Warm the vial of medication by rubbing it between your hands prior to drawing the medication into the syringe. To return blood to the heart, the veins in the legs must work against gravity. It is essential to seek medical assistance if a person experiences prolonged or severe side effects after their 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. Take five deep breaths or encourage children to breathe deeply before the shot. the particular drug would irritate the veins, the digestive system would render pills ineffective, a puncture-resistant container to dispose of the needle. The injection site will be approximately 2 inches below the Advertising revenue supports our not-for-profit mission. 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. cdc.gov/vaccines/hcp/acip-recs/general-recs/ adverse-reactions.html. A healthcare professional should provide people with training and education before asking them to administer intramuscular injections to themselves or another person. If you received a cortisone shot in your knee, stay off your feet when you can. Press down on the plunger of the syringe to inject the medication. We avoid using tertiary references. Unable to load your collection due to an error, Unable to load your delegates due to an error, The image was created and edited by Dr. Shalom Philip, Senior Resident, AIIMS Rajkot. Reviewed June 21, 2019. Other complications are much less frequent and include: Injecting a blood vessel can cause serious complications in rare cases. Healthline only shows you brands and products that we stand behind. While the prevalence of SIRVA in Canada is unknown, as it is under-reported,1 the global increase in case reports demonstrates that SIRVA is a developing topic. When a medication is injected directly into muscle, it is called an intramuscular injection (IM). Intramuscular (IM) injections are used to deliver medication deep into your muscles. 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. 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. Your doctor or pharmacist will give you specific guidelines about which needle and syringe are appropriate to administer your medication. In addition to VAERS, health care providers should familiarize themselves with the National Vaccine Injury Compensation Program (VICP). Triangular injection site, formed by, Figure 4. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. -. An intramuscular injection delivers medication into a muscle. J Clin Epidemiol. Mayo Clinic does not endorse companies or products. Renita White, MD, FACOG, is a board-certified obstetrician/gynecologist who practices at Georgia Obstetrics and Gynecology. J Allergy Clin Immunol. Medicines or supplements you take, especially aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox DS), blood thinners, iron supplements or herbal supplements. Injection site reactions can vary depending on if the shot was subcutaneous (under the skin), intravenous (in a vein), or intramuscular (in a muscle). (2021). Heart failure: Could a low sodium diet sometimes do more harm than good? To prevent blood clots, your nurses get you up as soon as possible after your operation. 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. When a needle breaks the skin, it may cause a small amount of pain; however, what constitutes an actual injection-site reaction? This is known as a pulmonary embolism. Nakajima Y, Mukai K, Takaoka K, Hirose T, Morishita K, Yamamoto T, Yoshida Y, Urai T, Nakatani T. Hum Vaccin Immunother. The bleeding may start immediately, or several days after surgery. Reviewed April 5, 2019. Can an Armpit Lump Be a Symptom of Breast Cancer? Intramuscular injections are used when other types of delivery methods are not recommended. Before giving the shot, get the following items ready: A doctor should provide advice on the type of needle to use. Turn the vial and syringe upside down so that the needle points upward. Weakened valves, also called incompetent valves, within the veins might cause varicose veins. Draw back the plunger to fill the syringe with the correct amount of medication. When to Call Your Healthcare Provider About an Injection Side Effect. Hum Vaccin. (n.d.). Use a numbing cream on the area a few minutes before the injection. Shoulder injury related to vaccine administration is an under-reported, preventable series of events caused by incorrect technique or landmarking for intramuscular deltoid injections. There are several possible locations for administering intramuscular injections, including the shoulder, hip, and thigh. However, they can also happen at the healthcare providers office or hospital if the person administering the injection does not adhere to aseptic techniques. The tissue in the muscles can also hold more medication than fatty tissue. After your cortisone shot, your doctor might ask that you: Protect the injection area for a day or two. Postoperative bleeding is bleeding after surgery. All rights reserved. You can learn more about how we ensure our content is accurate and current by reading our. 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. Don't shave your legs or use lotion on them. If a lump of clotted blood forms in a treated vein, it might need to be drained. Last medically reviewed on September 19, 2018, A subcutaneous injection is an injection into the 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. Thank you, {{form.email}}, for signing up. 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. 