Intradermal, Subcutaneous, and Intramuscular Injections: Clinical Nursing Skills |

[@LevelUpRN]

When I switched to intramuscular injections, I referred to the site as vastus lateralis when I'm actually demonstrating ventrogluteal. - Ellis

[@yasmiensharaan7321]

In IM is the bevel up as well?

[@sweettnt_homemade9111]

Thank you for clearing that up.

[@LevelUpRN]

@@yasmiensharaan7321 There's no way to bevel up an IM injection because you're inserting the needle at a 90 degree angle. - Ellis.

[@gaze9885]

​@@LevelUpRNyou have to aspirate it a little right,to check whether it's actually in the muscle or not, bcz if it's not in muscle then blood will come while aspirating na I don't know it's correct practice or not , but our tutors taught us this , need to do it or not

[@CelenaKaye35]

I am just a Medical Assistant student and a Pre-Nursing student, but I was recently taught that when you put the needle in, you do it strongly and swiftly, like confidently and kind of fast, especially for IM injections, and then we pull it out at the same angle we went in, also fairly strong and swift.

[@shaddymay96]

Thank you! This is great for us future Medical Assistants as well! 😉

[@annadorn7388]

I loved the instructional delivery. I'm not even a nurse. Muy Interesting.

[@LevelUpRN]

Glad you enjoyed it!

[@joycelynray6848]

this helped but i want to point out that the sight she is showing for intramuscular is actually the ventrogluteal and not the vastus laterus

[@LevelUpRN]

You are correct! I have a pinned comment explaining this slip-up. - Ellis

[@Nrsesand1]

Thank you for taking the time in sharing these videos.

[@LevelUpRN]

Very welcome!

[@chrishiggins1934]

Why did you release the pinched fat on SQ prior to injecting? I thought the whole point of pinching was to ensure placement in subcutaneous tissue. Doesn’t releasing negate this?

[@LoganLovell]

Thank you!! This was such a good refresher. Very well demonstrated

[@janetconran1146]

I was taught to withdraw to see if I entered a blood vessel. I was also taught to pinch the skin when administering an injection in the arm. Did they change this technique with evidence base practice as I witnessed none of that when I took my daughter to the pediatrician’s office. She also has a quarter size bruise. Are we not withdrawing or pinching skin up anymore?

[@LIMLG]

The Z track method is the recommended vaccine administration now and not the pinching of the skin.

[@penelopekeys8911]

Sorry I was meant to say, you did not withdraw the plunger once you had injected to make sure you are not in a blood vessel.

[@RanDeeCherry]

Thank you! I really enjoyed your video. Great job!

[@RogueOntheRoad]

For my insulin injections I try to find a spot where there are no pain nerves. The best area I've found is off from center on the stomach over near the side. It's about 6 to 7 inches from center. Doesn't seem to matter how high or low.

[@mohamedezzo4602]

thanks, love you from Egypt . شكرًا❤

[@victoriasfire]

Min. 4:43 you said you were demonstrating IM injection to the vastus lateralis site. No, you were not, because that is the thigh. You said "This is the rear end" which is the dorsogluteal. However, the site you demonstrating appeared to be what I learned in nursing school for the ventrogluteal. So the IM injection demo should be redone imo.

[@Noname-qk3hr]

Same thing I thought too

[@jamieusername]

Do you aspirate to make sure there is no blood when doing IM injection?

[@theotower268]

Although aspiration prior to intramuscular injection was standard practice until a few years ago, it is no longer recommended by the World Health Organisation and the Centres for Disease Control and Prevention

[@researchofufos1205]

🙏❤️ Excellent instructional video! G0D BLESSED!

[@ashimonyemary-frances4695]

My Chief Thanks for this video I noticed that during the IM, you didn't aspirate. Is it not necessary?

[@alvetareese7367]

The IM was given in the ventral gluteal muscle, not the vast us lateralis

[@JuliusRomeo-bn7xz]

Is a 1 inch needle enaugh to get to the muscle? And what size are I using

[@NaseerAhmad-ys9xv]

U r doing a great job.... Keep going!!!

[@xoxoxoxo1111]

You explain so well! Thank you 💕

[@LevelUpRN]

Thank you so much!

[@Nrsesand1]

Anything is helpful at this point. Worked as an LVN for a few years, got my RN in 2006, never worked as an RN. I completed a refresher course in 2019 then the pandemic started ;( I do not know where to go from here……

[@penelopekeys8911]

Sort of similar to my situation.

[@سبيستونالقديمه-ق8ض]

In the IM does her insert the needle verticaly or horizantly because it not clear for me

[@MichelleKorte-t1g]

Liked watching the Intramuscular injection z track method.

[@daysijimenez7244]

Aren’t you supposed to wait with the needle inserted at least 5-10 seconds when injecting IM medication?

[@tonyas8785]

Just wanted to see the arm for IM injection thank you tho this was great

[@dalejansen127]

To aspirate or not to aspirate...seems to be a bone of contention on multiple sites. Is this a "know your state/local/facility protocol/policy" item?

[@theotower268]

Although aspiration prior to intramuscular injection was standard practice until a few years ago, it is no longer recommended by the World Health Organisation and the Centres for Disease Control and Prevention

[@smchingu755]

Do we need to aspirate for IM injection?

[@theotower268]

Although aspiration prior to intramuscular injection was standard practice until a few years ago, it is no longer recommended by the World Health Organisation and the Centres for Disease Control and Prevention

[@Aliyah27312]

Can you demonstrate how to draw up medications and reconstitute??

[@LevelUpRN]

Great suggestion! Sending this suggestion to the team!

