VAERS website. We include products we think are useful for our readers. Try putting ice on the area to numb it a few minutes before the injection. The tissue in the muscles can also hold more medication than fatty tissue. Apply ice to the injection site as needed to relieve pain. Vaccine administration practices. Jung Kim H, et al. Reviewed July 12, 2017. If you received a cortisone shot in your knee, stay off your feet when you can. When AEs occur, pharmacists should utilize VAERS so that the events may be studied to help identify any issues with a particular vaccine. On the outside of the arm above the armpit in the deltoid muscle. journals.sagepub.com/doi/10.1177/0300060514531924, nursingtimes.net/clinical-archive/medicine-management/are-techniques-used-for-intramuscular-injection-based-on-research-evidence-16-12-2008/, onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2009.02177.x, cdc.gov/handwashing/when-how-handwashing.html, cdc.gov/vaccines/pubs/pinkbook/vac-admin.html, Zara Risoldi Cochrane, Pharm.D., M.S., FASCP, Insulin Injection Sites: Where and How to Inject. When the body secretes too little of its own HGH, it can cause, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. For women who weigh 152-200 lbs (70-90 kg) and men . You may notice minor bleeding after the injection. The following steps can help people deliver a safe injection into a muscle: Wash the hands thoroughly with soap and warm water. The site is secure. 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. Javier J, Gutierrez P, Munakomi S. Stat Pearls Publishing [Internet] Treasure Island, FL: StatPearls Publishing; 2022. Many doctors offices have these available. They encourage you to move around or do your leg exercises. What is the latest research on the form of cancer Jimmy Carter has? Heres how to administer, Low levels of the male hormone testosterone affect muscle mass, bone density, and more. For example, certain drugs that treat multiple sclerosis or rheumatoid arthritis may require self-injection. Wempe BM. A lump under the skin thatfeels soft, mushy, and painful may indicate a developing abscess. Bethesda, MD 20894, Web Policies Anaphylaxis develops very quickly and needs to be treated immediately with a shot of epinephrine (adrenaline). Intramuscular (IM) injections are used to deliver medication deep into your muscles. Sclerotherapy involves using a needle to put a solution into the vein. 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. 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. Jung Kim H, Hyun Park S. Sciatic nerve injection injury. Zone between the halfway point, Figure 7. Vaccines are very safe, with minimal risk for AEs. For instance, if you received a cortisone shot in your shoulder, avoid heavy lifting. People should avoid self-administering medications into the dorsogluteal muscles. You can learn more about how we ensure our content is accurate and current by reading our. Sclerotherapy is usually done to make the veins look better. 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. Rarely, a blood clot can travel to a deeper vein in the leg, a condition known as deep vein thrombosis. Importance. A sharps container is a red container that you can purchase at any pharmacy. What causes postoperative bleeding? Providers often use subcutaneous injections for medications that must be absorbed into the bloodstream slowly and steadily, such as insulin. Recent illnesses or medical conditions, such as a heart condition or a history of blood clots. PRISMA flowchart of the systematic, Figure 2. An intramuscular injection delivers medication into a muscle. Facts about VISs. Nakajima Y, Mukai K, Takaoka K, et al. gov/vaccines/hcp/vis/about/facts-vis.html. Abnormal vaginal bleeding after epidural steroid injection: is there a cause for concern? A new class of self-injectable medications are showing promise in treating high cholesterol. However, due to the potential for injury to the sciatic nerve, the ventrogluteal muscle is most often used instead. Accessed September 9, 2019. Intramuscular injections are a common practice in modern medicine. 2021; doi:10.1002/14651858.CD001732.pub3. Epub 2011 Aug 1. The collapsed vein then fades. To give a subcutaneous injection, people should follow these steps: The best location for a subcutaneous injection depends on a persons pain sensitivity and where they have some subcutaneous fat. Clean the site selected for injection with an alcohol swab and allow the skin to air dry. (n.d.). Draw back the plunger to fill the syringe with the correct amount of medication. If there is blood, it means the needle is in a blood vessel and not a muscle. What Are the Best Intramuscular Injection Sites? Cough or blow before or during the injection. The area around the shoulder joint and up to the lower level of the intertubercular sulcus is highly vascularized by the presence of many anomalous arterial patterns. cdc.gov/vaccines/hcp/acip-recs/general-recs/ adverse-reactions.html. 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. A single copy of these materials may be reprinted for noncommercial personal use only. 