and transmitted securely. Pharmacists and other immunizers should continually review the proper administration technique to be sure to provide the safest administration possible. Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia. Some veins need more than one sclerotherapy treatment. Ultrasound is a painless procedure that uses sound waves to create pictures of structures inside the body. Vaccine Information Statements (VISs). After sclerotherapy, treated veins tend to fade within a few weeks, although they might not disappear completely. Some people feel minor stinging or cramping when the needle goes into the vein. Do not push the plunger in. 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). Sometimes looking at the shot makes it hurt more. Any time an immunizer witnesses or is informed by a patient of any reaction to a vaccination that would be considered a significant AE, the immunizer should report the event to the Vaccine Adverse Event Reporting System (VAERS), which is co-managed by the CDC and the FDA. But, at other times, it may be due to an infection that might only get worse if it's not untreated. The side effects of cortisone shots occur right away or within 48 hours of receiving the shot. Mayo Clinic; 2021. To locate this site, feel for the bone (acromion process) thats located at the top of your upper arm. If there is blood, it means the needle is in a blood vessel and not a muscle. CDC website. doi: 10.5694/mja2.50881. Affiliation 1 Department of Anesthesia, McMaster . The efficacy of vaccines administered outside the proper injection site is not guaranteed or quantified. In these patients, bleeding will usually stop spontaneously. All rights reserved. Blood Aspiration During IM Injection The World Health Organization and Centers for Disease Control and Prevention no longer recommend aspiration during intramuscular (IM) injections. Injection site reactions are common after vaccines or treatments delivered through a shot. 2017;13:21232129. A site 1-3 fingerbreadths/5 cm below the mid-acromion point (7 studies); mid-deltoid site/densest part of the deltoid (1 study); a site at the middle third of the deltoid muscle (1 study); triangular injection site (1 study). The injection site will be approximately 2 inches below the Am J Emerg Med. Light bleeding at the injection site is normal, but a person can use a bandage if necessary. Rarely, a blood clot can travel to a deeper vein in the leg, a condition known as deep vein thrombosis. Most adults will require a 1-inch needle, but the exact size depends on the persons weight. 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. sharing sensitive information, make sure youre on a federal How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://opentextbc.ca/clinicalskills/chapter/6-8-iv-push-medications-and-saline-lock-flush/, https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Practice-Management/Pages/Vaccine-Administration.aspx, https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html. Here, learn about the possible side effects, how the injections work, and who may, Managing diabetes involves taking regular injections of insulin to manage blood sugar levels. Warm the vial of medication by rubbing it between your hands prior to drawing the medication into the syringe. THE NATIONAL VACCINE INJURY COMPENSATION PROGRAM. It typically manifests as swelling, pain, rash, redness, or bleeding. Dolan SB, Patel M, Hampton LM, Burnett E, Ehlman DC, Garon J, Cloessner E, Chmielewski E, Hyde TB, Mantel C, Wallace AS. The thumb should point toward the groin. VAERS website. 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. The deltoid muscle is a large, rounded, triangular shape. Subcutaneous injections are usually safe and do not require as much force as intramuscular injections into the muscle tissues. The https:// ensures that you are connecting to the You have questions about how to give an injection. To locate the correct spot, imagine dividing the thigh vertically into three equal parts. A member of your health care team cleans the area to be treated. Give a baby a pacifier before an injection. your particular bleeding disorder. You should not put any of these materials into the regular garbage, as needles can be hazardous to anyone who handles the trash. official website and that any information you provide is encrypted 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. The bleeding may start immediately, or several days after surgery. Fevers higher than 101 F following an injection warrant a call to your healthcare provider or visit the nearest emergency room. 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. J Allergy Clin Immunol. Kang S, et al., eds. Some people find it difficult to inject themselves. Case reports that mention SIRVA also describe other shoulder injuries that can occur when landmarking is not performed correctly. Sign In to Email Alerts with your Email Address. Turn the vial and syringe upside down so that the needle points upward. What to know about different types of injections. 