Intramuscular Injection

How is intramuscular injection used by UCLAH? Can IM injections help terminally ill patients? How does it compare with other ways of delivering medicine?

What Is Intramuscular Injection?

Without a doubt, you almost certainly have received a shot into your muscle at some point in your life. Vaccines, especially inactive vaccines, are commonly given intramuscularly, as are a wide variety of other medicines: antibiotics, immunoglobulin, and hormones. Moreover, people with severe anaphylactic allergies often carry around an EpiPen to give themselves an intramuscular injection at need.

For a few conditions, patients are taught to self-administer their intramuscular medication. This is not the case for hospice patients, who require a specially trained nurse or physician to administer the shot while causing a minimum of discomfort for the patient. We at Unique Care Los Angeles Hospice know that injections can be unpleasant and painful for anyone, so our nurses and doctors make it their business to lessen discomfort as much as possible when giving shots.

Why Do We Inject Medicine into the Muscles?

Swallowing a pill is the easiest way to administer medicine, but there are some cases where a shot is necessary:

- Some medicines cause nausea when swallowed, but not when injected.
- The contents of a patient’s stomach can weaken or disable entirely the effect of some medicines.
- Medicine is absorbed quickly through the muscles, though this might not be the case for patients with poor circulation, as happens during shock and heart attack episodes.
- Most importantly for hospice care, many terminally ill patients struggle with swallowing. A speech therapist can help patients retain their ability to swallow, but during a crisis, we need to be able to administer medicine quickly.

Intramuscular injections are given deep within muscle tissue. We regularly give shots in other locations—for example, patients with diabetes need insulin delivered just under the skin—but in most cases, IM is the preferred method.

- Muscles have few sensory nerves. Drugs that cause great pain in veins are much more manageable when given into a muscle.
- Many terminally ill patients suffer from conditions that make finding a suitable vein very difficult.
- Even when veins are visible, IV shots involve catheters, tubing, and other bulky medical apparatus. This is often more troublesome for a patient than individual shots into muscles.

We know that nobody enjoys needles, so our doctors and nurses always take great care in ensuring that our patients experience a minimum of discomfort when it is time to receive a dose of medicine. We always make sure that the patient is relaxed and unafraid before proceeding, and our expert care ensures that any paint and risk of infection are minimized.

Why Use IM Injection in Hospice?

When considering medication to give to a terminally ill patient, families and health care workers must consider the comfort and quality of life of the patient above all else. In some cases, this might mean not giving medicine at all. If the patient is in the final moments of life, giving her a shot or forcing her to swallow medicine will probably cause more distress than provide any tangible benefit. Or if a patient expresses a wish to let her illness take its course and denies all medication, we believe that care workers and the family should respect that wish and allow her to pass peacefully into death.

But “terminally ill” does not mean “dying tomorrow.” A terminally ill patient in hospice may have up to six months left to live, and in those circumstances, medication can improve the quality of life in her remaining days.

Taking pills is often difficult for seriously ill people. Any number of illnesses and symptoms can make swallowing difficult, and though our speech therapists can help a patient regain control of her swallowing muscles, sometimes the urgent need for medicine precludes waiting for speech therapy to show results. In that case, an IM injection can give life-improving medicine when it’s needed most.

What about Other Treatments?

Some terminally ill patients might benefit from an IV. This can be a difficult choice to make for caregivers and families: IV therapy can prolong a patient’s life by providing medicine, nutrition, and hydration to patients who lack the capacity to take substances orally. But this comes at a cost.

- There is the discomfort of applying the IV, which, for a terminally ill patient, will probably remain in her body for the remainder of her life. Doctors and nurses will consider the pain and the possibility of an infection at the insertion site before applying an IV.
- The tubing and apparatus needed to keep an IV operational are greatly inconvenient for the patient and her caregivers. All the equipment will hamper whatever freedom of motion the patient enjoys, and it causes plenty of complications for executing basic actions of personal care, such as dressing and bathing.
- UCLAH workers and family must consider together the possibility of unpleasant side effects that come with IVs. Antibiotics are great at fighting infections, but they might cause problems with the patient’s liver and kidneys. Nutrition and hydration can extend the life of the patient but can cause electrolyte imbalances and fluid overload.

IVs have a place in hospice. They have helped many patients live their last months to their fullest. But families must weigh the possible benefits against the downsides. We always discuss all the available options with the patient and the family so they can make the choice that will best improve her quality of life.

We evaluate our patients on a case-by-case basis, discussing with families and, if possible, the patients themselves the different modes of treatment. If taking oral medicine is impossible, a shot into the muscle is a good alternative to a bulky, movement-limiting intravenous equipment setup. Our skilled nurses and physicians can minimize any momentary discomforts and pains that come with muscular shots. Physical or occupational therapy can alleviate any resulting muscle soreness. But as in all hospice matters, the comfort and quality of life of the patient are the top priority. We will do our best to make the patient as comfortable as possible and assuage the fears of the family.