Aspiration is not necessary or recommended. Assistant Professor in the School of Pharmacy at the University of Waterloo. Heart failure: Could a low sodium diet sometimes do more harm than good? All rights reserved. Learn if testosterone injections work and if they're right for. Renita White, MD, FACOG, is a board-certified obstetrician/gynecologist who practices at Georgia Obstetrics and Gynecology. The authors received no specific funding for this study except for the journal publication charges. If treatment is needed, it may include: Minor discomfort after an intramuscular injection is normal. To locate the correct spot, imagine dividing the thigh vertically into three equal parts. Last medically reviewed on August 8, 2018, Intramuscular injections are for medicines that people must inject into a muscle rather than the bloodstream or fatty tissue. For women who weigh 152-200 lbs (70-90 kg) and men . Sclerotherapy generally has few serious complications. This article explains some serious injection reactions that you should be aware of and what to do if you experience them. Use a piece of gauze to apply light pressure to the injection site. Distract yourself with a movie, video game, or conversation. Position the index and middle fingers into a V then administer the shot in the middle of the V. Typically, people who need to self-administer injections use the vastus lateralis muscle in the thigh. Accessed Nov. 11, 2022. You can learn more about how we ensure our content is accurate and current by reading our. Injection site reactions are usually caused by an immune response to the needle, vaccine, or other medicine. Intramuscular injections are used when other types of delivery methods are not recommended. Turn the vial and syringe upside down so that the needle points upward. This muscle is in the upper arm near the shoulder. Light bleeding at the injection site is normal, but a person can use a bandage if necessary. In low-income countries, drugs to prevent or treat postpartum haemorrhage (uterotonics) are not always available. Pharmacists should refer any patients who complain of SRIVA to an appropriate medical professional for treatment. Site for intramuscular injection at the middle third of the deltoid muscle taking, Figure 6. Vaccine Information Statements (VISs). There is a range of types, and people use them in the treatment of diabetes and other. Go to the full text of the article online and click on the CFPlus tab. Or use sunscreen with at least 30 SPF. Before 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). 2014;42(4):887-897. doi:10.1177/0300060514531924, McNeil MM, DeStefano F. Vaccine-associated hypersensitivity. Clean the skin with the alcohol swab and allow to air-dry. Can diet help improve depression symptoms? A subcutaneous injection is a minor and very safe medical procedure when done correctly. We thank Adrian Poon, who designed the infographic. Heres how to administer, Low levels of the male hormone testosterone affect muscle mass, bone density, and more. De Avila Oliveira R, et al. The following discussion describes the adverse effects (AEs) that make up true injection-site, or local, reactions and how pharmacists should respond to them. If there is no blood, the needle is in the correct position. If person has a . People who need to self-administer an injection should ask their doctor for advice and guidance, and familiarize themselves with the process before they inject themselves. Typically, veins return blood from the rest of the body to the heart. National Vaccine Injury Compensation Program. Most maternal deaths occur within the first 24 hours after delivery. Healthline Media does not provide medical advice, diagnosis, or treatment. Give the injection in the center of the triangle. There is a lump, swelling, or bruising where the injection was given that does not go away. All rights reserved. We developed an infographic (Figure 1), also available at CFPlus,* to guide all health professionals in proper injection administration and the prevention of SIRVA. J Int Med Res. Subcutaneous injection technique: An evidence-based approach. The injection site will be approximately 2 inches below the Keywords: You should not put any of these materials into the regular garbage, as needles can be hazardous to anyone who handles the trash. sharing sensitive information, make sure youre on a federal Figure 1. 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). Using proper administration technique can help to minimize injection-site reactions. It generally takes an hour or less to complete. Government immunization advisories, standard anatomy textbooks, and researchers have proposed various injection techniques and sites, but specific guidelines are lacking for the administration of IMIs in the increasingly used deltoid site. Postoperative bleeding can become life-threatening. 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. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Triangular injection site, formed by, Figure 4. 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. Tiny air bubbles can rise in the blood. They can also ask a caregiver to help. If a lump of clotted blood forms in a treated vein, it might need to be drained. Subcutaneous injections are usually safe and do not require as much force as intramuscular injections into the muscle tissues. When a needle breaks the skin, it may cause a small amount of pain; however, what constitutes an actual injection-site reaction? Pain near the injection site can happen when inserting the needle at the wrong angle, or when it moves slightly during the injection. Be sure to thoroughly scrub between your fingers, on the backs of your hands, and under your fingernails. If you are giving two deltoid IM injections into the same arm, separate them by a minimum of one inch. A lump under the skin thatfeels soft, mushy, and painful may indicate a developing abscess. What causes postoperative bleeding? How to administer intramuscular and subcutaneous vaccine injections. Answer (1 of 3): No, not normal. vaers.hhs.gov/about.html. Would you like email updates of new search results? You should not use an injection site that has evidence of infection or injury. Everything you need to know about trigger point injections. Give a baby a pacifier before an injection. As a result, inflammation of the shoulder structures causes patients to experience pain, a decreased range of motion, and a decreased quality of life. Best food forward: Are algae the future of sustainable nutrition? Weakened valves, also called incompetent valves, within the veins might cause varicose veins. Triangular injection site, formed by an apex based on a line drawn laterally, Figure 5. Reviewed July 12, 2017. Sciatic nerve injection injury. Ultrasound is a painless procedure that uses sound waves to create pictures of structures inside the body. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). After any injection, swelling and irritation (inflammation) can occur at the site where the needle entered the skin. Jung Kim H, Hyun Park S. Sciatic nerve injection injury. It can take a month or more for full results. 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. 