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. To locate this site, feel for the bone (acromion process) thats located at the top of your upper arm. But call your health care provider for problems with moving or feelings in arms or legs after the procedure. However, the likelihood of hitting a blood vessel in the subcutaneous fat is extremely rare. It typically manifests as swelling, pain, rash, redness, or bleeding. Clean the wound with soap and water, and cover it with a bandage, if needed, to protect it. The provider might tape a pad onto the injection site to keep pressure on the area before moving on to the next vein. Medicines or supplements you take, especially aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox DS), blood thinners, iron supplements or herbal supplements. You should insert the needle in a quick but controlled manner. 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. 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. Sclerotherapy is typically done in a health care provider's office. A subcutaneous injection or shot is one into the fatty tissues just beneath the skin. 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. Apply a plaster or wound pad to the area if there is any bleeding. Please ask the person administering the vaccine for a compression bandage to the injection site. At the bottom of the two fingers will be an upside-down triangle. Other complications are much less frequent and include: Injecting a blood vessel can cause serious complications in rare cases. If you buy through links on this page, we may earn a small commission Heres our process. Are techniques used for intramuscular injection based on research evidence? Numb the injection site with ice or a numbing cream before cleaning the skin with the alcohol swab. Can an Armpit Lump Be a Symptom of Breast Cancer? Your doctor or pharmacist will give you specific guidelines about which needle and syringe are appropriate to administer your medication. To locate this area, lay three fingers across the deltoid muscle and below the acromion process. What are intramuscular injections used for? 2020 Dec;213 Suppl 11:S3-S32.e1. It is essential to seek medical assistance if a person experiences prolonged or severe side effects after their injection. Push down on the plunger of the syringe slowly, then withdraw the needle once all the contents have been administered. 9th ed. To locate the ventrogluteal muscle on someone else, place the heel of the hand on the hip, with the fingers pointing toward the head. -. This muscle is in the upper arm near the shoulder. Careers. reactions. Injections that occur below the deltoid muscle can hit the radial nerve and injections that are too far to the side of the deltoid muscle can hit the axillary nerve.3,4 If a nerve is hit, the patient will feel an immediate burning pain, which can result in paralysis or neuropathy that does not always resolve.3,4, Proper landmarking includes determining the injection zone of the deltoid muscle, including the upper and lower borders of a safe injection area.4 This technique has been developed and recommended by content experts in order to avoid injury to the surrounding structures of the deltoid muscle. 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. Position your fingers so your thumb points toward their groin and you feel the pelvis under your pinky finger. Some veins need more than one sclerotherapy treatment. As a result, inflammation of the shoulder structures causes patients to experience pain, a decreased range of motion, and a decreased quality of life. Determination of safe sites of intramuscular arm injections and its relevance to the community. Sometimes there is a little spot of blood as the needle may have hit a capillary, but to keep bleeding, no, not if nothing done to keep it bleeding by squeezing or poking it, which you would not normally be doing, and even then, shouldn't be much. (2010). Hum Vaccin Immunother. For men and women who weigh 130-152 lbs (60-70 kg), a 1-inch needle is sufficient. Intramuscular injections are absorbed faster than subcutaneous injections. The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Enter multiple addresses on separate lines or separate them with commas. You should not use an injection site that has evidence of infection or injury. Your muscles have lots of blood flowing through them, so medications injected into them are quickly absorbed. There is a lump, swelling, or bruising where the injection was given that does not go away. If a lump of clotted blood forms in a treated vein, it might need to be drained. Injection site reactions are usually mild when they do occur. Healthline Media does not provide medical advice, diagnosis, or treatment. Bancsi A, Houle SKD, Grindrod KA. The following discussion describes the adverse effects (AEs) that make up true injection-site, or local, reactions and how pharmacists should respond to them. Take five deep breaths or encourage children to breathe deeply before the shot. 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. Subcutaneous injection technique: An evidence-based approach. This study analyzes the procedures of administering IMIs in the deltoid related to the neurovascular network underlying the muscle and proposes a preferred site with the least chance of injury. Can poor sleep impact your weight loss goals? Awareness is crucial to identifying patients who are displaying signs of this injury so they can access treatment in a timely manner. 