Reducing Discomfort in Subcutaneous and Intramuscular Administrations
The following are recommended techniques for reducing discomfort when injecting medications subcutaneously or intramuscularly:
Select a needle of the smallest gauge that is appropriate for the site and solution to be injected and select the correct needle length.
Be sure the needle is free of medication that may irritate superficial tissues as the needle is inserted. The recommended procedure is to use two needles—one to remove the medication from the vial or ampule and a second one to inject the medication. If medication is in a prefilled syringe with a nonremovable needle and has dripped back on the needle during preparation, gently tap the barrel to remove the excess solution.
Consider application of manual pressure at the insertion site by pressing the insertion site firmly for 10 seconds before needle insertion. It has been suggested that this action stimulates the surrounding nerve endings, leading to a reduction in the sensory input from the injection and resulting decreased pain intensity (Chung et al., 2002; Öztürk et al., 2017).
Use the Z-track technique for intramuscular injections to prevent leakage of medication into the needle track, thus minimizing discomfort.
Inject the medication into relaxed muscles. More pressure and discomfort occur when the medication is injected into a contracted muscle.
Do not inject areas that feel hard on palpation or tender to the patient.
Insert the needle with a dartlike motion without hesitation and remove it quickly at the same angle at which it was inserted. These techniques reduce discomfort and tissue irritation.
Do not administer more solution in one injection than is recommended for the site. Injecting more solution creates excess pressure in the area and increases discomfort.
Inject the solution slowly so that it may be dispersed more easily into the surrounding tissue (10 seconds per 1 mL).
Apply gentle pressure after injection, unless this technique is contraindicated.
Allow the patient who is fearful of injections to talk about their fears. Answer the patient's questions truthfully and explain the nature and purpose of the injection. Taking the time to offer support often allays fears and decreases discomfort.
Rotate sites when the patient is to receive repeated injections. Injections in the same site may cause undue discomfort, irritation, or abscesses in tissues.
Consider age-appropriate nonpharmacologic methods for infants and children (American Academy of Pediatrics, 2019; CDC, 2020, 2021), such as breastfeeding, the administration of sweet solutions, front-to-front upright holding, rapid injection without aspiration, administration of the most painful vaccine last, tactile stimulation, and other distractions. Consider use of pain-relieving ointments or sprays at the injection site (American Academy of Pediatrics, 2019; CDC, 2020). Involve the child's parent/family/caregiver for support when possible (CDC, 2020).