Deltoid injections in obese patients

oceanblue52 · Mar 1, 2017

If you have your landmark right, you shouldn't hit bone. The glute is a relatively large, thick muscle. I've never hit bone and I always push all the way in...you would run the risk of the med not absorbing properly otherwise. Unless a patient is REALLY skinny, 1.5 inch should be used for all glute injections. It gets less intimidating the more you administer them.

klone, MSN, RN · Mar 1, 2017

If you have your landmark right, you shouldn't hit bone. The glute is a relatively large, thick muscle.

The glute is in a totally different place than the deltoid, just fyi.

OP, don't worry about it - the good thing about hitting bone is there aren't any nerves in the bone. It will probably bother you more than the patient. If you do hit bone, just withdraw a tiny bit and then inject.

Psychrn6685 · Mar 1, 2017

Thank you. So do you recommend going all the way in? I hate this. I used to never have problems with this until i messed up one time and now I'm a nervous wreck every time on things I never had a problem with! What's the matter with me! I feel like a terrible nurse I serisouly want to just turn my license in after all these years. I never thought I'd stoop to this level. Thank you

sallyrnrrt, ADN, RN · Mar 1, 2017

I frequently use 2 in long needles, in the obese, I do truly at least one obese, physician ordered to be given, with 3.5 in needle

allnurses Guide · Mar 1, 2017

Thank you. So do you recommend going all the way in? I hate this. I used to never have problems with this until i messed up one time and now I'm a nervous wreck every time on things I never had a problem with! What's the matter with me! I feel like a terrible nurse I serisouly want to just turn my license in after all these years. I never thought I'd stoop to this level. Thank you

Unless you are using the Deltoid due to patient preference (Which I totally understand with my psych patients) I always prefer to use the ventral/gluteal site. No pesky nerves or big blood vessels in the way and a great big muscle to take that injection. Still as I said if the patient prefers the delt and is obese I would go with the 1.5" and if your landmark is right you will definitely have enough muscle to work with. My Invega rep told me the shot appears to be more efficacious in the glute though.

Still better in the delt than not at all.

Hppy

sallyrnrrt, ADN, RN · Mar 1, 2017

Thank you. So do you recommend going all the way in? I hate this. I used to never have problems with this until i messed up one time and now I'm a nervous wreck every time on things I never had a problem with! What's the matter with me! I feel like a terrible nurse I serisouly want to just turn my license in after all these years. I never thought I'd stoop to this level. Thank you

what obstacles did you experience? I appreciate your concern, my 45+ years experience.... Gives me more confidence

we will advise direct etc..as long as possible, to ensure IM needed injections.

Psychrn6685 · Mar 1, 2017

Thank you!!!!! I have one female who gets haldol dec and she doesn't let me go anywhere but her arm! And she's always making noises... honestly I get it- it can hurt but geez I'm not murdering you!!!! None of my other guys make noises ... she's the only one and since she won't let me give it anywhere else I'm stuck doing it in her arm! And she's about 250 so I'm always terrified when I go in with the 1.5 . I'm cringing just thinking about it!!!! Thanks for the invega advice!

Psychrn6685 · Mar 1, 2017

Thank you for writing...last month I gave a haldol dec in the glut ( only place he'd let me) with a 1.5. He started having sx 2 weeks later. I've been blaming myself this entire time that I should have used a 2 because I might have gone subcutaneous... he's 188 lbs 5'6! Now I'm giving an IM in the deltoid and I'm terrified to use a 1.5 although I know a 1 will not cut it for this 250 lb lady. I used to be so confident until that haldol dec patient screwed everything up for me. I feel completely defeated...