How critical is the technique of giving a hypodermic injection?

Factual Questions
1

All this talk about A-Rod’s drug use has reminded me of a question I’ve had for a while…

How critical is the technique of giving a hypodermic injection? Do you have to find a vein, like when you draw blood, or can you stick the needle in any old place and just push the plunger?

Does it go half inch under the skin? An inch? Does it matter?

Are all injectables the same, or must some be done one way and others another way?

Forgive me if these sound like naive questions, but I seldom have to deal with shots, and when I do I usually just close my eyes or turn away. Yes, I’m a big baby.

Thanks all, in advance.

2

Most injections are “IM”- intramuscular, and not difficult to perform. Usually injections are performed by someone else, but it is not difficult to give an injection to one’s self once taught the proper technique.

Others types of injections are intramuscular, intradermal, intravenous, etc.

3

I’ve never given one, but IMs pretty much look like a no-brainer. Stick it in the deltoid muscle, try not to hit a bone or a nerve, and Bob’s your uncle. I’ll ask my roomie when she gets home—she’s an LVN. What I’ve always wondered about were venipunctures. Could Robert Forster’s character in BB really have successfully done one after just watching a YouTube video? What happens if you screw up?

4

I’ve never heard of intradermal, I assume that’s the same as subcutaneous…just under the skin.

I’ve given myself plenty of shots. They were supposed to be SC, but I probably did them a bit deeper since if they tended to sort of leak/squirt right back out if I did it like that.

OTOH, I have an acquaintance that had to go in for a vaccine of some sort a few years ago. The person who was doing the injection was fresh out of nursing school. As the nurse was prepping the injection site, my friend said “Hey, that seems a little high” The nurse said it was just fine and my friend said “I just finished a section on injections in school and they said you’re supposed to go two fingers below (and he gestured to me to show exactly where you’re supposed to do it).” Nurse was adamant that it was fine, friend figured a nursing school graduate probably knew more then him and a year later he was about to go in for his second surgery to correct a problem caused by it.

It doesn’t happen often, but looking around online, it sounds like if they stick the needle into the actual shoulder or AC joint it can cause some nasty issues that almost seem to replicate various injuries/tears.

5

And, no, just doing an IM injection really isn’t hard. The hardest part is knowing it’s going to hurt (or not wanting to hurt someone else). Just make sure you stick it in some nice thick muscle and not up in the shoulder. A few youtube videos would probably be more then enough to help you give someone one or two shots (IM) without killing them. If you’re going to be doing it everyday, I’d recommend having someone train you, I’d assume sooner or later you’ll run into some kind of issue or question that the internet can’t answer.

Also, I think IV injections are an entirely different animal.

6

My wife has a condition that requires intramuscular shots.

The doc taught me how to do it.

Depth in our case is determined by the needle they give us. About an inch and a half long.

Placement was my big worry. They told me to make a triangle…the top point is the top of her shoulder, and the 2 bottom corners are the front and back of the upper arm. They told me to shoot her in the center of the triangle and to jab it in like the doc do in the movies, like throwing a dart.:cool:

7

I’ve given sub-q and IM shots to another person, with no difficulty. Prep the needle so there’s no air bubble, find the general area, and poke. I also injected myself IM with saline to test my technique.

8

I’ve heard that it’s pretty much a myth that if you don’t get the bubble out it’s instant Hollywood-style death. I read somewhere that bubbles form in the bloodstream all the time. Any truth to this?

9

The only risk I know is with IV - if you hit an artery instead of a vein; I once asked a person drawing blood (inside elbow) what would happen if he hit the artery which runs by there -
“you could bleed out before we could stop it”.
Don’t know if he was being overly dramatic or not; will try to remember to ask the next.

10

No, that’s not true. I don’t know exactly how much air it would take to harm someone- perhaps a few cc’s in a vein- but a small bubble in a syringe to a muscle would not do any harm.

11

That’s probably not true. Phlebotomists draw from arteries for some special tests.

12

Retired nurse speaking. The trick with IM is to not irritate or otherwise harm nerves running through the muscle. Upper outer quadrant of the buttocks or central triangle of the upper arm are favourites.

There is a difference between intra-dermal (which places a pool of liquid between layers of the skin (anti TB injection) and sub cutaneous which is into the fat layer below the derma ( insulin).

13

The depth of the injection is, if you have a good supply closet, dictated by the length of the needle you choose for the syringe. Subcutaneous injections are done with a needle that’s 1/2 to 5/8 of an inch long - the fatter patients get the longer needle. IM injections are done with 3/4 inch (for a very thin person in the deltoid) 1 inch (for a normal weight person in the deltoid or a thin person in the hip) or 1 1/2 inch (for a fat person in the hip). You choose the correct length needle so that you can insert it all the way to the hub and know that it’s more likely than not in the correct tissue. Medical IV’s are usually done not with a rigid needle, but a flexible catheter that stays in place. (It’s rare that you need to give a single one-and-done IV injection; keeping the IV cath in means I only have to find your vein once, and I don’t have to worry as much about “blowing out” your vein by poking a bunch of holes in it over a couple of days for various meds and fluids.) Drug abusers, of course, will often use rigid needles for frequent IV injections because it’s what they have, and that’s one reason their veins tend to be damaged.

