What Are the Best Intramuscular Injection Sites? Bookshelf FOIA These types of reactions are typically mild and resolve in a day or two without treatment. Accessed Nov. 11, 2022. Some tips for IM injection administration are listed in the table.5, SHOULDER INJURY RELATED TO VACCINE ADMINISTRATION. A single copy of these materials may be reprinted for noncommercial personal use only. 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. Authors Harsha Shanthanna 1 , Jason W Busse. Use a piece of gauze to apply light pressure to the injection site. If you have any of the following symptoms after an injection, seek medical attention right away. You should never squeeze abscesses. Tiny air bubbles can rise in the blood. An injection site reaction is your body's response to an immunization or other injection at the site where it was administered. This should be loose enough that you can slide a finger beneath it but still give a feeling of firm support. If there is blood, it means the needle is in a blood vessel and not a muscle. Vaccine administra- tion: intramuscular injections. Managing diabetes involves taking regular injections of insulin to manage blood sugar levels. The efficacy of vaccines administered outside the proper injection site is not guaranteed or quantified. 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. Injection site reactions are usually mild when they do occur. Disturbance of the menstrual pattern after local injection with Case reports that mention SIRVA also describe other shoulder injuries that can occur when landmarking is not performed correctly. Patients: After care Ice the area immediately after injection as described above. It is essential to ask a doctor or pharmacist which size needle to use before giving an injection. Subcutaneous injection can be used to give many types of medications for various medical conditions. CDC website. We thank Adrian Poon, who designed the infographic. RhoGAM is a shot given to pregnant people whose blood is negative for Rhesus factor (Rh) protein but who are carrying an Rh-positive fetus. Vaccine administration practices. 2005-2023 Healthline Media a Red Ventures Company. This site is difficult for self-injection and may require the help of a friend, family member, or caregiver. Can diet help improve depression symptoms? official website and that any information you provide is encrypted Your health care provider might tell you to avoid hard exercise for two weeks after the procedure. Blood Aspiration During IM Injection The World Health Organization and Centers for Disease Control and Prevention no longer recommend aspiration during intramuscular (IM) injections. However, they can also happen at the healthcare providers office or hospital if the person administering the injection does not adhere to aseptic techniques. 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. (2017, August 29). 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. Then your care provider uses a small needle to slowly put solution into the vein. An evidence based protocol for the prevention of upper arm injury related to vaccine administration (UAIRVA). Other treatments you've had for varicose veins and the results. You may experience . Pharmacists and other immunizers should continually review the proper administration technique to be sure to provide the safest administration possible. 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. Shoulder injury related to vaccine administration is an under-reported, preventable series of events caused by incorrect technique or landmarking for intramuscular deltoid injections. Would you like email updates of new search results? Oxytocin injected into a vein or muscle for reducing blood loss after If you received a cortisone shot in your knee, stay off your feet when you can. Evid Based Med. This article explains some serious injection reactions that you should be aware of and what to do if you experience them. Intramuscular injections are a common practice in modern medicine. What Is the Ventrogluteal Injection Site? - WebMD At the bottom of the two fingers will be an upside-down triangle. cdc.gov/vaccines/hcp/acip-recs/general-recs/ adverse-reactions.html. The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Veins that respond to treatment generally don't come back. This is likely if the veins are causing symptoms. Two finger-widths below this, there is a triangular muscle. These types of reactions are typically mild and resolve in a day or two without treatment. But symptoms might include seeing light flashes, having headaches, fainting and having nausea. Immunization Technique for Intramuscular (IM) Injections - Deltoid Muscle 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. To locate this site, feel for the bone (acromion process) thats located at the top of your upper arm. Light bleeding at the injection site is normal, but a person can use a bandage if necessary. It is essential to seek medical assistance if a person experiences prolonged or severe side effects after their injection. Recommended site: Deltoid muscle in the upper arm Use anatomical landmarks to determine the injection site. 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. 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 (. Divide the upper thigh into three equal parts. These symptoms are thought to occur as a result of unintended injection of vaccine antigen or trauma from the needle going into and around the underlying bursa of the shoulder, resulting in an . Can poor sleep impact your weight loss goals? Intramuscular injection: Locations and administration - Medical News Today Therefore, doctors do not use it for drugs that require larger quantities. People can follow the instructions on the package if they are using an auto-injector. While swelling and minor bruising can happen after a shot, they usually getbetter within a day or so. When a needle breaks the skin, it may cause a small amount of pain; however, what constitutes an actual injection-site reaction? The person receiving the injection should get into a position that is comfortable, provides easy access to the location, and keeps the muscles relaxed. Postoperative bleeding is bleeding after surgery. This is because muscle tissue has a greater blood supply than the tissue just under your skin. What to know about different types of injections. When blood pools in the veins, the veins become larger, making them show under the skin. Thus, shoulder injury related to vaccine administration is a term that describes improper landmarking of vaccinations that results in shoulder injuries such as adhesive capsulitis or bursitis. Theyre used to deliver drugs and vaccines. To minimize possible discomfort before your injection: Its typical to experience some discomfort after an intramuscular injection. Mishra P, et al. The purpose of this study was to investigate the technique registered nurses (RNs) use during IM injections and incidence of blood aspiration. A doctor may use an intramuscular shot if: Intramuscular injections have other advantages too. In this article, we explain where and how to administer an intramuscular injection. 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. 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 NEW and the OLD intramuscular injection sites. Cough or blow before or during the injection. The injection site will be approximately 2 inches below the Remove air bubbles by gently tapping the syringe and pressing the plunger. PRISMA flowchart of the systematic, Figure 2. You have questions about how to give an injection. Results of sclerotherapy for small varicose veins or spider veins usually show in 3 to 6 weeks. Use a numbing cream on the area a few minutes before the injection. Reviewed July 12, 2017. 