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Media depiction of Flu shot technique
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David Naismith (retired physician), Vernon BC, January 15, 2019.

On January 11th I was so disturbed by the portrayal of health professionals on TV, both in adverts and on the National, that I fired off an email to some colleagues. As usual, I learnt something as the thread progressed, so here is a distillate of that exchange.

In 1967-ish, when home on vacation from Medical school, I was helping out my father, who had injured his arm. An anaesthetist working as a GP in post WW2 Scotland before anaesthetics were moved from the intern to a fully trained specialist. He introduced me to the skill of a "good" injection.

Before we went on the monthly house calls list he made clear how he expected me to handle taking BPs, drawing blood & giving injections. He explained the sharp pain of skin penetration is reduced by a quick jab technique. Secondly the pain of tissue stretching by the instilled fluid is reduced by a slow steady pressure on the plunger.

Rolling forward to 1972, as a paediatric resident I was giving immunization to infants at the Ottawa clinic. I soon learned the art of engaging & distracting these short humans, with the assistance of their mothers.

Since that time other measures have been discovered. Emla & similar local anaesthetic creams. Along with benefits of distraction with video cartoon or video games.

In 2019 my Injection checklist looks like this.

  1. PLANNING – Discus EMLA, Tablet/phone video at prior appointment. Arrange booking time to minimize wait.
  2. PREPARE – Injection materials outside the room.
  3. DISTRACT – starts after introductions.
  4. INJECTION – Rub alcohol swab on skin briskly – more distraction.
    Penetrate skin with a quick jab.
    Instill the fluid with a slow steady pressure on the plunger. NB it helps to have the other hand bracing the syringe against the patient to prevent needle movement.
    Remove syringe in a smooth rapid motion to an out of sight location. I use the sink.
  5. Keep any contact with the injection area as light as possible to minimize pressure pain.

The Shot BlockerChris Sedergreen posted a picture of an intriguing device, the Shot Blocker, which he reports works very well in his hands. See attachment below.

A quick search found the following supplier options:
Amazon.ca $43.00 each.
Amazon.com $5.29 each.
Surgo Surgical supply Canada 1 = $47; 100 = $68.

I would love to try one of these, so please post if you find better pricing for single package.

Lastly, my dentist has wonderful technique for blocks. He holds the cheek, squeezes & stretches it gently, just as he inserts or advances the needle. Takes a lot of time to install the local. All the while carrying on an engaging monologue conversation. A true artist.

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Injection_Pain_Block_.jpg28.73 KB
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