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Pre‐procedural considerations

Specific patient preparation

Patients are often afraid of receiving injections because they believe the injection will be painful (Downie et al. [82]). Torrance ([351]) listed a number of factors that can cause pain:
  • the needle
  • the chemical composition of the drug or solution
  • the technique
  • the speed of the injection
  • the volume of drug.
Applying manual pressure to an injection site before performing the injection can be an effective means of reducing pain intensity (Chung et al. [40]). A small study carried out by Chan ([38]) showed that administering subcutaneous heparin slowly (over 30 seconds rather than 10) can reduce site pain intensity as well as bruising. Pain may also be reduced when using retractable needles (Lamblet et al. [163]). Other ways of reducing pain during injections are covered in Box 15.9.
Box 15.9
Reducing the pain of injections
  • Use correct length and gauge of needle (use smallest possible)
  • Use correct site
  • Use correct angle (90° for intramuscular injections)
  • Use correct volume (no more than 3 mL at a site for intramuscular injections)
  • Rotate sites to prevent formation of indurations or abscesses
  • Consider using ice, freezing spray or topical local anaesthetic to numb the skin
  • Listen to the views of experienced patients
  • Explain the benefits of the injection
  • Position the patient so that the muscles are relaxed
  • Use distraction
  • If appropriate, ask the patient to turn their foot inwards (for intramuscular injections into the upper leg)
  • Insert and remove the needle smoothly and quickly
  • Hold the syringe steady once the needle is in the tissue to prevent tissue damage
  • Inject the medication slowly but smoothly
Source: Adapted from Dickerson ([69]), Downie et al. ([82]), Perry ([282]).
Procedure guideline 15.15

Medication: injection administration

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