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Method 1

The essence of this technique is to ensure good muscle relaxation. The patient should be as comfortable as possible. For injections into the deltoid region, the patient should be sitting down with hand on the hip and with the muscle as relaxed as possible. For deep intramuscular injections the buttock is preferred, but care must be taken to inject in the upper outer quadrant. These patients should be lying face down. The buttock should be exposed and the patient encouraged to relax.

  1. Massage for muscular relaxation: The injection site should be well massaged for 20 to 30 seconds. This is a traditional preparation of the injection site, but it is probably more important for achieving relaxation than for ensuring that the skin is cleaned. It is easy to ensure that the underlying muscle is fully relaxed if firm, gentle pressure is applied with the left hand. When the muscle is relaxed, hold the syringe like a dart between the thumb and forefinger of the right or dominant hand.

  2. Sharp tap over site: Before giving the injection, use the side of the back of the right (or dominant) hand to give a smart tap over the injection site (Fig. 2.1). A sharp flick with a finger can also be effective, but not as much as a tap.

  3. The injection: Follow this immediately by injecting the needle using the dart technique.

Note: These steps follow in very rapid succession.

Fig. 2.1

Sharp tap with side of hand

Many patients will tell you with surprise that they did not feel the needle but were conscious of the sting of the injection material going into the tissues.

Method 2: Almost painless injections

A subcutaneous or intramuscular injection is almost always painless if the skin is stretched firmly before inserting the needle. If injecting the arm, for example, the third, fourth and fifth fingers should go medial to the arm while the thumb and index finger stretch the skin on the lateral surface (Fig. 2.2). The needle should be inserted quickly into the stretched skin.

Fig. 2.2

Stretching the skin with thumb and index finger

Method 3: Muscle contraction–relaxation method

Use the muscle energy method by asking the patient to push their elbow against their hip as an isometric contraction for 7 seconds. Then quickly give the injection into the deltoid muscle (now relaxed).

Method 4: Needle gauge

The discomfort from an IM or SC injection can be minimised by using a smaller gauge needle, e.g. 30-gauge, especially for vaccinations in children.

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