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 . Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Before doctors began using the hip as an injection site, they used the dorsogluteal muscles in the buttocks. 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. 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. official website and that any information you provide is encrypted Kang S, et al., eds. However, due to the potential for injury to the sciatic nerve, the ventrogluteal muscle is most often used instead. Shoulder injury related to vaccine administration is an under-reported, preventable series of events caused by incorrect technique or landmarking for intramuscular deltoid injections.1,2 Specifically, SIRVA occurs when an intramuscular deltoid injection is administered into the shoulder joint.1,2 This results in an inflammatory process that causes damage to the musculoskeletal structures including the bursae, tendons, and ligaments.2 The main symptoms include persistent shoulder pain and a limited range of motion.2 The keys to distinguishing SIRVA are that the symptoms typically begin within 48 hours of vaccine administration and that they do not improve with over-the-counter analgesic medications.2 Patients will often visit their physicians months later because they are not able to carry out daily tasks that were possible before the vaccination.2 These patients are often diagnosed with inflammatory injuries such as bursitis, rotator cuff tears, and adhesive capsulitis.1,2 During physical examination and on ultrasound scan, SIRVA will not appear to be any different from routine shoulder injuries. Limitations included the unavailability of free access to complete text in many articles resulting in exclusion. 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. We avoid using tertiary references. They help save lives by preventing disease. Blood Aspiration During IM Injection The World Health Organization and Centers for Disease Control and Prevention no longer recommend aspiration during intramuscular (IM) injections. The symptoms include trouble breathing, chest pain or dizziness, or coughing up blood. Zone between the halfway point, Figure 7. 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). 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. Find out about the benefits of common insulin injection, Injections of human growth hormone or HGH are used medically in children and adults. Philadelphia, USA: Wolters Kluwer: Lippincott Williams & Wilkins; 2015. Sclerotherapy also treats spider veins, a mild form of varicose veins. When a needle breaks the skin, it may cause a small amount of pain; however, what constitutes an actual injection-site reaction? Heart failure: Could a low sodium diet sometimes do more harm than good? 2017 Sep 2;13(9):2123-2129. doi: 10.1080/21645515.2017.1334747. However, if swelling and discoloration persist, it may signify an infection. Is the ketogenic diet right for autoimmune conditions? FAQs. Doctors frequently use intramuscular injections to administer vaccines and certain other drugs. CDC website. Please enable it to take advantage of the complete set of features! doi: 10.1136/eb-2013-101582. People should avoid self-administering medications into the dorsogluteal muscles. Enter multiple addresses on separate lines or separate them with commas. and transmitted securely. Sclerotherapy involves using a needle to put a solution into the vein. 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 (. A doctor will help remove the needle. If you have any of the following symptoms after an injection, seek medical attention right away. People can follow the instructions on the package if they are using an auto-injector. 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. Too many injections in the same location can cause scarring and skin changes. The authors have declared that no competing interests exist. Mastering the technique of injecting at home can take some practice. Locate the middle of these three sections. When blood pools in the veins, the veins become larger, making them show under the skin. Accessed Nov. 11, 2022. Shoulder injury related to vaccine administration (SRIVA) is a serious complication that can be caused by the immunizer administering the vaccine into the shoulder capsule, rather than into the deltoid muscle.6 The resulting damage can be hard to diagnose and is not something that can be treated at the pharmacy. The sclerotherapy solution causes the vein to scar. Assistant Professor in the School of Pharmacy at the University of Waterloo. 1961;61:5657. Theyll be 22-gauge to 25-gauge thick, noted as 22g on the packaging. 1,2 This results in an inflammatory process that causes damage to the musculoskeletal . 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). While many infections occur due to a self-administered injection, such as with diabetes or autoimmune disorders. AskMayoExpert. 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. Surgical problems can cause postoperative bleeding. Before sclerotherapy, a health care provider might ask for an ultrasound test of the legs. What are the different types of injection? You may experience . 