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Dr. Natasha
Dr. Natasha, Doctor
Category: Medical
Satisfied Customers: 11886
Experience:  American Board Certified in Emergency Medicine and Ivy League trained. Medical Review Officer trained in Drug Testing
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How should allergy injections be injected Should they be intramuscular

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How should allergy injections be injected? Should they be intramuscular or subcutaneously? Does it make a significant difference? What happens if they are injected incorrectly? If an injection is supposed to be an intramuscular one but is injected as subcutaneous, then is the solution still effective? Will the medication still be delivered properly? What if it is vice-versa and a subcutaneous injection is injected in the muscle? I have to inject a series of 11 shots and I think that each time depending on who is injecting me, they are doing it differently. I believe some are performing subcutaneous injections and some are performing intramuscular injections. My question is: does this affect the delivery of the solution and will my body still benefit from the solution as intended by the physician? Also, what if a nurse messes up and the injection is only given as an intrdermal one because they didn't insert the needle properly? Does this affect anything?
Submitted: 5 years ago.
Category: Medical
Expert:  Dr. Natasha replied 5 years ago.
<p>Hi</p><p>Allergy shots are supposed to be give subcutaneously. There is not intradermal shot- either it is subcutaneous (SQ) or intramuscular (IM).</p><p>Having an intramuscular shot is rather painful and they go pretty deep with a large needle. Even if it looks like it is IM, it might actually be SQ because of the length of the needle and the gauge. I imagine that they are using the TB (or insulin) syringes- these deliver SQ. The risk of IM shot is more of anaphylaxis (because more of it enters the bloodstream because the muscle has more blood flow) than it being ineffective... </p><p> </p><p> <a href="http://homepage.mac.com/changcy/allergyshotinstruct.htm">http://homepage.mac.com/changcy/allergyshotinstruct.htm</a></p><p> </p><p>best wishes</p><p> </p><p>press the green accept button if this was helpful</p>
Customer: replied 5 years ago.
Thanks for the response. I'd still like some clarification though. Let's just assume that a few injections were given to me as IM. Just to clarify, does this mean that asides from physical pain, irritation and discomfort, that the medication is still as effective as if it were given as a SQ injection?

Also, I understand that most injections are either IM or SQ. However, I've read that intradermal injections exist, although not intended for allergy shots and are pretty rare. I understand that all this means is that the solution is injected between the layers of the skin, where the needle is inserted into the epidermis, and not subcutaneously.

I am concerned because I honestly think that this is what happened to me yesterday when I went to get my shot. The person seemed like he barely knew what he was doing. I've been gettin injections regularly for a few years now and know more or less how a vaccination shoud be administered. The only confusion I had was the difference between IM and SQ. And each time the needle would be injected "into" my arm at either a 90 degree or a 45 degree angle, and it barely hurt at all. This last time, the person did not even touch my arm to test for a good site for injection. He also didn't pinch the skin like they usually do. It was extremely painful. Basically he inserted the needle (without pinching any skin) at an extremely awkward and shallow angle. I swear I was able to see the shape of the needle in my arm beneath the skin. It was as if it was inserted right below the top layer of skin before reaching SQ tissue. Now my arm is extremely red, sore, swollen and hard like a rock. The site of the injection is extremely tight and sore and the swelling has spread to the whole upper arm. It is also extremely painful when I touch it.

I know there is no such thing as an intradermal allergy shot. But assuming that there was a mistake and the injection was indeed only injected into the skin, what will happen? Is the solution still effective? Should I seek medical attention? What should I do? Or is this OK, in a sense that the injection will still be effective but that I'll just be in more pain?
Customer: replied 5 years ago.
Also, normally when the injections are given to me, it is injected in the tricep region and they pinch the skin, exactly like the link you included demonstrates. However, this time it was injected at a completely different site where there was less flesh. It was underneath my deltoid, but not in my bicep or tricep - basically the area on the side of the arm where it is very boney. Which once again gave me reason to believe that the person did not know what they were doing.

Asides from the tricep area, are there any other areas in the arm that profesionals generally choose as the site of injection? Does a SQ shot have to be injected in a specific site?
Expert:  Dr. Natasha replied 5 years ago.
I understand, in cases of giving certain things like TB tests- which should be RIGHT under the skin for a reading, it is important to give it intradermal. But in allergy shots, you are supposed to pinch the skin and put it in at 45-90 degrees- SQ It still should be effective if the injection was given to you in a shallow manner- you are still getting exposure to the allergen, which is the intended goal- it sounds like he placed intradermally.

http://www.health.gov.nl.ca/health/publications/immunization/S7/method_for_intradermal_injection.htm

Here is a fantastic pic- so we both agree- you got it intradermal.

The sites usually are deltoid/tricep and gluteal (buttock). It is for patient comfort. You can give SQ shots in the abdomen too, but less popular.

That being said, I think that you have an infection. I think that some bacteria got introduced at the time of the shot (which is a complication of the procedure and sometimes avoidable, but sometimes not). Now the bacteria has spread and your arm is swollen and hard. This is not from the mode of injection. This is because of infection. You need to seek medical attention for this- you will likely need antibiotics for your arm cellulitis.

Go to the ER today (or to your regular doctor if they are open- I am california time and it is 7pm here)

best wishes press the green accept button if this was helpful.
Customer: replied 5 years ago.
Great! Your responses were very helpful and make alot of sense. I'll go see a doctor for this fro treatment.

Just for clarification, the deltoid/tricep and gluteal are areas that are usually selected for SQ for comfort reasons. But in fact can they be injected "anywhere" in the bosy as long as it in in SQ tissue?
Expert:  Dr. Natasha replied 5 years ago.
That is correct. The deltoid/bicep/gluteal are chosen for comfort but you can do it anywhere as long as there is enough tissue... People give themselves IVF shots in their bellies...

Please press the green accept button so I can get credit for this interaction. It allows me to help people like you :)
Dr. Natasha, Doctor
Category: Medical
Satisfied Customers: 11886
Experience: American Board Certified in Emergency Medicine and Ivy League trained. Medical Review Officer trained in Drug Testing
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