Needle size for intramuscular injection - 27G okay?

[swatchgirl]

It's almost flu season. IM shots are usually done with 19-25G for adults 18 and up, but if patient requests a smaller gauge needle such as the 27G due to fear of pain, is it okay to use to give IM shots? It would be harder to push in, right? Are there other harmful effects if using a 27G on an adult for an IM vaccination? I'll be using it on the deltoid.

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[zelman]

It's almost flu season. IM shots are usually done with 19-25G for adults 18 and up, but if patient requests a smaller gauge needle such as the 27G due to fear of pain, is it okay to use to give IM shots? It would be harder to push in, right? Are there other harmful effects if using a 27G on an adult for an IM vaccination? I'll be using it on the deltoid.

Work on your technique with 25g needles. They shouldn't hurt to begin with.

 

[ldiot]

I don't really see how 27G would be a problem but just because they asked I'd pull out the 16

 

[WVUPharm2007]

Making sure the patient's arm is limp when you inject goes a lot further towards avoiding pain than needle gauge.

 

[swatchgirl]

Work on your technique with 25g needles. They shouldn't hurt to begin with.

Bevel up is less painful than bevel down, right? Because you would be slicing the skin, instead of tearing it? Or would it even matter which way the bevel was facing for 90 degree angle IM shots?

 

[swatchgirl]

Making sure the patient's arm is limp when you inject goes a lot further towards avoiding pain than needle gauge.

I do tell them all to relax and make sure the arm is dangling down and relaxed, my issue though is I need to make sure I "dart" the needle in quickly, and push it in quickly. The darting is going to need practice and I can get that done. I was under the impression that pushing in slower is less painful, that might not be the case?

And I do these three things, too:
- draw the skin taut for IM
- pinch skin for SubQ
- always change out the needle after piercing it through a multi-dose vial with a rubber top

I need to stop being "gentle" when pushing the needle in, as if pushing it in slowly will hurt less. This is one of the only situations in life where gentle-ness brings more pain. It's so counter-intuitive.

 

[swatchgirl]

I don't really see how 27G would be a problem but just because they asked I'd pull out the 16

Haha, right? I should show them this one first, then they won't complain about the real one.

 

[RPh Who]

Bevel up is less painful than bevel down, right? Because you would be slicing the skin, instead of tearing it? Or would it even matter which way the bevel was facing for 90 degree angle IM shots?

Doesn't matter, you are entering from a perpendicular angle