Intramuscular and Subcutaneous Injections - Clinical Skills

This video - produced by students at Oxford University Medical School in conjunction with the faculty - demonstrates the principles and techniques underlying intramuscular and subcutaneous injections.It is part of a series of videos covering clinical skills and is linked to Oxford Medical Education (www.oxfordmedicaleducation.com)
This video was produced in collaboration with Oxford Medical Illustration - a department of Oxford University Hospitals NHS Trust. For more information, please visit www.oxfordmi.nhs.uk

[@AKUHaySIYA]

I'm currently out of med school and watching your videos help me remain on track. Thank you for sharing! :)

[@seasonings2taste115]

It's been 8 years. How's your career going?

[@mashrafkhan1638]

@@seasonings2taste115 yes omg😮😮😮

[@tiffanymcphie4441]

I cannot believe they just said that you don't have to clean with an alcohol swab. Always, always, always clean the area first to reduce chance of infection

[@user-wq6hr9xi2n]

There will be different guidelines depending on what country you work in! In the UK it generally isn't recommended at the moment.

[@acobraco6235]

"Short sticks" alcohol cleaning is not evidence based - hence why some regions here in Sweden dont do it. It is however super important for longer sticks, like pvk (pvc?)

[@jacktran3272]

you need to open your mind a bit

[@AishiBhattacharyaOfficial]

The guidelines are changing. It's been seen that the ethanol in spirit may dissolve part of the components of the vaccine this destroying it and may reduce its effectivity. Which is why it's not recommended to always clean the area with spirit

[@mdjiya7915]

@@user-wq6hr9xi2n mf.4

[@OxfordMedicalVideos]

Just to clarify: 1. There is no need to clean the skin with alcohol if the skin appears clean. 2. There is no need to aspirate with SC injections. The fact that some liquid came back into the syringe is a function of the model arm. 3. SC can be administered at 45 or 90 degrees. Choice depends on needle size and amount of adipose tissue. Further details: Hunter J (2008) Subcutaneous injection technique. Nursing Standard. 22, 21, 41-44.

[@abdikadirnasiib3959]

please understand me ? is there for same places when we are making IM injection SC injection because you have injected same places

[@waqas103]

We would like to use your video for training purposes, please let me know how much do you charge for us to use your videos? Thanks you can email me at [e-mail]

[@stianajohn2195]

If you don't clean the area there is chance for infective endocarditis

[@krane15]

@@stianajohn2195 The assumption is that the area is already clean. Its a confusing way to say it though.

[@rozeypozey5941]

Not trying to be critical but I’m 3 minutes in and there’s some things I found wrong. #1 not sterilizing area #2 did not get out the air bubbles which can be dangerous #3 I thought you were not required to aspirate (draw back) giving a intramuscular injection in the arm. Only the glute..

[@humanist-mace5560]

I've been doing my own IM injections in my thigh (21 gauge 1½inch needle) for about 3 years and wasn't taught to aspirate 😳 Guess I should be doing that from now on!

[@traceymurray2516]

Evidence based practice states not to aspirate anymore

[@la11lomx]

that subcutaneous injection looked like it turned into an IM injection.

[@ManishYadav-qk4qk]

Exactly.

[@peterlongwood9933]

Not sure why they didn’t just use a shorter needle

[@grace-anncampbell3786]

Before injection isn't cleaning the site with alcohol mandatory ? Because I didn't see it. Following students both nursing and medical please to clean the site before "ANY" injections being done. It does not matter if the site doesnt appears dirty or not.

[@kimberly8164]

Its so scary what is on the internet, having credentials also i hope people will have better teaching than this!

[@dominiquebryan-gillespie7761]

Thanks for posting. Would prefer u state the size of the needle rather than the colour. Colours may be different e.g we dnt use a green needle for IM.

[@TotalDestructionStudios]

Good video, very informative! But I couldn't help but think, "Oh god. They've cut off his arm."

[@daniellehamilton6216]

Me too lol

[@hirotakakokubu1268]

What a cute and pleasant voice!

[@withapulse]

surely a sharp swift jab is preferable to the slooowww injection seen in the video. I suspect the patient would be writhing in pain if done that way. Also shouldn't the Z track sideways tension on the skin be used to avoid leakage after the needle is withdrawn?

[@inaamulhassanjaffer8238]

withapulse the patient is fine. The patients arm did not move once throughout this injection. 😒

[@taylorread6775]

you never aspirate an sub q, only IM. and what happened to the z track method?

[@sabinadervisevic4995]

Actually now you do, aspirate sq for example if you are giving morfin sq

[@chasing_happiness]

God help the patients they treat. 😳

[@fcknluke]

Useful, except for the I.m. and s.c. you should ALWAYS ASPIRATE (to check if you didn't puncture a blood vessel), and remove the needle by grabbing the needle cone

[@YOana1dinamovista]

Really useful! Thank you!

