How to Use a Needle

The doctor or nurse who tries to spare a patient pain by giving an intramuscular injection as fast as possible is making a mistake. The results of a quick stab' with a hypodermic needle, says Ohio Pathologist Daniel J. Hanson, may be worse than the condition that the injection is supposed to cure.

Nobody knows how many patients suffer severe reactions to injections, but Dr. Hanson is sure that there are many more than doctors report. He is not concerned with simple soreness, but with abscesses and cysts, severe scarring, lingering pain, injection directly into an artery, bone inflammation, and--most serious of all--damage to a major nerve, with consequent paralysis. One trouble, says Dr. Hanson in the magazine GP, published by the

American Academy of General Practice, is that doctors and nurses are not given sufficient training in how and where to use the needle. And the importance of a safe technique has grown with the popularity of injections of all kinds. It is not unusual, Dr. Hanson notes, for a patient to get from six to twelve injections in a single day after an operation.

Traditional Trick. From studying patients' sores and where they got them, Dr. Hanson is convinced that, with rare exceptions, the upper arm is not the proper place for adults' injections. The muscle bed there is not big enough, he says, and a slight slip of the needle is enough to drive it into the radial nerve, wh re it may cause paralysis of the arm.

By far the best spot for the needle, according to Dr. Hanson, is the gluteal muscle in the buttock. This, he insists, is not to be confused with the whole buttock, which has a lot of fatty tissue lower down. Doctors have a traditional trick for picking the place for the needle. They draw two imaginary lines, one vertical and one horizontal, on the buttock (see diagram) and make the injection into the upper, outer quadrant. But this is risky, says Dr. Hanson, because people are not all built alike, and if the needle goes in a little too close to the midline of the body, it may hit the sciatic nerve.

Squirming Target. The best way for the doctor to find the safe region, says Dr. Hanson, is to draw an imaginary diagonal line from a ridge on top of the hipbone to the top of the thighbone. Then he aims above and outside this line. This sort of careful placement rules out the fast injection. It also rules out the common practice of having a woman patient lean over a table and pull up her underclothes with one hand: that way, she exposes only the lower part of the buttock, where an injection may be dangerous.

There is one main exception to his general rule, Dr. Hanson admits. Infants have only small gluteal muscles, and because of their squirming he thinks it is safer to give them injections in the front or outer side of the thigh.

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