the lips, fingers, or toes (. If person has a . Veins that respond to treatment generally don't come back. When in doubt about whether or not to report an event, the best decision is usually to report it and keep an accurate record of all patients who are experiencing the same type of AE. Most adults will require a 1-inch needle, but the exact size depends on the persons weight. Verywell Health's content is for informational and educational purposes only. Withdraw the needle quickly and discard it into a puncture-resistant sharps container. muscle fibrosis, or scarring of muscle tissue, hematoma, where blood seeps out of blood vessels into the surrounding tissue, redness, swelling, or warmth at the injection site, signs of an allergic reaction, such as swelling or breathing problems. To avoid stinging, ensure the alcohol dries completely. At the bottom of the two fingers will be an upside-down triangle. Apply a plaster or wound pad to the area if there is any bleeding. In addition to VAERS, health care providers should familiarize themselves with the National Vaccine Injury Compensation Program (VICP). FAQs. While swelling and minor bruising can happen after a shot, they usually getbetter within a day or so. It is essential to ask a doctor or pharmacist which size needle to use before giving an injection. This type of response can occur if thebody reacts adversely to the injected medication, causing acascade of severe and potentially life-threatening symptoms. Immunization Technique for Intramuscular (IM) Injections - Deltoid Muscle However, if the pain persists or worsens, you should call a healthcare provider and have it checked out. Rarely, a blood clot can travel to a deeper vein in the leg, a condition known as deep vein thrombosis. Most people return to their regular activities on the same day, but you might want to have someone drive you home after the procedure. MNT is the registered trade mark of Healthline Media. Vaccine Information Statements (VISs). These include: In some cases, the pain may be extreme but not particularly dangerous (such as when an intramuscular injection accidentally hits the sciatic nerve). There is a range of types, and people use them in the treatment of diabetes and other. Doctor of pharmacy candidate in the School of Pharmacy at the University of Waterloo in Ontario. MNT is the registered trade mark of Healthline Media. In particular, a 16-mm (5/8-inch) needle should be chosen for patients weighing less than 60 kg (130 lb) and a 25-mm (1-inch) needle is appropriate for patients weighing 60 to 70 kg (130 to 152 lb).5 Women weighing 70 to 90 kg (152 to 200 lb) or men weighing 70 to 118 kg (152 to 260 lb) should receive injections with either a 25-mm (1-inch) or 38-mm (1.5-inch) needle.5 A 38-mm (1.5-inch) needle is necessary for women weighing more than 90 kg (200 lb) and men weighing more than 118 kg (260 lb).5 All health care professionals who provide injections should make individualized needle length selection part of their injection administration routine. Do not put the cap back on the needle. Over a period of 8 months, 26 men received 551 weekly injections into the gluteal, deltoid or thigh muscle and s Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. You can ask your doctor or pharmacist to go through the procedure with you beforehand. The upper border is found by measuring 2 to 3 finger widths from the acromion to ensure injection below the shoulder capsule.4 Two fingers are recommended for those with thicker fingers, and 3 fingers for those with slender fingers.4 The lower border is marked by the armpit to ensure the injection is not inserted below the deltoid.4 The thumb and forefinger are used to make a V to outline the deltoid muscle and keep the injection zone visible before using the needle to inject at a 90 angle.4, If inserted outside the injection zone, the needle should be pulled out, a fresh needle tip should be applied, and landmarking should occur again before injection is re-attempted. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Are techniques used for intramuscular injection based on research evidence? Read on to learn more about the different types, including their uses and possible injection sites. For a patient who experiences pain, redness, or itching, the pharmacist can recommend applying a cold compress at the site, as well as an OTC pain reliever for pain or an antihistamine for itching. axillary nerve; deltoid muscle; intramuscular injections; needle depth; safe site for injection. J Int Med Res. Health Resources and Services Administration website. Osborne SR, Alston LV, Bolton KA, Whelan J, Reeve E, Wong Shee A, Browne J, Walker T, Versace VL, Allender S, Nichols M, Backholer K, Goodwin N, Lewis S, Dalton H, Prael G, Curtin M, Brooks R, Verdon S, Crockett J, Hodgins G, Walsh S, Lyle DM, Thompson SC, Browne LJ, Knight S, Pit SW, Jones M, Gillam MH, Leach MJ, Gonzalez-Chica DA, Muyambi K, Eshetie T, Tran K, May E, Lieschke G, Parker V, Smith A, Hayes C, Dunlop AJ, Rajappa H, White R, Oakley P, Holliday S. Med J Aust. your particular bleeding disorder. Allow the alcohol to dry completely before the injection. The initial search identified 174 articles. How to give a subcutaneous injection. If you buy through links on this page, we may earn a small commission Heres our process. Medication is injected into the wrong area Redness, swelling, increasing pain, excessive bleeding, or any discharge from the injection site Rash or