As I’ve mentioned before, I’m currently on a travel nursing assignment providing Covid-19 testing and vaccinations. We’ve given over 11,000 vaccinations in this community and I’ve given a few hundred of them myself. One constant is that no one looks forward to getting an injection. It isn’t fun, and they don’t feel good. Sometimes they are downright painful. Here are some tricks you can use to minimize your patient’s anxiety.
Easy, Nonpharmacologic Tips To Decrease Injection Pain
Apply pressure. Research shows that applying manual pressure before an injection decreases the *perception* of pain. Almost like it primes the nerves in the area. I do this by scrubbing the injection site with an alcohol pad in the recommended circular motion to achieve this. Remember to allow the alcohol to dry before injecting or it can cause a burning sensation.
Be quick! IM injections should be given at a 90-degree angle in a quick, darting motion. Inject at a rate of 1ml/10 seconds and withdraw just as quickly as inserted. Apply light pressure afterward but do not massage or scrub so that the medication stays within the muscle.
Relax. The patient, not you. (Ok, maybe you too). No one likes getting shots. The patient is usually sitting in dread as you prepare your supplies. I have all my patients dangle their arm by their side and tell them to relax. You can watch as their shoulders physically slump. They aren’t even aware of how tense they are! A contracted muscle increases pain so it is vital to relax.
Consider the Z-Track method. Think far back to nursing school. We were taught the Z-track method as the best way to administer an IM injection. This allows you to pull the tissue to the side, inject the medication, then release, trapping the medication in the muscle so it can’t seep into surrounding tissue. This prevents leakage of medication and potentially decreases irritation. This is usually a technique saved for other injection sites, but it can be used for any intramuscular injection.
Choose the right needle size. This depends on your patient’s body type and muscle mass. A large, 250-pound man or someone with a well-developed deltoid can handle a 1.5-inch needle. While a frail, elderly person with an atrophied muscle may only need a 1-inch needle. Usually with IM injections it is not necessary to “bunch up” the skin because we want to make sure it is going into the muscle, not subcutaneous tissue. If a patient’s muscle site is very small, bunching (holding the tissue between your thumb and fingers) may be necessary to increase surface area.
A pain sensation will also depend on the drug being administered, the drug volume, muscle site, and needle size. Some medications are thicker, require a slower injection, and are irritating to tissues.
Injection Pain is Often Unavoidable
Despite all your best efforts, some people have a low pain tolerance. Others may be so fearful of needles that no trick will work. Another tip you can try is distracting your patient. Ask them questions or chat about the weather. I love when my patients have tattoos and I can joke about using their tattoo as a target. Some patients want a countdown so they are prepared while others say “don’t tell me!” so they don’t tense up. No matter what techniques you try, the best thing you can do is just get it over with.