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. Extreme bleeding (blood flows visibly at the surgery site) can be controlled by rinsing or cleaning old clots from the mouth first, then placing gauze (folded to about 1 square inch) over the part biting vigorously for half an hour. Injection site reactions are usually caused by an immune response to the needle, vaccine, or other medicine. What is SIRVA? -, The NEW and the OLD intramuscular injection sites. Some side effects may take months or longer to go away completely. To isolate the muscle and target where youll place the injection, spread the skin at the injection site between two fingers. These types of reactions are typically mild and resolve in a day or two without treatment. Patients: After care Ice the area immediately after injection as described above. The provider might tape a pad onto the injection site to keep pressure on the area before moving on to the next vein. 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. Avoid touching the needle to ensure it stays clean. To minimize possible discomfort before your injection: Its typical to experience some discomfort after an intramuscular injection. Generally, needles should be 1 inch to 1.5 inches for an adult and will be smaller for a child. Bancsi A, Houle SKD, Grindrod KA. 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. The most common side effect of a cortisone shot is pain at the injection site. These may include a little swelling, tenderness, pain, itching, or redness around the area where the injection was given. www2.cdc.gov/nip/isd/ycts/mod1/courses/genrec/10907. Certain reactions to an injection are potentially serious and should be evaluated by a healthcare provider. An evidence based protocol for the prevention of upper arm injury related to vaccine administration (UAIRVA). vaers.hhs.gov/about.html. Use the index finger and thumb to stabilize the syringe while using the other hand to pull back on the plunger slightly to look for blood. Intramuscular injections are often given in the following areas: The deltoid muscle is the site most typically used for vaccines. Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia. That's because to prevent infection from spreading throughout the body, a healthcare provider must properly drain it. You can get up and walk around soon after the procedure. Typically, veins return blood from the rest of the body to the heart. Sign In to Email Alerts with your Email Address. The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Bethesda, MD 20894, Web Policies Accessed September 11, 2019. 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. The number of shots depends on the number of veins being treated. Some subcutaneous injections come in the form of an auto-injector. Healthcare professionals often give intramuscular injections into the ventrogluteal muscle of the hip. Have someone you trust give you the injection. 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. Clean the skin with the alcohol swab and allow to air-dry. Left upper arm where the distance measured from point a to b is, MeSH Immunization Action Coalition website. Repeat this procedure if needed. Hum Vaccin Immunother. 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. Oxytocin is one such drug. Read more about these alternatives to traditional statin, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. 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. Avoid spitting, as this might cause bleeding. MNT is the registered trade mark of Healthline Media. The injection point is between the armpit and shoulder. Clean the site selected for injection with an alcohol swab and allow the skin to air dry. Pain relievers can be used to treat fever and injection-site pain that might occur after vaccination. This should be loose enough that you can slide a finger beneath it but still give a feeling of firm support. 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. Typically, any minor discomfort goes away in one or two days. Or it may start hours after the injection. In this article, find, Trigger point injections can help relieve chronic muscle pain. 2017 Jul 1;216(suppl_1):S152-S160. "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. Sclerotherapy usually works best on small varicose veins. This type of response can occur if thebody reacts adversely to the injected medication, causing acascade of severe and potentially life-threatening symptoms. 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. Keywords: When AEs occur, pharmacists should utilize VAERS so that the events may be studied to help identify any issues with a particular vaccine. 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. Health Resources and Services Administration website. The purpose of this study was to investigate the technique registered nurses (RNs) use during IM injections and incidence of blood aspiration. Wear loose, comfortable clothing. Most people return to their regular activities on the same day, but you might want to have someone drive you home after the procedure. 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. Am J Emerg Med. We include products we think are useful for our readers. What are intramuscular injections used for? Intramuscular injections are absorbed faster than subcutaneous injections. Affiliation 1 Department of Anesthesia, McMaster . Some may be easily treated, while others may be far more serious and lead to a potentially deadly, all-body reaction (such asanaphylaxis or sepsis). A lump under the skin thatfeels soft, mushy, and painful may indicate a developing abscess. When in doubt about whether or not to report an event, the best decision is usually to report it and keep an accurate record of all patients who are experiencing the same type of AE. 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.