hives develop Difficulty breathing Fever If you think you have an emergency, call for medical help right away. This muscle is a very safe injection site for adults and infants more than 7 months old because it is thick and located away from major nerves and blood vessels. Table 3: needle selection guidelines, Determining if and how older patients can safely stay at home with additional services, Managing type 2 diabetes in primary care during COVID-19, Effectiveness of dermoscopy in skin cancer diagnosis, Examens et traitements reconsidrer en mdecine du sport et de lexercice pdiatrique, Tests and treatments to question in pediatric sport and exercise medicine, Optimizing delirium assessment, management, and prevention, http://www.cfpc.ca/Canadianfamilyphysician/, https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-1-key-immunization-information/page-8-vaccine-administration-practices.html#t3, Landmarking to prevent SIRVA and other injection site events, Copyright the College of Family Physicians of Canada. This site in the dorsogluteal muscle is difficult to use for self-injection and is not recommended. A mid-deltoid intramuscular injection site,, Figure 6. Doctors administer most injectable vaccines into the muscles. https://www.uptodate.com/contents/search. We avoid using tertiary references. A mid-deltoid intramuscular injection site, considering acromion as the origin of the deltoid, Figure 7. This muscle is in the upper arm near the shoulder. The side effects of cortisone shots occur right away or within 48 hours of receiving the shot. Vaccine recommendations and guidelines of the ACIP. You may have received an intramuscular injection at a doctors office the last time you got a vaccine, like the flu shot. The incision may bleed, but bleeding can also occur inside the body. This incompatibility can cause a pregnant person's immune system react to the Rh protein on the fetus's red blood cells that have entered their bloodstream. Intramuscular injections are often given in the following areas: The deltoid muscle is the site most typically used for vaccines. Its also difficult to use this site for self-injection. Remove the cap from the syringe. All rights reserved. While it is not uncommon to have localized swelling or redness for a day or two following an injection (or even longer for certain types of intramuscular shots), some symptoms warrant further investigation. All rights reserved. Sometimes looking at the shot makes it hurt more. Side effects that can occur where the needle goes into the skin include: These side effects usually go away within days to weeks. The review protocol was submitted with PROSPERO (ID: 319251). It typically manifests as swelling, pain, rash, redness, or bleeding. Following an injection, the most severe reaction is an all-body allergic response known as anaphylaxis. official website and that any information you provide is encrypted asp?seg=A#targetText=mostly%20local%20and%20may%20occur,of%20reac- tion%20to%20learn%20more. The most common side effect of a cortisone shot is pain at the injection site. All the authors strictly adhered to a well-developed registered review protocol throughout the study and followed the risk of bias in systematic reviews (ROBIS) guidance tool. The number of shots depends on the number of veins being treated. Timing. Position your fingers so your thumb points toward their groin and you feel the pelvis under your pinky finger. Reviewed June 21, 2019. Am J Nurs. 1961;61:5657. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Other treatments you've had for varicose veins and the results. Subcutaneous injections tend to be less painful than intramuscular injections because the needles are smaller and do not have to push through as much tissue. VAERS website. Our team thoroughly researches and evaluates the recommendations we make on our site. Women undergoing epidural steroid injection should be advised of abnormal bleeding as a potential adverse effect and providers should be aware of this association whe This makes it an ideal way to administer medications that the body must use slowly over time, such as insulin for the treatment of diabetes. If you are giving two deltoid IM injections into the same arm, separate them by a minimum of one inch. The weakened valves let blood pool in the veins instead of traveling to the heart. In contrast, spontaneous muscular hematomas are often the site of active bleeding. Managing diabetes involves taking regular injections of insulin to manage blood sugar levels. Follow these steps for a safe intramuscular injection: Wash your hands with soap and warm water to prevent potential infection. Being in the sun can lead to dark spots on the skin, especially for those with dark skin. Excerpt: So i did my first deltoid injection and after I pulled the needle out; blood was pouring from the deltoid till i placed a towel with rubbing alcohol on it. Less commonly, injection reactions are due to an infection or allergy. An intramuscular injection site, 7.4, Figure 8. Locate the middle of these three sections. Before doctors began using the hip as an injection site, they used the dorsogluteal muscles in the buttocks. Go to the full text of the article online and click on the CFPlus tab. Epub 2013 Nov 26. Cardiovascular health: Insomnia linked to greater risk of heart attack. Understanding the basics: general recommendations on immunization. government site. PMC J Allergy Clin Immunol. Using gauze, apply light pressure to the injection site. Establishing a new appropriate intramuscular injection site in the deltoid muscle. Generally, needles should be 1 inch to 1.5 inches for an adult and will be smaller for a child. On the outside of the arm above the armpit in the deltoid muscle. Thank you for your interest in spreading the word on The College of Family Physicians of Canada. If a lump of clotted blood forms in a treated vein, it might need to be drained. 