BASIC INJECTIONS: PAINLESS INJECTION TECHNIQUE
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.
Massage for muscular relaxation: In this traditional method the injection site is well massaged for 20 seconds with an alcohol swab; probably more important for achieving relaxation than for ensuring that the skin is cleaned. Distract with conversation. It is easy to ensure that the underlying muscle is fully relaxed if firm, gentle pressure is applied with the non-injecting hand. When the muscle is relaxed, hold the syringe like a dart between the thumb and forefinger of the injecting hand.
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 or squeeze of the muscle can also be effective.
The injection: Follow this immediately by injecting the needle using the dart technique.
Sharp tap with side of hand
Note: These steps follow in very rapid succession.
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 (SC) or intramuscular (IM) 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.
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).
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.