IM inj hitting humerus

  1. Hi. I'm a new nurse on my first nursing job. I was giving vaccinations today on 2 teens. One of them was really really skinny and I managed to hit bone. I've been feeling horrible all day, naive me never even thought of that happening, no one ever mentioned it during my education, not the books either. I wanted to take a smaller needle but it came prefilled with needle that wasn't removeable She was a bit nervous and flinched when I pierced the skin but didn't say anything, I know bone doesn't have pain receptors but could I have hurt her beyond pain? I pulled the needle back a tiny bit before injecting, there was basically almost no room to use. I got so horrified I forgot to aspirate too. I might just be the worst nurse ever Just looking for some support!
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  2. 30 Comments

  3. by   Esme12
    BREATHE! You are not the worst nurse ever. In very thin patients you grab and pinch the skin to avoid hitting the bone. As long as you didn't break the needle tip you're fine. I am more concerned about a teen girl being that thin and an eating disorder..
  4. by   hybr1d
    Thank you thank you Esme12. *breathes a bit* Yes, I should have pinched, I thought I'd manage without doing it and simply being a bit more careful with how far in I put the needle. Needle was maybe 1 inch and I hit bone not even having half in. PT was 13 years old. Yes when you mention it, I mean some are just skinny but she was really skinny. Though she got tbe-vacc due to competing in orienteering, maybe skinny due to that, I don't know. I barely got any contact with her, very flat responses. Maybe she was just shy though.
  5. by   Been there,done that
    "No one ever mentioned it, there was nothing in the books".
    Where did you receive your education?
  6. by   hybr1d
    Northern European university. I mean logically of course I realize that it's possible just surprised that I've never heard anyone mention it. Maybe it's something you don't tell other nurses though? I ask a lot of questions and asked a whole lot about injections, like tell me everything type of questions but nope, no one mentioned it during my internships or anything.
  7. by   klone
    The only place you need to aspirate is dorsal gluteal. Anywhere else, not necessary to aspirate. I have to ask, though, where were you giving it if you think you hit the humerus.
  8. by   klone
    Fwiw, I was giving an injection in the deltoid to a very thin woman and I hit the bone too.
  9. by   nursel56
    I don't believe aspirating is best practice for giving injections of vaccines anymore, either. I found this link that has so much useful information in it I'll share it here. Best wishes! http://www.cdc.gov/vaccines/pubs/pin...vacc_admin.pdf

    edit: I see klone already mentioned it!
  10. by   SoldierNurse22
    As a nurse who's been hit in the humerus while receiving an injection from an inexperienced medic, trust me--your patient will be fine. S/he probably won't forget it, but s/he'll be fine.
  11. by   RNsRWe
    Quote from hybr1d
    Northern European university. I mean logically of course I realize that it's possible just surprised that I've never heard anyone mention it. Maybe it's something you don't tell other nurses though? I ask a lot of questions and asked a whole lot about injections, like tell me everything type of questions but nope, no one mentioned it during my internships or anything.
    It's something you should have learned in school, right on the same page as 'this is how you do it correctly'. The same instruction should have included 'and this is what happens when you do it incorrectly'. That's why you were asked where you got your education.....it was supposed to be part of it.

    No, it's not something "you don't tell other nurses". We learned it in school, before being let near a patient....that's why you were met with surprise that you didn't know this. And it hasn't been best practice to aspirate since.....when?
  12. by   TheGooch
    Quote from Esme12
    BREATHE! You are not the worst nurse ever. In very thin patients you grab and pinch the skin to avoid hitting the bone. As long as you didn't break the needle tip you're fine. I am more concerned about a teen girl being that thin and an eating disorder..

    I once was that skinny but I didn't have an eating disorder. It's possible that she just can't put on weight like me. That changed later in life.
  13. by   Junebug903
    Yes, it happens. Some elderly, etc. are so thin. No worries. Somethings you may only learn by experiencing it.
  14. by   hybr1d
    I totally agree, this is something I should have learned. I was quite displeased with my education overall and did voice it too, this didn't better my impression. Though my best friend who's at a imo better university hasn't been taught it either, yet. klone, I injected in the deltoideus muscle. Regarding aspiration: Sweden still has guidelines for aspirating when IM. For a country with really good health care I'm not sure why if there is no reason behind it. But I've been annoyed before with guidelines that waste material like putting heparin locks in ports, no actual scientific reason behind it yet one of the best university hospitals here still have guidelines for it along with most other hospitals - "better safe than sorry" or something.

    I did learn something for sure, completely horrifying feeling though pt seemed to only react to the skin being pierced, I looked up and asked if it was going ok and she said yes. She's coming back for second vaccination in a month, if I'm on duty I'll do my best to pinch whatever little muscle there is.

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