Common Ways an Injection Can Be Given Incorrectly
Even in a clinical setting, errors can occur during the administration of injections. These mistakes can be categorized into issues with the site, the technique, and the substance itself. Being aware of these potential failures is the first step toward preventing them.
Incorrect Injection Site or Depth
Administering an injection in the wrong location or at the wrong depth is one of the most common errors. The consequences depend on the intended injection type (intramuscular, subcutaneous, or intravenous) and the location of the error. For example, a vaccine intended for intramuscular (IM) delivery into the deltoid muscle but injected too high or too deep can result in a Shoulder Injury Related to Vaccine Administration (SIRVA). SIRVA can cause persistent and severe shoulder pain, bursitis, or a rotator cuff tear.
Similarly, injecting into an incorrect location in the buttocks can damage the sciatic nerve, the largest nerve in the body. The sciatic nerve is most commonly affected in children, the elderly, and underweight patients when an injection is administered into the incorrect, usually more medial or inferior, part of the gluteal region. Damage can lead to foot drop, paralysis, and severe sensory disturbances.
Contamination and Hygiene Errors
Infections are a serious risk, especially when proper sterile techniques are not followed. The Centers for Disease Control and Prevention (CDC) emphasizes that safe injection practices are essential to prevent the transmission of bloodborne pathogens like hepatitis C, hepatitis B, and HIV. Contamination can occur in several ways:
- Reusing a syringe or needle: A single syringe and needle should be used only once per patient. Reusing equipment, even for the same patient, can introduce bacteria.
- Unclean injection site: The skin must be properly disinfected with an alcohol swab before an injection to prevent skin flora from being introduced into the body.
- Accessing vials improperly: Medication vials can become contaminated if accessed with a used syringe or needle, or if multiple doses are drawn improperly.
Medication and Dosage Mistakes
Injecting the wrong medication or an incorrect dosage can have severe or even fatal consequences. Healthcare providers must follow strict protocols to verify the medication and dosage against a patient's chart. Errors can include administering the wrong drug, an incorrect concentration, or an over- or under-dose. Patients can also play a role by ensuring they understand the medication they are receiving and asking questions if something seems incorrect.
Poor Technique
The technique of administering an injection is just as important as the site. Errors can include:
- Incorrect angle: A subcutaneous injection typically uses a 45- to 90-degree angle, while an intramuscular injection requires a 90-degree angle to reach the muscle properly. Using the wrong angle can lead to injecting into the wrong tissue layer, affecting drug absorption.
- Hitting a blood vessel: If blood appears in the syringe upon pulling back the plunger (a practice called aspiration, though not always recommended), it indicates a blood vessel has been punctured. If ignored, this can cause a hematoma or, in rare cases, block a blood vessel, leading to more serious issues.
- Improper speed: Injecting too quickly can cause tissue trauma and increase pain.
Potential Consequences of an Incorrect Injection
Understanding the potential outcomes of an improperly administered injection highlights the importance of safe practices.
Nerve Damage
As mentioned, hitting a major nerve, such as the sciatic nerve, can result in immediate and severe pain, and potentially lead to permanent disability like foot drop or sensory loss. Direct injection into a nerve can also cause inflammation and damage that may become a lifelong issue.
Infections and Abscesses
When bacteria are introduced into the body, they can cause localized infections like cellulitis or a pus-filled abscess at the injection site. In more severe cases, bacteria can enter the bloodstream and spread throughout the body, causing systemic infections like sepsis or endocarditis (an infection of the heart lining), which can be life-threatening.
Tissue and Blood Vessel Damage
An improperly inserted needle can rupture a blood vessel, causing blood to leak into the surrounding tissue and form a bruise or hematoma. While often minor, some situations can be more serious. Accidentally injecting into an artery, rather than a vein, can be particularly dangerous and may lead to gangrene or blood clots, which can be life-threatening if they travel to the lungs.
Reduced Medication Efficacy
If medication is injected into the wrong layer of tissue, its absorption can be impaired. For example, a vaccine meant for the muscle but administered into fatty tissue may not elicit the proper immune response, rendering the vaccination ineffective.
| Table: Comparison of Correct vs. Incorrect Injection | Aspect | Correct Injection | Incorrect Injection |
|---|---|---|---|
| Primary Outcome | Effective medication delivery with minimal side effects. | Complications like pain, infection, or tissue damage. | |
| Injection Site | Administered to the designated, safe anatomical location (e.g., ventrogluteal muscle for IM). | Administered to a risky area, potentially hitting a nerve or artery. | |
| Technique | Aseptic, using the correct needle size, angle, and speed. | Non-sterile process, improper needle handling, or incorrect depth. | |
| Medication Efficacy | Full therapeutic effect achieved as intended. | Reduced efficacy due to improper absorption or degradation. | |
| Patient Experience | Mild, temporary discomfort or swelling. | Intense pain, persistent swelling, nerve-related symptoms, or systemic illness. |
Preventing Errors and Ensuring Safe Injection Practices
Both patients and healthcare providers have a role in ensuring injections are administered safely. The following practices are crucial for minimizing risk:
For Healthcare Providers:
- Aseptic Technique: Always use a new, sterile needle and syringe for each patient and procedure. Prepare injections in a clean, designated area.
- Confirmation Protocol: Double-check the medication, dosage, and patient information against the prescription before administration.
- Site and Technique Selection: Confirm the correct injection site and use the appropriate needle size and angle for the type of injection being given. For intramuscular injections, especially in the gluteal region, using the ventrogluteal site is safer due to fewer nerves and blood vessels.
- Patient Education: Clearly explain the procedure, potential side effects, and what to watch for afterward.
For Patients:
- Ask Questions: As an active participant in your healthcare, you have the right to ask what medication you are receiving, the dosage, and the reason for the injection.
- Understand the Procedure: Ask your provider to confirm the injection site and technique. For self-injecting, be thoroughly trained on the proper procedure, including rotating injection sites.
- Monitor Symptoms: Pay attention to any severe pain, swelling, spreading redness, or signs of infection after an injection. Contact a healthcare provider if symptoms worsen or persist.
- Observe After Vaccines: After receiving a vaccine, it is often recommended to wait 15–30 minutes to be monitored for rare but severe allergic reactions, such as anaphylaxis.
For more detailed information on preventing unsafe injection practices, visit the CDC's official website: Centers for Disease Control and Prevention.
Conclusion
While injections are a routine part of modern medicine, they are not without risks. Understanding that an injection can be given incorrectly is the first step toward prevention. From improper technique and site selection to hygiene and medication errors, the potential for complications is real. However, by following strict aseptic and procedural guidelines, healthcare professionals can drastically minimize these risks. Similarly, informed and proactive patients can contribute to their own safety by asking questions and being vigilant. The vast majority of injections are administered safely, but recognizing the potential for error ensures that everyone involved remains committed to the highest standards of patient care and safety.