We used to teach nurses that when doing an IM injection, they should draw back on the syringe a little bit to see if blood appeared in the syringe. If it did, then they were considered “in a vein” and should withdraw the needle and change it before trying again. We don’t do that anymore, because it wasn’t found to actually be effective at decreasing risk, and it’s stressful on both the nurse and the patient.

If you mess up an IV stick, either nothing happens (you didn’t get into the vein) or bruising happens or the person bleeds a lot. I can’t fathom anyone without a clotting disorder losing a dangerous amount of blood from a blown IV stick, but blood does spread a lot, so it can look scary. I was taught to do IV sticks by my husband, a retired paramedic. The first one went in like butter, smooth and perfect. The second one, I blew the vein - the needle went in one side of the vein and right out the back…and he’s on blood thinners. Bled like a stuck pig and I was mortified and horrified and swore I was never going to become a nurse, I’d just go live under a bridge somewhere. He laughed, helped me clean up the blood and then made me do another one, which went okay.

I can’t remember where I found the information, but the question of air bubbles in IV tubing and in syringes has come up before on the Dope. Turns out you need about 60cc, or 1/4 cup, of air inside a vein before it becomes life threatening. That rarely happens with IV tubing these days now that we use pumps. It mostly happens during an accident or surgery, if an open vein isn’t clamped off and it sucks air in. The little bubble in the syringe won’t kill you. It can, however, mess up the dose of the medication, because it takes up room in the syringe that should be filled with medicine. So if you see a bubble in a syringe prefilled by the manufacturer, don’t worry about it; they fill them by weight, not volume, so it will be accurate. But do knock the bubble out of your insulin syringe when you’re filling it from a vial!

14

You have to go in at a much deeper angle of attack to get the arteries, and deeper into the limb. It’s not easy, and it can be painful. But it’s also not lifethreatening, although it will flow with some startling force, since the catheter will be pointing “upstream” in an artery, as opposed to “downstream” for an vein. As Ca3799 says, phlebotomists and some nurses get arterial access, particularly for “ABG’s” or “Arterial Blood Gas” tests. You have to have a little extra training to do it - it’s not taught in basic nursing school.

(Actually one of the dirty little secrets of nursing school is that most don’t let their students do IV’s any more due to legal fears. We learn *about *them, and we have stupid little plastic models in the skills lab we can fondle, but the first actual stick most nurses do is on a real patient after they’ve graduated and are working as nurses. That’s why my husband taught me on himself - he thinks it’s ridiculous that they won’t even let us stick each other in class, the way they used to teach it.)

15

My dentist told me that back in school, when they had to take turns giving each other novocaine for the first time, the rest of the class chanted, “Shot! Shot! Shot!”

16

I do insulin to myself all the time, no big deal though I have accidentally gotten myself in a capillary and it bleeds a few drops. Slap the alcohol swab over the top and press in a minute or so with a finger tip or the syringe cap and it stops. I swear I have bled more from sticking a finger.

I have also given shots to hubby and various animals [sheep, cats, chickens.]

I also got used as a shot training dummy - went in for a booster for tetanus once when mrAru and a bunch of his co-students were doing an ER rotation and got asked if they could give me more shots, I ended up with both the recruit package and the overseas package of innoculations. And sore arms. I also got given probably 15 or 20 various saline shots so they could practice the different types of shots.

17

I have to receive weekly injections and my wife does the honors. The injection is in the muscle and really isn’t difficult at all to do. In fact she usually screeches the theme to Physco just before stabbing me with the damn thing!

Pro Tip: Before she stabs me she takes the palm of her hand and slaps my thigh pretty hard. She then immediately stabs the needle. By doing this I almost never even feel the needle, I was quite amazed the first time she did this.

18

We were taught to do this with horses, in 4-H. Because they might kick out, thinking it’s a wasp or something. A horse’s butt skin has got to be a quarter-inch thick, you can’t be wimpy about your approach.

I do IM and subQ meds and vaccines on goats, sheep, and dogs regularly. It used to scare me to death thinking some weird thing was going to happen and they would suddenly drop dead. I got used to it though. SubQ (into the web of the elbow, typically) on a squirming goat kid can be frickin tricky though.

19

Former (sigh of relief!) IM medication user here - the other trick is to not end up with the needle in a vein, which is why you draw back the plunger after getting the needle in but before injecting the medication. The reasons I was given were (1) meds intended for IM use may include substances that are too viscous (e.g. oil) to move through smaller veins, so you end up with an oil embolism, and (2) medications are often given IM in order to take advantage of slower absorbtion; if you get it in the vein, the body will clear it quickly and you’re wasting medication.

I managed to stick myself close to a nerve exactly once, and it was an unpleasant experience. I stuck a vein once, but that was just annoying and a little messy.

Measuring levels of dissolved gases in the blood, correct?

My dentist graduated 20 years ago and he *still *shudders when he talks about being someone’s practice dummy for injection practice.

20

I’ve had Arterial Blood Gases done on me a few times. Hurt like hell, but there wasn’t blood on the ceiling and I didn’t bruise much more than when I get a klutsy phlebotomist do a normal blood draw.