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. A doctor may use an intramuscular shot if: Intramuscular injections have other advantages too. Mastering the technique of injecting at home can take some practice. Resources Family DoctorAmerican Academy of Family Physicians http://familydoctor.org "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Withdraw the needle quickly and discard it into a puncture-resistant sharps container. cdc.gov/vaccines/hcp/acip-recs/general-recs/ adverse-reactions.html. Doctors administer most injectable vaccines into the muscles. PRISMA flowchart of the systematic, Figure 2. Parents can help reduce pain and anxiety from vaccinations, Giving a subcutaneous injection [Fact Sheet]. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, absorbed into the bloodstream slowly and steadily, Medications used in subcutaneous injections, https://www.npr.org/sections/health-shots/2016/07/12/485140592/parents-can-help-reduce-pain-and-anxiety-from-vaccinations, https://www.cc.nih.gov/ccc/patient_education/pepubs/subq.pdf, https://www.nature.com/articles/s41598-017-10110-w, https://rcni.com/sites/rcn_nspace/files/ns.29.3.53.e9183.pdf, https://www.hopkinsarthritis.org/patient-corner/how-to-give-a-subcutaneous-injection/. Or it may start hours after the injection. Thank you, {{form.email}}, for signing up. The following steps can help people deliver a safe injection into a muscle: Wash the hands thoroughly with soap and warm water. Before putting medication into the syringe, warm the vial up by rubbing it between the hands. Bancsi A, Houle SKD, Grindrod KA. This article explains some serious injection reactions that you should be aware of and what to do if you experience them. Accessed September 6, 2019. Malkin B. Can diet help improve depression symptoms? 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. Safety. Don't rub the injection site. Side Effects. Sclerotherapy usually works best on small varicose veins. Federal government websites often end in .gov or .mil. Importance. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). This muscle is in the upper arm near the shoulder. The following discussion describes the adverse effects (AEs) that make up true injection-site, or local, reactions and how pharmacists should respond to them. Walking and moving helps keep blood clots from forming. Site for intramuscular injection at the middle third of the deltoid muscle taking, Figure 6. This is known as a pulmonary embolism. 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. doi: 10.1136/eb-2013-101582. It can only receive small volumes of medication, usually 1 milliliter or less. Its normal to see slight bleeding. A mid-deltoid intramuscular injection site, considering acromion as the origin of the deltoid, Figure 7. Treatment of varicose veins and telangiectatic lower-extremity vessels. Nicole Galan, RN, is a registered nurse and the author of "The Everything Fertility Book.". The incision may bleed, but bleeding can also occur inside the body. Facts about VISs. Divide the upper thigh into three equal parts. When should I contact my healthcare provider? Most post-injection inflammation is mild. Assistant Professor in the School of Pharmacy at the University of Waterloo. An intramuscular injection site, 7.4 cm below the mid-acromion (relatively safe much below, Figure 9. Deep vein thrombosis carries a risk of a blood clot traveling from the leg to the lungs and blocking a vital artery. Its deep and not close to any major blood vessels or nerves. Intramuscular injections offer some benefits over other types of delivery methods, such as oral, intravenous injections into a vein, and subcutaneous injections into fatty tissue under the skin. Recommended site: Deltoid muscle in the upper arm Use anatomical landmarks to determine the injection site. Awareness is crucial to identifying patients who are displaying signs of this injury so they can access treatment in a timely manner. Radiological Society of North America. In: Fitzpatrick's Dermatology. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Can poor sleep impact your weight loss goals? Tell your provider if it hurts a lot. Varicose veins are usually in the legs. For men and women who weigh 130-152 lbs (60-70 kg), a 1-inch needle is sufficient. Do not put the cap back on the needle. Wolicki J, et al. -, The NEW and the OLD intramuscular injection sites. This work was supported in part by the Ontario College of Pharmacists through funding in support of the Pharmacy5in5 program. What is the latest research on the form of cancer Jimmy Carter has? Apply ice to the injection site as needed to relieve pain. The provider examines your veins and checks for blood vessel disease. They encourage you to move around or do your leg exercises. What are the different types of injection? Vaccine recommendations and guidelines of the ACIP. Renita White, MD, FACOG, is a board-certified obstetrician/gynecologist who practices at Georgia Obstetrics and Gynecology. To avoid, SRIVA, proper administration technique should always be used. asp?seg=A#targetText=mostly%20local%20and%20may%20occur,of%20reac- tion%20to%20learn%20more. National Library of Medicine To return blood to the heart, the veins in the legs must work against gravity. Then your care provider uses a small needle to slowly put solution into the vein. Subcutaneous injection technique: An evidence-based approach. What are the complications of intramuscular injections? After any injection, swelling and irritation (inflammation) can occur at the site where the needle entered the skin. The number of shots depends on the number of veins being treated. An injection site reaction is your body's response to an immunization or other injection at the site where it was administered. What is SIRVA? Accessed Dec. 1, 2022. Find out about the benefits of common insulin injection, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. If person has a . The symptoms include trouble breathing, chest pain or dizziness, or coughing up blood. CDC website. The weakened valves let blood pool in the veins instead of traveling to the heart. We encourage readers to share some of their practice experience: the neat little tricks that solve difficult clinical situations. Your muscles have lots of blood flowing through them, so medications injected into them are quickly absorbed. 