[@medicalgashi3319]

Allergy should be the very first thing you should ask the patient then you move with procedure but you must clean with alchool that skin before you inject needle.

[@danielul05]

No pushing the air out? You just killed the arm

[@digantabiswas5085]

to say the truth in case of IM injections not really necessary to pushing air out. But large air bubble can damage. But too much mistakes are present in this video

[@daryl4083]

A mistake was made when removing the product into the syringe, alchol wipe should always sterilize product lid before loading up with product.

[@LegendArhamofficial]

Buo400💉💉💉💉💉💉💉

[@14banapples]

Uhh....what happned to the z track method?!

[@adeolaohanacho6176]

that's what I thought....with intramuscular injections, I was taught to do the Z track by slightly pulling the skin.

[@HashemSmashem]

What's the z track method?

[@ajinubabu6528]

Z track is not done for all IM

[@kightremin]

How about the little amount of air in the injection needle, he didn't remove that

[@pushpayadav8177]

Very nice 👌 video thanks for you

[@armedwithmedicine775]

Thank you!

[@harmanmaan2090]

Very helpful 👍good job ☺

[@winteriscoming7493]

How about skin pinch in subcutaneous injection??

[@dr.monikabhuriya10]

Nice

[@kishanrajput4165]

What length of needle inject inside skin???

[@8150shaf]

The needle should never be inserted fully inside, at least 1cm of the needle should remain outside the skin!

[@carilo6162]

Good tip

[@stub_born]

In which case

[@nyuntlwin3895]

Thanks

[@jonahoche5769]

Very fantastic

[@rajivdas8185]

Excellent 👌

[@Wyn_Wins]

"dont worry its just like a ant bite" Me- *OW F*&K*

[@vijaylonde9336]

Great tips injection

[@Isiltarie]

I see air bubbles. Is it OK to have air bubbles in IM or SC injections? I heard bubbles in IV can kill by blockage; not sure whether it is harmful to have bubbles for IM, SC.

[@mannagarwal5390]

Very good question! I'm an intern doctor and the best possible answer to this question is.. generally no. Cannulas and drip sets have filters so that air usually isn't getting in the patient's vein. Now even if some amount, a few mLs of air goes inside the patient's vein, it'll just get adsorbed by the blood or removed by the lungs. Venous air embolisms don't kill unless you're talking about a massive amount of air getting in like maybe 100-200 mLs. In I.M. and S.C injections.. probably not that risky either. Arterial air embolisms are serious business though.. it's said 1 mL of air in arteries can cause infarcts. Keep in mind I'm just beginning so I may be a bit off. But those are the stats.

[@Isiltarie]

@@mannagarwal5390 Thanks for sharing this information. I wonder why arterial air is more dangerous. Do you know?

[@dimodimov3267]

@@Isiltarie Hey, if you are still interested: arterial blood vessels go in the direction of getting thinner and thinner until they reach the capillary. Also the walls of the arterial vessels are thicker and the blood is moving at a much more rapid velocity. Just a med student though.

[@jonathanarnold5133]

What about pulling back the tissue slightly? does that make the injection hurt less? Another video (the Z-track one) talked about that.

[@daviddelfino2666]

Great video. Helpful.

[@SaruEMSEducation]

There is no need to clean the skin with alcohol if the skin appears clean. There is no need to aspirate with SC or IM injections. Use Z-track method instead.

[@KoreenColpoys]

he didn't clean the the valve with alcohol swab

[@sysamanthahope9033]

great!

[@dndkahao]

he pulled the needle out to slow , that can cause burning and slight pain..

[@CeciB80]

omg...he didn't clean the vital, the site, and did he throw the needle in the trash!!!!!!!! So many steps were skipped.

[@kiranrajkp]

Instructions not clear. I've cut off the arm, given the injection. But now how to rejoin arm to body?🫤

[@qwmx]

I decided to look this up after my second COVID vaccine dose. I can't watch the injection happen to me or I will flinch because of my reflexes (I'm fine seeing the needle in my arm after it has entered my arm). So I have to satisfy my curiosity with this.

[@petercieslar964]

How about removing any air bubbles

[@zemlen00]

Peter Cieslar

[@jiteshkumarojha]

Should check the air.

[@DevalKoradiya]

are you from bhayavadar

[@musiCal624]

They didn't push air before taking the med

[@yaz1458]

Anyone here for Family medicine ?

[@ranamostafa5408]

COM 366?

[@vaibhavjain3234]

He injected too slow during the IM procedure, that will be very painful for the patient.