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 have any of the following symptoms after an injection, seek medical attention right away. The key to preventing SIRVA and other vaccine injuries is to always use landmarking. 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/. The incision may bleed, but bleeding can also occur inside the body. Have someone you trust give you the injection. 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 A caregiver, friend, or family member can assist with injections into this muscle. Accessibility Generally, you need to wait about six weeks before having another sclerotherapy session. Doctor of pharmacy candidate in the School of Pharmacy at the University of Waterloo in Ontario. More than likely, if there is blood, it is from slight bleeding after the injection. Some tips for IM injection administration are listed in the table.5, SHOULDER INJURY RELATED TO VACCINE ADMINISTRATION. You have questions about how to give an injection. Is the ketogenic diet right for autoimmune conditions? Two finger-widths below this, there is a triangular muscle. 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. To prevent blood clots, your nurses get you up as soon as possible after your operation. Sclerotherapy generally has few serious complications. Disclaimer. Deep vein thrombosis carries a risk of a blood clot traveling from the leg to the lungs and blocking a vital artery. The person receiving the injection should get into a position that is comfortable, provides easy access to the location, and keeps the muscles relaxed. But symptoms might include seeing light flashes, having headaches, fainting and having nausea. It typically manifests as swelling, pain, rash, redness, or bleeding. On the outside of the thigh between the hip and the knee. J Int Med Res. 8600 Rockville Pike Remove the cap from the needle and push it through the top of the vial. Cardiovascular health: Insomnia linked to greater risk of heart attack. Pain relievers can be used to treat fever and injection-site pain that might occur after vaccination. This content does not have an Arabic version. Pharmacists and other immunizers should continually review the proper administration technique to be sure to provide the safest administration possible. Larger veins might take 3 to 4 months. Figure 2. All rights reserved. AskMayoExpert. This site in the dorsogluteal muscle is difficult to use for self-injection and is not recommended. The purpose of this study was to investigate the technique registered nurses (RNs) use during IM injections and incidence of blood aspiration. Patients: After care Ice the area immediately after injection as described above. 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. 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. Pain near the injection site can happen when inserting the needle at the wrong angle, or when it moves slightly during the injection. 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. Go to the full text of the article online and click on the CFPlus tab. Renita White, MD, FACOG, is a board-certified obstetrician/gynecologist who practices at Georgia Obstetrics and Gynecology. Before sclerotherapy, a health care provider might ask for an ultrasound test of the legs. sharing sensitive information, make sure youre on a federal Avoid spitting, as this might cause bleeding. An auto-injector is a self-contained device that does not require drawing the medication up first. What Are the Injectable Alternatives to Statins? Clipboard, Search History, and several other advanced features are temporarily unavailable. Heart failure: Could a low sodium diet sometimes do more harm than good? Vaccine recommendations and guidelines of the ACIP. You can even massage the area to help the medication be absorbed into the muscle. Epub 2013 Nov 26. However, this site is not common for self-injection because its small muscle mass limits the volume of medication that can be injected typically no more than 1 milliliter. It is a good idea for all health care providers who administer immunizations to familiarize themselves with VAERS to ensure they know what to do if an AE occurs. Use a bandage if necessary. Some side effects may take months or longer to go away completely. Be sure to thoroughly scrub between your fingers, on the backs of your hands, and under your fingernails. Then your care provider uses a small needle to slowly put solution into the vein. An intramuscular injection is a technique used to deliver a medication deep into the muscles. Medical management of vaccine reactions in adults in a community set- ting. You can get up and walk around soon after the procedure. 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. Generally, needles should be 1 inch to 1.5 inches for an adult and will be smaller for a child. -, The NEW and the OLD intramuscular injection sites. 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. But certain symptoms may be a sign of a more serious complication. Case reports that mention SIRVA also describe other shoulder injuries that can occur when landmarking is not performed correctly. Make sure you're taking your insulin the best way possible. Last medically reviewed on September 19, 2018, A subcutaneous injection is an injection into the fatty tissue. Injection Site Reactions, Fever, Swelling, and More, Nicole Galan, RN, is a registered nurse and the author of "The Everything Fertility Book.". Patients: After care Ice the area immediately after injection as described above. Affiliation 1 Department of Anesthesia, McMaster . 