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. Remove the cap from the syringe. Intramuscular injections. Numb the injection site with ice or a numbing cream before cleaning the skin with the alcohol swab. Shoulder injury related to vaccine admin- istration and other injection site events. Where do you inject in the deltoid? Data were depicted by self-generated images. Cough or blow before or during the injection. An intramuscular injection is a technique used to deliver a medication deep into the muscles. cdc. Reviewed June 21, 2019. You can learn more about how we ensure our content is accurate and current by reading our. Answer (1 of 3): No, not normal. Shoulder injury related to vaccine administration is an under-reported, preventable series of events caused by incorrect technique or landmarking for intramuscular deltoid injections. A few strategies can help with the pain and anxiety: The most common complication of a subcutaneous injection is pain near the injection site for 1 to 2 days afterward. People with specific conditions, such as multiple sclerosis and rheumatoid arthritis, may need to give themselves this type of injection at home. The initial search identified 174 articles. Sclerotherapy involves using a needle to put a solution into the vein. After removing the needle, your provider applies pressure to the area and massages it to keep blood out of the vein and to spread the solution. subcutaneous (injected into the fatty tissue just under the layer of skin), puncture-resistant container to discard the used needles and syringe (typically a red, plastic sharps container). J Infect Dis. You lie on your back with your legs slightly raised. If you try yourself, it could burst under the skin and spread the infection through the bloodstream, causing a potentially life-threatening blood infection known as sepsis. A mid-deltoid intramuscular injection site,, Figure 6. Administering the shot at a 90 angle can ensure that the needle goes directly into the deltoid and not upward into the shoulder area (see table ).5. 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. Please enable it to take advantage of the complete set of features! Intramuscular (IM) injections are used to deliver medication deep into your muscles. For example, certain drugs that treat multiple sclerosis or rheumatoid arthritis may require self-injection. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. Thats because the fever may indicate an infection caused by needle contamination or an allergic reaction to the medication itself. Two finger-widths below this, there is a triangular muscle. Other treatments you've had for varicose veins and the results. Less commonly, injection reactions are due to an infection or allergy. Repeat this procedure if needed. Draw air into the syringe by pulling back the plunger. Pain might result from the solution leaking from the vein into the tissue around it. The following tips may reduce discomfort before and after the injection: People who find injecting themselves difficult should ask a friend, family member, or caregiver to help them. Authors Harsha Shanthanna 1 , Jason W Busse. On the outside of the arm above the armpit in the deltoid muscle. Philadelphia, USA: Wolters Kluwer: Lippincott Williams & Wilkins; 2015. Am J Nurs. Heart failure: Could a low sodium diet sometimes do more harm than good? Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Recent illnesses or medical conditions, such as a heart condition or a history of blood clots. Use a numbing cream on the area a few minutes before the injection. Snell Anatomy by Regions Edition 9. Many drugs that must be taken daily, or injected at home, are designed for subcutaneous injection. The site is secure. However, you might need more than one treatment to get the results you want. Intramuscular injections are used when other types of delivery methods are not recommended. Your health care provider might tell you to avoid hard exercise for two weeks after the procedure. 