[@user-ks7bq8uc7i]

lol no cleaning and no Z tracking for IM

[@423moore]

No skin cleaning required if skin looks clean

[@محمدالشمري-ض6ت8ه]

Thank you

[@ShudanLaklo]

Wow, compared to use student nurses who literally get one theory lesson and then do it from our very first day in practice. You doctors are spoiled. Thanks for the video though, learned a little more for my OSCE.

[@gigi6539]

ShudanLaklo Actually we often don’t even get the theory lesson - we are just expected to learn by a ‘see one, do one’ technique then get experience. Certainly at my medical school we had to just learn injections from videos such as this then ask a nurse to watch us do it in real life to check technique. I’m not sure how else you can learn simple practical procedures. I know this is an old comment but I’m just getting quite tired of this nastiness I keep picking up from (a handful of) nurses. We are all in the same boat when it comes to learning this sort of thing, can’t we just support each other without this oneupmanship about who has it worse?

[@vwapatriyotla2322]

What is considered "large volume" in IM injections?

[@cutlet9227]

More than 10ml I guess but we usually give 5ml. 3rd year students.. Hehe..

[@vwapatriyotla2322]

@@cutlet9227 thank you

[@rachaelbruyette6759]

very. cool

[@techloby6072]

Waqas ahmad(1),18, 4th sem

[@dailydebateswitheshmakhan]

injection use from hand to shoulder side...not vice versa......wrong procejr

[@bradboisvert4892]

I think I'm allergic to Tren I always cough

[@MrMethadrine]

lol.Thats a normal side effect of that shit.

[@pabna-top-anil3244]

I/V দিয়ে কি বোঝায়?

[@jamilkh3586]

That needle size is totally uneccesary.

[@digantabiswas5085]

There are too many mistakes in this video. Even our medical University gives us task to find out total no. of mistakes here !!

[@eufemiamusilika1245]

❤❤

[@kimberly8164]

Yeah, I don't approve of this video, not necessary to clean the area as long as they are clean?!! Wth wow!!

[@sousleszarbres]

So bad! it must be painful to be your patient!

[@باسمالموسوي-ح6ه]

Good

[@j30045]

This video makes no sense! you always clean with an Alcohol swab before injection. this is standard nursing protocol and required.!

[@hellokitti1987]

+James B i said the same thing

[@cjam191]

+James B as someone curently going throuh university studying to become a nurse I can verify what Janet Jaderko says it isnt actually necessary unless you can see that the person is physically dirty.

[@ceeg9006]

Yeah because you can see germs with your eyes...

[@cjam191]

Corey H your body is covered in a germ and bacteria that your body is already adapted to. The non visible germs are very unlikely to cause an infection. the needle is pretty fine and isnt in for a long period of time. the risk is slimmer than the needle.

[@anneteller3128]

The main problem is that is takes 20 minutes for the alcohol from the swab to kill the bacteria we would be concerned about according to research. Supposedly, it is only useful for removing visible dirt. So, using an alcohol swab makes the nurse feel better, but according to the most recent research does nothing to assist the patient. However, old habits die hard and trying to get nurses who were taught in nursing school to use alcohol swabs to stop using them when administering injections is almost impossible if they are available.

[@Anonymous-ho1mt]

OMG this so unhelpful for a tutorial

[@durgabhavani2590]

Telugu

[@manuphilendran2176]

He is touching the sterile part of the syringe

[@shan.a]

You’re suppose to aspirate before u with draw any medication....

[@423moore]

Not with subcutaneous injections

[@omidmohammadi8257]

Not bad but he did 2 or 3 mistakes

[@WickedFairies]

I was told that you no longer aspirate

[@AdemJashari56]

no no no always always always aspirate on IM injection!!!

[@daniellehamilton6216]

APhA does not recommend aspirating for IM injections as of 2018

[@cemogulhan9043]

This is actually discusting the way you guys are doing it

[@abdullaahmed1615]

thanks God my teachers are not British....hard to understand them

[@cassandrafoster616]

+Abdulla Ahmed It's not hard to understand her lol

[@joshb701]

+Abdulla Ahmed its not hard at all to understand her...

[@SotoAdvert]

Wrong wrong wrong. You need to pull the syringe to check up for blood pulling. otherwise you risk shooting in a blood vessel, and then the person gets cardiac arrest. wrong information

[@423moore]

With IM yes but not with SC

[@OxfordMedicalVideos]

Clinical skills teaching begins in the first clinical year (year four of the standard six-year course, year one of the graduate-entry course)

[@omidmohammadi8257]

Not bad but he did 2 or 3 mistakes

[@shritisinha1042]

Greattt

[@ELIAS533.]

Nice topic thanks