2018;141(2):463-472. doi:10.1016/j.jaci.2017.12.971, Long B, Gottlieb M. Emergency medicine updates: anaphylaxis. https://www.radiologyinfo.org/en/info/sclerotherapy. Left upper arm where the distance measured from point a to b is, MeSH Sclerotherapy of varicose veins and spider veins. Learn if testosterone injections work and if they're right for. Pain might result from the solution leaking from the vein into the tissue around it. Injection sclerotherapy for varicose veins (Review). Expert: Infusion Pharmacy Technicians Can Reduce Workload in Oncology Pharmacy, Clinical Forum Recap Data Show Melanoma Site to Be Independent High-Risk Factor for Recurrence, Poor Outcomes, Complete Immunization Services Start With Gathering Patient Information, Encouraging Immunization Information System Use in Community Pharmacy Practice, Exploring Techniques to Increase Vaccination Rates Among Adult Patients with Chronic Disease, The Community Pharmacist as a Provider of Immunizations, Injection-Site Reactions and How to Manage Them, Pharmacy Intern and Technician Roles in Immunizing Are Growing, HPV Update: Making Sense of the New ACIP Recommendations, Immunization Guide for Pharmacists November 2019. What are the complications of intramuscular injections? (2017, August 29). Before the procedure, a health care provider does a physical exam. They tend to avoid using these muscles now because of the potential risk of injury to the sciatic nerve. Can poor sleep impact your weight loss goals? Mastering the technique of injecting at home can take some practice. Therefore, doctors do not use it for drugs that require larger quantities. An intramuscular injection site, 7.4 cm below the mid-acromion (relatively safe much below, Figure 9. The sclerotherapy solution causes the vein to scar. Thank you for your interest in spreading the word on The College of Family Physicians of Canada. Don't use heating . the particular drug would irritate the veins, the digestive system would render pills ineffective, a puncture-resistant container to dispose of the needle. Do not push the plunger in. official website and that any information you provide is encrypted Minor discomfort after an intramuscular injection is normal. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. McGraw Hill; 2019. https://accessmedicine.mhmedical.com. It can take a month or more for full results. The review protocol was submitted with PROSPERO (ID: 319251). Reviewed April 5, 2019. Divide the upper thigh into three equal parts. Wearing compression stockings or bandages usually for about two weeks will keep pressure on the treated veins. The deltoid muscle is a large, rounded, triangular shape. Injection site reactions are usually caused by an immune response to the needle, vaccine, or other medicine. Veins that respond to treatment generally don't come back. However, as with all medications, there can be serious adverse reactions or side effects that require prompt medical care. Intramuscular injections. All rights reserved. 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. Am J Nurs. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Otherwise, it might cause stinging. 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. People should ask for help from a medical provider and not shy away from asking questions about the benefits of treatment or how best to minimize pain. Light bleeding at the injection site is normal, but a person can use a bandage if necessary. Injection site reactions can vary depending on if the shot was subcutaneous (under the skin), intravenous (in a vein), or intramuscular (in a muscle). 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. 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. Treatment for SIRVA is the same as treatment for routine inflammatory injuries.1,2. The provider might tape a pad onto the injection site to keep pressure on the area before moving on to the next vein. axillary nerve; deltoid muscle; intramuscular injections; needle depth; safe site for injection. You can learn more about how we ensure our content is accurate and current by reading our. People can receive intramuscular injections in the following areas: The deltoid muscle is the most common site for vaccines. An abscess is awalled-off collection of pus. Anaphylaxis can lead to shock, coma, or even death if left untreated. How to administer an intramuscular injection, Centers for Disease Control and Prevention (CDC). We avoid using tertiary references. An evidence based protocol for the prevention of upper arm injury related to vaccine administration (UAIRVA). The number of shots depends on the number of veins being treated. Mayo Clinic does not endorse companies or products. Turn the vial and syringe upside down so that the needle points upward. Mishra P, et al. It's a very rare complication of sclerotherapy that needs immediate medical care. Injection site reactions are usually caused by an immune response to the needle, vaccine, or other medicine.