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. Varicose veins and spider veins. Cough or blow before or during the injection. prolonged or excessive bleeding tingling or numbness around the muscle redness, swelling, or warmth at the injection site drainage at the injection site signs of an allergic reaction, such as. Before sclerotherapy, a health care provider might ask for an ultrasound test of the legs. Epub 2013 Nov 26. Injection site reactions are common after vaccines or treatments delivered through a shot. If a child needs restraining, hold them in a hugging way rather than holding them down or yelling at them. Less commonly, injection reactions are due to an infection or allergy. If so,. Intramuscular (IM) injections are used to deliver medication deep into your muscles. CDC website. Sometimes looking at the shot makes it hurt more. Limitations included the unavailability of free access to complete text in many articles resulting in exclusion. It is often warm to the touch and accompanied by enlarged lymph nodes, small bean-shaped glands that are part of the immune system. 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 (. Place the heel of your hand on the hip of the person receiving the injection, with your fingers pointing toward their head. A caregiver, friend, or family member can assist with injections into this muscle. immunize.org/catg.d/p3082.pdf. But it can be challenging to self-administer medication into the hip. Primary care providers are well positioned to prevent injury through proper injection technique and by recognizing, diagnosing, and offering treatment to patients with SIRVA. National Women's Health Information Center. Ruffing, V. (2012, December 18). In some cases, a person may also self-administer an intramuscular injection. J Infect Dis. Cardiovascular health: Insomnia linked to greater risk of heart attack. Draw back the plunger to fill the syringe with the correct amount of medication. Try putting ice on the area to numb it a few minutes before the injection. You have questions about how to give an injection. Avoid having the treated areas in sun for two weeks, as well. 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. Hum Vaccin. The .gov means its official. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). To establish that the product manufacturers addressed safety and efficacy standards, we: We do the research so you can find trusted products for your health and wellness. Fill the syringe with air up to the same level as the medication dose. 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. Recent illnesses or medical conditions, such as a heart condition or a history of blood clots. (2021). Please ask the person administering the vaccine for a compression bandage to the injection site. 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/. AskMayoExpert. 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. Accessed September 11, 2019. Theyre more than willing to help you understand how to perform a safe, proper injection. For men and women who weigh <130 lbs (<60 kg), a -inch needle is sufficient to ensure intramuscular injection in the deltoid muscle if the injection is made at a 90-degree angle and the tissue is not bunched. Information needed about your medical history includes: Aspirin, ibuprofen, naproxen sodium or blood thinners can increase the risk of bleeding. Cochrane Database of Systematic Reviews. Remove the cap from the needle and push it through the top of the vial. Physicians can mitigate SIRVA and other injection site events by refreshing their knowledge of and adopting proper landmarking and injection technique. CDC website. To locate this site, feel for the bone (acromion process) thats located at the top of your upper arm. Make sure you're taking your insulin the best way possible. 2021; doi:10.1002/14651858.CD001732.pub3. Vaccine administration practices. A new class of self-injectable medications are showing promise in treating high cholesterol. Before putting medication into the syringe, warm the vial up by rubbing it between the hands. You can ask your doctor or pharmacist to go through the procedure with you beforehand. The remaining 14 articles were the immunization guides issued by the National Public Health Agencies of the Government of India and abroad, whose data was used for comparison. Over a period of 8 months, 26 men received 551 weekly injections into the gluteal, deltoid or thigh muscle and s https://www.uptodate.com/contents/search. government site. 2022 Oct;11(10):6101-6106. doi: 10.4103/jfmpc.jfmpc_792_22. People should avoid self-administering medications into the dorsogluteal muscles. Establishing a new appropriate intramuscular injection site in the deltoid muscle. Patients: After care Ice the area immediately after injection as described above. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. 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. However, if swelling and discoloration persist, it may signify an infection. 1,2 Specifically, SIRVA occurs when an intramuscular deltoid injection is administered into the shoulder joint. An intramuscular injection could cause an infection, bleeding, numbness, or pain. Have someone you trust give you the injection. 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. What is SIRVA? 2017 Sep 2;13(9):2123-2129. doi: 10.1080/21645515.2017.1334747. We do not capture any email address. Am J Emerg Med. Less-common side effects of sclerotherapy that might need treatment include: Blood clot. Locate the injection site according to the instructions above. (n.d.). We avoid using tertiary references. FOIA Relax the muscles, as much as possible, when receiving the injection. People can receive intramuscular injections in the following areas: The deltoid muscle is the most common site for vaccines. They tend to avoid using these muscles now because of the potential risk of injury to the sciatic nerve. Clean the site selected for injection with an alcohol swab and allow the skin to air dry. Even when the immunizer uses proper technique, AEs may occur. axillary nerve; deltoid muscle; intramuscular injections; needle depth; safe site for injection. An abscess is awalled-off collection of pus. 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. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Intramuscular injections are often given in the following areas: The deltoid muscle is the site most typically used for vaccines. 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. You lie on your back with your legs slightly raised. Doctor of pharmacy candidate in the School of Pharmacy at the University of Waterloo in Ontario. In these patients, bleeding will usually stop spontaneously. That's because to prevent infection from spreading throughout the body, a healthcare provider must properly drain it. Accessed September 9, 2019. Injection Site Reactions, Fever, Swelling, and More, Nicole Galan, RN, is a registered nurse and the author of "The Everything Fertility Book.". The sclerotherapy solution causes the vein to scar. After-care information can be given to patients or parents before vaccines are administered, leaving the parent free to comfort the child immediately after the injection. Treatment for SIRVA is the same as treatment for routine inflammatory injuries.1,2. We encourage readers to share some of their practice experience: the neat little tricks that solve difficult clinical situations.