[@meltem__cvs]

heyy ı have a questıon?? should we do the aspiration on aour all IM ınjectıons because she dıdnt show ıt and our teacher saıd that we should aspirate first for precautıon

[@hax0n23]

Usually per institution policy, what I've learned is for vaccines aspiration is not required(per CDC). All other IM injections should be aspirated

[@cynthiawithers2555]

Great instructions.

[@LevelUpRN]

Glad it was helpful!

[@tatalhinotreasurehuntertv1620]

Great job.🎉🎉🎉

[@LevelUpRN]

Thank you! 😃

[@robertarowland728]

New subscriber, 💭 your content is extremely valuable and helpful ☕️ Thank You 🌤️

[@researchofufos1205]

Thanks 🙏 very useful instructions! G0D BLESSED Y0UR HEART ❤️

[@ukelilly]

How deep do you go with SQ and IM needle ? Half way ? All the way ?

[@LevelUpRN]

Generally, insert it all the way. That's why choosing the appropriate length is critical. If your IM needle is too long, you run the risk of it hitting bone.

[@penelopekeys8911]

You did not drawback the needle, for the intramuscular to make sure you are not in a blood vessel.

[@gervaisbotanyi7439]

For the ZTrack?

[@theotower268]

"Although aspiration prior to intramuscular injection was standard practice until a few years ago, it is no longer recommended by the World Health Organisation and the Centres for Disease Control and Prevention"

[@deebee1022]

Question: at the 4:40 time mark please clarify the type of injection demonstrated.

[@LevelUpRN]

Hello! I'm demonstrating an intramuscular injection in the vastus lateralis muscle. The next intramuscular injection uses the Z-track method. That is the only difference. - Ellis

[@adrianaguerrero9517]

Ventrogluteal?

[@deebee1022]

@@LevelUpRN I believe you said you were attempting a vastus lateralis when in fact you were showing a skill for a ventral gluteal injection

[@josephongogan8000]

Thank you 😭😭

[@hannyco2320]

I was just learning these in school, but we have to hold the needle after we stick it in and before we inject the solution. Is there a difference in the technique requirement in every state?

[@LevelUpRN]

Hi there! Could you describe more what you mean about holding the needle? - Ellis

[@ericahunt99]

I understand what you mean- you have to keep the syringe stabilized while your injecting the medication and keep your fingers stabilized on the syringe until the medication is injected.

[@palee4744]

What is the gauge needles size for each site

[@LevelUpRN]

It depends on your facility and your text book; our Clinical Skills flashcards cover our suggestions for needle length and gauge on cards 83 - 85!

[@LevelUpRN]

Intradermal: 25 - 27 gauge, ¼ - ½” needle. Subcutaneous: 25 - 30 gauge, ⅜ - ⅝” needle. Intramuscular: 20 - 25 gauge, 1 - 1.5” needle. :) Ellis

[@mm-zd9ml]

Pls could you be so kind of explaining again the reason the bevel should be pointing up?

[@LevelUpRN]

Absolutely! The bevel is where the medication will exit. If the bevel is pointing up, it allows the bleb (or bubble) to form under the skin. If the bevel is pointing down, the medication is injected towards the dermis tissue and the bleb will not form. - Ellis

[@mm-zd9ml]

@@LevelUpRN That's clears it up....but lastly why we need the bleb or bubble to form? 😓🙏

[@muhammadumairmuhammadumair4174]

Wao

[@RogueOntheRoad]

I've had clinicians do fast hard presses on the plunger. One time while getting a tetanus shot the shot fluid squirted all over my arm. They need to learn to press it slowly and not do fast.

[@ayeshanaveed8958]

For test dose which layer should we reach

[@LevelUpRN]

Ayesha, I'm not sure what exactly you're referring to. Do you mean to see if there's a potential allergy? That is usually intradermal. - Ellis

[@chaucerflanders7918]

Thank you. you are amazing, please can you make a video on Flushing catheters xx

[@mmanzano8226]

It would be helpful if you mention how to find the correct site like for intradermal injection is it 3-4 inches below the antecubital and so on.

[@pd9605]

Different states have different guidelines. The states that no longer require aspiration to ensure no vein has been accessed should also explain why not? I have recently seen lab techs use the same needle again and again while attempting to draw blood and in the ED nurses have done the same with IV attempts. Two words STAPH INFECTION. I would love to see every video that addresses needles to begin with the reminder not to do this!

[@pforpeace4041]

Thank you🤗

[@LevelUpRN]

You’re welcome 😊

[@mva6213]

no aspiration????????????????

[@LevelUpRN]

Whether or not we aspirate depends wholly on the route and type of injection. For example, the CDC no longer recommends aspirating an IM vaccination.

[@bottles-updivingej5041]

Just watched this video and first thing I noticed that you did not aspirate... Dr John Campbell noticed this during Covid epidemic and sadly the stupid WHO also does not mention aspiration while it used to be mandatory. You need to know if you accidently hit an artery or vein....so either make a new movie or add the importance of aspiration.

[@reenursingknowledge]

👍👍👍

[@Guguluff]

"Mine is not really cooperating"... maybe because the needle is not suppose to go all the way under the skin, after the bevel is completely under the skin stop advancing the needle. Not enough cleaning time for a few seconds. "The WHO suggests that the standard practice for skin preparation with regards to vaccination or other injectables is swabbing the injection site with a saturated 60% to 70% alcohol swab for 30 seconds and allowing the area to dry for 30 seconds."

[@martinenriquez3508]

But that's a huge needle!!!!😮

[@prettyblack9306]

Would be nice if its done in actual human hihi

[@DrAnkitJangid]

Ok

[@LevelUpRN]

Thanks for watching!

[@DrAnkitJangid]

@@LevelUpRN you are welcome

[@yuhin4694]

Who is this nurse? She's cute af