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 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. The purpose of VAERS is to compile and analyze data related to reports of AEs associated with vaccinations.7 Both health care providers and patients can submit reports to VAERS. You can ask your doctor or pharmacist to go through the procedure with you beforehand. Minor discomfort after an intramuscular injection is normal. In some cases, a person may also self-administer an intramuscular injection. The pain also depends on the medication they are injecting, as it may cause stinging, burning, or aching during or following the injection. When administering IM injections, immunizers must be sure to identify the location of the deltoid muscle and attempt to administer the vaccination deep into its middle. Using gauze, apply light pressure to the injection site. An auto-injector is a self-contained device that does not require drawing the medication up first. We avoid using tertiary references. A new class of self-injectable medications are showing promise in treating high cholesterol. If there is no blood, the needle is in the correct position. Children and people who fear needles may still have issues with these injections that can cause anxiety. Don't shave your leg or use lotion on it until the site heals. Because AEs and injuries can occur even with perfect technique, it is important for pharmacists to know how to respond to minor AEs appropriately and how to report and manage more serious. How to give a subcutaneous injection. the top of the buttocks, where there is more fat than muscle. Go to the full text of the article online and click on the CFPlus tab. Zone between the halfway point, Figure 7. Pay careful attention to the area between the fingers and under the fingernails. Evidence was found that triamcinolone acetonide (TA) influenced menstruation after intramuscular application, 9-13 but no literature was found about disturbance of the menstrual pattern after intra-articular or periarticular corticosteroid injections and because knowledge of the possible side effect is important for medical practice it was More than likely, if there is blood, it is from slight bleeding after the injection. 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. Is the ketogenic diet right for autoimmune conditions? Intramuscular injections are often given in the following areas: The deltoid muscle is the site most typically used for vaccines. The needle size and injection site will depend on many factors. Withdraw and start over with a new needle, syringe, and injection site. 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. Find the acromion process, which is the bony point at the end of the shoulder. Fill the syringe with air up to the same level as the medication dose. We developed an infographic (Figure 1), also available at CFPlus,* to guide all health professionals in proper injection administration and the prevention of SIRVA. Learn if testosterone injections work and if they're right for. MNT is the registered trade mark of Healthline Media. Clean the site selected for injection with an alcohol swab and allow the skin to air dry. gov/vaccines/hcp/vis/about/facts-vis.html. A caregiver, friend, or family member can assist with injections into this muscle. When AEs occur, pharmacists should utilize VAERS so that the events may be studied to help identify any issues with a particular vaccine. The .gov means its official. Structures underlying the deltoid muscle. The next time you give a vaccine to a patient, pay attention to your technique. The correct area to give the injection is two finger widths below the acromion process. Immunization Action Coalition website. If you buy through links on this page, we may earn a small commission Heres our process. Takeaway A subcutaneous injection is a minor and very safe medical procedure when done correctly.. 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. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Press down on the plunger of the syringe to inject the medication. They tend to avoid using these muscles now because of the potential risk of injury to the sciatic nerve. Give the injection into the outer top part of the middle section. Wear loose, comfortable clothing. Accessed September 9, 2019. Discuss changing injection sites with a doctor. Most maternal deaths occur within the first 24 hours after delivery. Whiting P, Savovi J, Higgins JP, et al. Epidural steroid injections are associated with subsequent abnormal vaginal bleeding for both premenopausal and postmenopausal women. After your cortisone shot, your doctor might ask that you: Protect the injection area for a day or two. The provider might tape a pad onto the injection site to keep pressure on the area before moving on to the next vein. Oxytocin is one such drug. To avoid stinging, ensure the alcohol dries completely. Hold the needle like a dart and insert it into the muscle at a 90-degree angle. Apply a plaster or wound pad to the area if there is any bleeding. It can take a month or more for full results. Insert the needle into the muscle at a 90-degree angle. Preventing and manag- ing adverse reactions. These may include a little swelling, tenderness, pain, itching, or redness around the area where the injection was given. Mayo Clinic is a not-for-profit organization. An intramuscular injection delivers medication into a muscle. Allow the alcohol to dry completely before the injection. Shoulder injury related to vaccine administration and other injection site events, A needling problem: shoulder injury related to vaccine administration, Dont aim too high: avoiding shoulder injury related to vaccine administration, An evidence based protocol for the prevention of upper arm injury related to vaccine administration (UAIRVA), Best vaccination practice and medically attended injection site events following deltoid intramuscular injection, Canadian immunization guide.