4 Some patients may develop a low- grade fever after receiving an injection, which is usually self-limiting, but this can be treated with antipyretics, if needed. Spread your index and middle fingers in a slight V shape, and inject the needle into the middle of that V. The dorsogluteal muscle of the buttocks was the site most commonly selected by healthcare professionals for many years. The symptoms include trouble breathing, chest pain or dizziness, or coughing up blood. The injection site will be approximately 2 inches below the It is often warm to the touch and accompanied by enlarged lymph nodes, small bean-shaped glands that are part of the immune system. Unauthorized use of these marks is strictly prohibited. If youll be giving the injection more than once, make sure to rotate injection sites to avoid injury or discomfort to the muscles. High fever, swelling, drainage from the injection site, severe pain, or a whole-body response are all reasons to see a healthcare provider for an evaluation. National Vaccine Injury Compensation Program. Immunization room conversations often start with a joke from a nervous patient who will say that they do not like needles or that they are afraid the needle stick will hurt. Javier J, Gutierrez P, Munakomi S. Stat Pearls Publishing [Internet] Treasure Island, FL: StatPearls Publishing; 2022. (2014). PhotoAlto/Michele Constantini/Getty Images. Keywords: Tell your provider if it hurts a lot. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Heart failure: Could a low sodium diet sometimes do more harm than good? Divide the upper thigh into three equal parts. -, The NEW and the OLD intramuscular injection sites. Heres how to administer, Low levels of the male hormone testosterone affect muscle mass, bone density, and more. National Women's Health Information Center. People should avoid self-administering medications into the dorsogluteal muscles. Can poor sleep impact your weight loss goals? Surgical problems can cause postoperative bleeding. pain around the injection site, ranging from minor to intense pain, which is often called a cortisone or steroid flare bruising around the injection site face flushing for a few hours thin or. Call your doctor or healthcare professional right away if you experience: You may have some anxiety about performing or receiving an injection, especially an intramuscular injection, due to the long needle. Answer (1 of 3): No, not normal. These include: Intramuscular injections may be used instead of intravenous injections because some drugs are irritating to veins or because a suitable vein cannot be located. doi: 10.5694/mja2.50881. There is a lump, swelling, or bruising where the injection was given that does not go away. After sclerotherapy, treated veins tend to fade within a few weeks, although they might not disappear completely. Accessed Nov. 11, 2022. Relax the muscles, as much as possible, when receiving the injection. Copyright 2023 by The College of Family Physicians of Canada. If you suspect you injected into the shoulder capsule, the patient should be informed about SIRVA and its symptoms.2 The patient should monitor for increasing pain and a decreased range of motion that develops during the next 48 hours and does not subside.1,2 If a patient reports symptoms of SIRVA, imaging should occur to determine the level and type of damage.2 A trial of nonsteroidal anti-inflammatory drugs should be started and, if ineffective, corticosteroid injections into the shoulder with physiotherapy might prove helpful to recovery.2, Needle length should be chosen based on the body habitus and weight of the patient.5 A needle that is too long can penetrate the deltoid muscle, hitting the bone.4 Although patients will not feel their bones being hit, the vaccine might not fully absorb into the muscle, leading to a reduced immune response.4 Furthermore, if the needle is too short the vaccine might be administered subcutaneously, which might result in decreased immune response and the development of nodules or cellulitis.4. Facts about VISs. Less commonly, more serious complications can arise, including: People who notice the following symptoms should call a doctor immediately: Intramuscular injections are a common and effective way to deliver medication. How to administer intramuscular and subcutaneous vaccine injections. HHS Vulnerability Disclosure, Help Mayo Clinic is a not-for-profit organization. Postoperative bleeding is bleeding after surgery. If there is no blood, the needle is in the correct position. Hold the needle like a dart and insert it into the muscle at a 90-degree angle. You can get up and walk around soon after the procedure. