am i wrong ahout this?

  1. Hi,
    all i was looking for your opinion on peds injection. I have started a new job in a peds office, i have worked family practice for 10 years, so i'm not new to giving peds inj. This office gives all injection IM sub-Q with allergy needles. When i asked why, the other nurse said because it was so easy to hit a bone with a 25 5/8 needle. I dont feel the vaccine is going deep enough to be absorped well. What do you think?
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  2. 9 Comments

  3. by   scribblerpnp
    AAAUUUGGGHHH!!!!!!! They are SOOOOO SOOOOO wrong. When giving an IM vaccine to a peds you must use a one-inch needle. Allergy needles would be OK for MMR and varicella. Think of fat, chubby baby legs, no WAY an allergy needle is going to get IM.

    At the office where I work, we have vaccines for the medicaid/no-insurance suppled by the state health department. The one-inch needle issue is so big for them that every year we must sign a contract swearing that we will only use one inch needles for IM vaccines. If we don't sign the contract, we don't get the vaccines. I remember being taught this in PNP school as well. VFC (vaccines for children) came to one of our lectures and said one-inch only, they don't ever approve of 5/8ths! They also come into our office to audit us once a year and look at our needles to make sure we have the one-inchers.

    Yeowza! :uhoh21:
  4. by   KnoxWarEagle
    I work at a family practice "womb to tomb" office with 50% peds. A couple of years ago we had a mother demand that we give her childs immunizations with a 5/8 needle. We presented several articles stating that not only do these needles fail to penatrate the muscle tissue but they are also not sturdy enough to be used safely in such a large muscle. She finally relented after the physician told her she would need to go elsewhere if she was not happy with an office not following the APA and AMA guidelines.
  5. by   SCRN1
    Anybody ever hit bone?
  6. by   scribblerpnp
    At one point or another. It feels weird and does make you cringe, but I've never seen the child cry harder at that point. You just want to take a good look at the needle when you pull it out to make sure the tip is still intact. But this can happen on adults as well. It maily happens on people with little stick arms (Think Ellen Pompilio from Grey's Anatomy), not the normal-sized people.
  7. by   SCRN1
    My point (that I didn't make clear) is go by the size of the child or thin adult. Just as everyone is not the same size, they don't all need the same size needle. I used to work in a peds office & gave lots of injections and we judged by the size of the child.
  8. by   fp nurse
    Quote from KnoxWarEagle
    I work at a family practice "womb to tomb" office with 50% peds. A couple of years ago we had a mother demand that we give her childs immunizations with a 5/8 needle. We presented several articles stating that not only do these needles fail to penatrate the muscle tissue but they are also not sturdy enough to be used safely in such a large muscle. She finally relented after the physician told her she would need to go elsewhere if she was not happy with an office not following the APA and AMA guidelines.
    Thanks i have only worked there for 2 days mostly leaening their routine. Itold my husband i have a real problem with this. I hate to start trouble but.... Do you know where i can find a copy of the guidelines?
  9. by   scribblerpnp
    The the AMA and APA both have websites, which should list this. Also, I'm pretty sure the CDC does as well.
  10. by   ElvishDNP
    I have given hundreds of IM vaccines to children/babies with 1" needles and have never hit bone. I have, however, hit bone giving IM injections to scrawny adults using same. I used to work in a comm. health center where we got vaccines from the state and same deal, we had to promise to only use 1" needles for IM vaccines, esp. HepB.

    You have to look at the size of the patient. I have had 2 yo's who were so fat I wasn't sure the vaccine was getting anywhere past SQ with 1in needles. There are always exceptions, but usually if you landmark it right you should be ok. Using allergy needles for IMs is NOT good practice.
  11. by   Zippedodah
    We don't use the allery/TB needles on our bigger kids...they don't go deep enough! You might try a Lippencott nursing procedure manual...it may have that in there.

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