Did I harm the patient??

Tenebrae, BSN, RN · Jul 17, 2017

Stop freaking out. Its not helpful for you and it certainly isnt helpful for the patient

A needle into a nerve sort of feels like boiling water being poured along the nerve. If you'd hit the patients sciatic nerve, BELIEVE me, you would have known

NuGuyNurse2b · Jul 17, 2017

I meant no disrespect to anybody.

None taken, I can tell the few people who responded to your comment obviously misread it. Personally I don't see how they did it, I mean, the syntax was there; they just chose one section of what you wrote and zeroed in on it.

Fermin Hernandez, ADN, ASN, RN · Jul 17, 2017

None taken, I can tell the few people who responded to your comment obviously misread it. Personally I don't see how they did it, I mean, the syntax was there; they just chose one section of what you wrote and zeroed in on it.

Yup. When it was said "It's what RNs do..." nursing is a huge field and just because one lacks experience with a role does not mean others do as well. IM medication certainly has a role in patient care at times. Its easy to get tunnel vision in this job if someone works at one facility or one type of care. Flexing between departments, like Med-Surg and ER, for example, can do wonders for skillsets and comfort levels.

allnurses Guide · Jul 17, 2017

I am kind of freaking out. I work in a facility where we do not give a lot of injections, usually just IM deltoid vaccines occasionally. Last week I gave a patient a dorsogluteal injection of Phenergan. I was trained to give these dorsogluteal, but now I am reading all of these horrible things about sciatic nerve damage, and how ventrogluteal is preferred. So when I gave the shot, the patient did bleed a little with needle retraction, at the time I assumed this was from capillary damage on the way out, since it was not an auto-retracting needle and I did aspirate. If I had hit the sciatic nerve, would it have been immediately obvious? The patient did not seem to experience any pain and he did not say anything. I definitely gave the injection in the outer upper quadrant, but what are the chances I harmed the patient?? I am now wondering about all the other dorsogluteal injections I have given over the years.

I'm just speculating, based on my personal experiences working various jobs which included giving injections to all shapes and sizes.The likelihood that you harmed the patient is pretty close to zero, assuming you used the appropriately-sized needle.

NunNurseCat · Jul 17, 2017

If you had hit the sciatic nerve the patient would have uncontrollably jerked away. Even getting close to a nerve can be really painful once you start to push.

A good stick is usually in the painless-to-tolerably-uncomfortable range.

djh123 · Jul 17, 2017

You say you definitely gave it in the upper outer quadrant, so I think there is no problemo whatsoever.

K9lover, ASN, RN · Jul 17, 2017

It would be immediately obvious if you hit the sciatic nerve.

calivianya, BSN, RN · Jul 17, 2017

I agree that 99% of meds are given IV... but when I'm giving IMs to a patient, I'm giving a lot of them.

I'm usually giving IMs to the totally out of control violent delirium/psychotic patients... so when I do give IMs, I probably give 10+ a shift. One recent night it was 4x IM Ativan, 3x IM Geodon, 4x IM Haldol... patient had been running precedex but had pulled out his central line and promptly spit in the face of the IV team nurse when she tried to get a peripheral, and swung at me when I tried, so no dice on getting IV access.

However, the last IM I gave him (Ativan), he pulled the syringe out of my hand after I stuck it in his leg and started swinging it at me, needle and all. He would have gotten me with it if it hadn't been for our intensivist doing a ninja move and bending his arm around backwards to get the needle out of his hand. He bought himself an IO insertion to start the Precedex back *while he was awake* after that. Never IO'ed an awake patient before. Heck of a lot more intimidating than giving an IM. I've never heard anyone scream like that, either.

For the record, I almost always give IMs in the vastus lateralis. Ventrogluteal, especially, requires careful landmarking... if someone's swinging at me, ain't nobody got time for that. Not to mention, you have to be a lot closer to the patient's arms for dorsogluteal or ventrogluteal, and if they're violent, that's a no go. If someone else is holding the patient's shoulders down, you can get to the vastus lateralis without risking getting hit.

NuGuyNurse2b · Jul 17, 2017

^ I have never IO'd anybody either. I honestly wouldn't even know what to do, we weren't taught that in our program.

calivianya, BSN, RN · Jul 17, 2017

^ I have never IO'd anybody either. I honestly wouldn't even know what to do, we weren't taught that in our program.

I've placed an IO in a code situation before... but that's totally different, because it's last ditch, and the patient is pretty much already dead anyway (hence the code) so it's less pressure. What I can tell from that guy's reaction is it really, really hurts. And hurts when you first start infusing medications, even if you primed with lidocaine, even if you push extra lidocaine before starting meds.

Julius Seizure · Jul 17, 2017

I've placed an IO in a code situation before... but that's totally different, because it's last ditch, and the patient is pretty much already dead anyway (hence the code) so it's less pressure. What I can tell from that guy's reaction is it really, really hurts. And hurts when you first start infusing medications, even if you primed with lidocaine, even if you push extra lidocaine before starting meds.

I've always wondered about this...because its not supposed to be particularly painful, according to the youtube videos of them demonstrating it on healthy awake individuals.

JKL33 · Jul 17, 2017

Yeah, they do hurt the average awake person when done without local. The videos are very useful for getting an idea of the technique, but they don't look like what you should expect if you just haul off and decide to put one in an awake patient next time you have trouble with an IV. Perhaps it's not your average characters who choose to participate in the videos....?