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Mayo Clinic's Center for Aesthetic Medicine and Surgery is now open in Rochester. Medical management of vaccine reactions in adults in a community set- ting. Can diet help improve depression symptoms? The amount of pain a person feels depends on factors such as where they or another person administer the injection, their pain tolerance, and skin sensitivity. The person receiving the injection should get into a position that is comfortable, provides easy access to the location, and keeps the muscles relaxed. Results of sclerotherapy for small varicose veins or spider veins usually show in 3 to 6 weeks. Several drugs and almost all injectable vaccines are delivered this way. Gently spread the skin between two fingers and keep the muscles relaxed. Dolan SB, Patel M, Hampton LM, Burnett E, Ehlman DC, Garon J, Cloessner E, Chmielewski E, Hyde TB, Mantel C, Wallace AS. Healthline only shows you brands and products that we stand behind. A caregiver, friend, or family member can assist with injections into this muscle. If you can't remove the needle, or if a broken part of the needle didn't come out, you need medical attention. Light bleeding at the injection site is normal, but a person can use a bandage if necessary. Some medications can cause a bruise or irritation at the injection site. Discuss changing injection sites with a doctor. Some veins need more than one sclerotherapy treatment. While many infections occur due to a self-administered injection, such as with diabetes or autoimmune disorders. These injections are shallower than those injected into muscle tissues. All rights reserved. You can learn more about how we ensure our content is accurate and current by reading our. By and large, allergies tend to happen quickly, while symptoms of an infection may take one to 10 days to appear. Sclerotherapy generally has few serious complications. J Clin Epidemiol. The solution, usually a liquid, works by irritating the lining of the vein, causing it to swell shut and block the flow of blood. Other complications are much less frequent and include: Injecting a blood vessel can cause serious complications in rare cases. The following discussion describes the adverse effects (AEs) that make up true injection-site, or local, reactions and how pharmacists should respond to them. Sclerotherapy is typically done in a health care provider's office. The Z-track method of IM is used to prevent tracking, For small amounts of delicate drugs, a subcutaneous injection can be a convenient way of getting a medication into your body. The following discussion describes the adverse effects (AEs) that make up true injection-site, or local, reactions and how pharmacists should respond to them. Treatment of varicose veins and telangiectatic lower-extremity vessels. The authors have declared that no competing interests exist. Many doctors offices have these available. Varicose veins (adult). Intramuscular injections are a common practice in modern medicine. There are fewer blood vessels in the fatty layer of connective tissue just beneath the skin than the muscle tissue. There is little information on the types of vaccines most likely to cause SIRVA, although case reports have been published on many different types of intramuscular vaccines. Ultrasound is a painless procedure that uses sound waves to create pictures of structures inside the body. The US Department of Health and Human Services, along with the US Department of Justice, will then determine if the claim meets the criteria for compensation to the patient as a result of the AE. The Centers for Disease Control and Prevention (CDC) recommends lathering for 20 seconds, which is the time it takes to sing the Happy Birthday song twice. When an immunizer uses improper technique, shoulder injury can occur. Accessed Nov. 11, 2022. To locate this area, lay three fingers across the deltoid muscle and below the acromion process. Repeat this procedure if needed. To return blood to the heart, the veins in the legs must work against gravity. Snell RS. This site complies with the HONcode standard for trustworthy health information: verify here. Accessed September 9, 2019. Less commonly,injection reactions are due to an infection or allergy. The procedure also can improve symptoms related to varicose veins, including: Experts suggest waiting to have sclerotherapy done after pregnancy or breastfeeding. If you have any of the following symptoms after an injection, seek medical attention right away. However, if swelling and discoloration persist, it may signify an infection. Bleeding at the site can be contained by applying pressure until bleeding has stopped and then covering the site with an adhesive bandage or compress. Your health care provider might tell you to avoid hard exercise for two weeks after the procedure. Subcutaneous injection technique: An evidence-based approach. In these patients, bleeding will usually stop spontaneously. Effectivemethod for drug injection into subcutaneous tissue. People can receive intramuscular injections in the following areas: The deltoid muscle is the most common site for vaccines. Epub 2017 Jun 12. 9th ed. Typically, an injection-site reaction is considered to be any pain, swelling, rash, bleeding, or redness that occurs at the site of an injection, although, serious reactions can occur (see sidebar1).2 A small amount of pain or redness is expected with an intramuscular (IM) or subcutaneous injection, and a warning to this effect is included in the Vaccine Information Statement for a majority of vaccines.3 Local reactions are usually quite easy to treat at the time of vaccination or with a simple recommendation post administration. Last medically reviewed on September 19, 2018, A subcutaneous injection is an injection into the fatty tissue.