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. Understanding Post-Injection Inflammation - Saint Luke's Health System If a lump of clotted blood forms in a treated vein, it might need to be drained. 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. Scovell S. Injection sclerotherapy techniques for the treatment of telangiectasias, reticular veins and small varicose veins. For example, certain drugs that treat multiple sclerosis or rheumatoid arthritis may require self-injection. We include products we think are useful for our readers. All rights reserved. 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. Sclerotherapy treats veins that are twisted and enlarged, known as varicose veins. Draw air into the syringe by pulling back the plunger. Find out about the benefits of common insulin injection, Injections of human growth hormone or HGH are used medically in children and adults. Before putting medication into the syringe, warm the vial up by rubbing it between the hands. 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. Javier J, Gutierrez P, Munakomi S. Stat Pearls Publishing [Internet] Treasure Island, FL: StatPearls Publishing; 2022. The injection site is in the middle of the deltoid muscle, about 2.5 to 5 cm (1 to 2 inches) below the acromion process. VAERS website. Typically, any minor discomfort goes away in one or two days. gov/vaccines/hcp/vis/about/facts-vis.html. Am J Emerg Med. Snell Anatomy by Regions Edition 9. Whiting P, Savovi J, Higgins JP, et al. The authors received no specific funding for this study except for the journal publication charges. 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. PDF Vaccine Administration: Intramuscular (IM) Injection Adults 19 years of You lie on your back with your legs slightly raised. Injection site reactions can vary depending on if the shot was subcutaneous (under the skin), intravenous (in a vein), or intramuscular (in a muscle). Sign In to Email Alerts with your Email Address. Sclerotherapy is usually done to make the veins look better. Apply a plaster or wound pad to the area if there is any bleeding. If person has a . The collapsed vein then fades. Withdraw the needle quickly and discard it into a puncture-resistant sharps container. Be sure to thoroughly scrub between your fingers, on the backs of your hands, and under your 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 General rule #6. Being in the sun can lead to dark spots on the skin, especially for those with dark skin. To prevent blood clots, your nurses get you up as soon as possible after your operation. Pain relievers can be used to treat fever and injection-site pain that might occur after vaccination. Doctor of pharmacy candidate in the School of Pharmacy at the University of Waterloo in Ontario. Shoulder injury related to vaccine administration (SIRVA) is a preventable occurrence caused by the injection of a vaccine into the shoulder capsule rather than the deltoid muscle. Triangular injection site, formed by an apex based on a line drawn laterally, Figure 5. 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. your particular bleeding disorder. Steroid Injections: Purpose, Treatment, Side Effects - Healthline FAQs. Following an injection, the most severe reaction is an all-body allergic response known as anaphylaxis. However, you might need more than one treatment to get the results you want. Varicose veins (adult). We developed an infographic (Figure 1), also available at CFPlus,* to guide all health professionals in proper injection administration and the prevention of SIRVA. Doctors administer most injectable vaccines into the muscles. Wear loose, comfortable clothing. 2017 Sep 2;13(9):2123-2129. doi: 10.1080/21645515.2017.1334747. 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. Deep vein thrombosis carries a risk of a blood clot traveling from the leg to the lungs and blocking a vital artery. Recent illnesses or medical conditions, such as a heart condition or a history of blood clots. PubMed, Google Scholar, and Websites of National Public Health Agencies were searched from 1950 up to 2022 for articles, advisories, and National Immunization Guidelines using Medical Subject Headings (MeSH) terms, including IMIs, deltoid muscle, safe injection sites, to identify recommendations for safer sites and techniques of administering deltoid IMIs. Side Effects. 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. These symptoms usually go away. After your cortisone shot, your doctor might ask that you: Protect the injection area for a day or two. J Allergy Clin Immunol. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Wearing compression stockings or bandages usually for about two weeks will keep pressure on the treated veins. The sclerotherapy solution causes the vein to scar. In some cases, a person may also self-administer an intramuscular injection. Read through the steps several times until you feel comfortable with the procedure and take your time. Thank you for your interest in spreading the word on The College of Family Physicians of Canada. Structures underlying the deltoid muscle. Anaphylaxis develops very quickly and needs to be treated immediately with a shot of epinephrine (adrenaline). The following steps can help people deliver a safe injection into a muscle: Wash the hands thoroughly with soap and warm water. Avoid touching the needle to ensure it stays clean. Distract yourself with a movie, video game, or conversation. Even the most experienced health care professionals can develop bad habits and need to polish their skills periodically. You should not put any of these materials into the regular garbage, as needles can be hazardous to anyone who handles the trash. 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. 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. Mayo Clinic does not endorse companies or products. 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. Aspiration is not necessary or recommended. Kang S, et al., eds. 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. If so,. 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 needle used for subcutaneous injection is usually small and short and causes minimal discomfort. Avoid having the treated areas in sun for two weeks, as well. 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. https://www.womenshealth.gov/a-z-topics/varicose-veins-and-spider-veins. 2018;141(2):463-472. doi:10.1016/j.jaci.2017.12.971, Long B, Gottlieb M. Emergency medicine updates: anaphylaxis. However, the likelihood of hitting a blood vessel in the subcutaneous fat is extremely rare. 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. -. About VAERS. J Int Med Res. MNT is the registered trade mark of Healthline Media. They encourage you to move around or do your leg exercises. Understanding the basics: general recommendations on immunization. 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. reactions. It's a very rare complication of sclerotherapy that needs immediate medical care. 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. Medical management of vaccine reactions in adults in a community set- ting. The procedure also can improve symptoms related to varicose veins, including: Experts suggest waiting to have sclerotherapy done after pregnancy or breastfeeding.