Did I harm the patient??

  1. 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.
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  2. 24 Comments

  3. by   Wuzzie
    Zero.
  4. by   JKL33
    Confession time: I've done a ton of precepting in my career. At one point, as an experienced RN myself, I was doing a basic orientation for an excellent and experienced RN who was new to the unit. Let's just say that through my interactions with her, I learned that the physical site that I'd been taught was "ventrogluteal" was actually DORSO gluteal. So...all the years I'd been giving IM injections in the "ventrolguteal"....welp, it was actually the dorsogluteal that I gave them in. Granted, I always erred on the side of being very sure I was 'to the upper-outer portion of the upper-outer quadrant', but still. Suffice it to say it was a humbling moment. However, no, I never caused unexpected pain to anyone at the time of injection, and I never received any kind of feedback that somehow my injections had caused a problem.

    I corrected my practice.

    Everything is fine, but do take measures to learn how to do a proper ventroguteal injection.
  5. by   brownbook
    I am terrible at IM injections site locations. I so seldom have to give IM's. Insert IV give meds, is what RN's do.

    I have never harmed a patient, but IM injections worry me more than starting an IV. I have to use cheat sheets, check out Youtube videos, etc., almost every time before I give one.
  6. by   Coffee Nurse
    Quote from brownbook
    Insert IV give meds, is what RN's do.
    This strikes me as unnecessary. We give meds IM if that's the correct route for them. I give vitamin K to newborns IM all the time, doesn't make me any less of an RN.
  7. by   soutthpaw
    Aspiration of IM injections is no longer needed or considered the standard of practice by the CDC. Just FYI
  8. by   CrunchRN
    If they didn't have pain it is fine. However, in the future use the safer VG site.
  9. by   brownbook
    Quote from Coffee Nurse
    This strikes me as unnecessary. We give meds IM if that's the correct route for them. I give vitamin K to newborns IM all the time, doesn't make me any less of an RN.
    No way was I saying anyone is less of anything. I'm saying most of my nursing career was working with patients with IV's and giving IV meds. I am saying I am less of a nurse because what should be a good basic skill gives me trouble.

    Honestly, I probably gave 40 IM injections over my 30 years of nursing. Just depends on what area you work.
  10. by   Kooky Korky
    Quote from brownbook
    I am terrible at IM injections site locations. I so seldom have to give IM's. Insert IV give meds, is what RN's do.

    I have never harmed a patient, but IM injections worry me more than starting an IV. I have to use cheat sheets, check out Youtube videos, etc., almost every time before I give one.
    What RN's do is every kind of injection. SubQ, IM in various locations, subdermal, intradermal, IV. What ever did you mean by "what RN's do"?

    OP - I think your patient would have been in pain if you'd hit the sciatic nerve. I think you have done no harm. Can you follow up with the patient? I'm not saying to do that, just wondering if you can so you can reassure yourself.

    Every so often, I study sites. Never hurts to review.
  11. by   brownbook
    Geeze honest folks, am I the only nurse who has only worked acute care where 99.9% medications are given IV ?

    I repeat, in my 30 years of nursing, in a variety of areas, I mainly give IV meds. By gosh it is what separates LVN's from RNs. I have the upmost respect for LVN's, many can start IV's better than me. But every where I have worked they cannot give IV medications. Is that not the norm?

    If an IM is ordered I often ask the LVN to give it because I know she is better than me. I watch her in the hopes I will learn and get better at it.

    It is the same as nurses worrying they don't know or remember how to insert Foley's. Some areas of nursing you insert Foley's frequently, other nurses feel like new grads or nursing students when a situation comes up where a patient needs a Foley. Same with inserting a NG tube, or setting up a continuous ice irrigation, or setting up a PCA pump.

    I could not set up a PCA pump if my life depended on it, I feel nervous giving IM's. It is simply a nursing task I seldom do.


    I meant no disrespect to anybody.
  12. by   NurseCard
    It does depend on where you work, and I suppose perhaps, what state,
    country, etc. you work in. Where I work, LPN's do give IV push meds.

    In my workplace, I too very seldom give IM meds. We give a lot
    of flu and pneumonia shots, but those are all given in the deltoid.
    I gave a TON of IM meds when I worked psych.
  13. by   OlivetheRN
    Quote from brownbook
    Geeze honest folks, am I the only nurse who has only worked acute care where 99.9% medications are given IV ?
    I think that will depend on the type of acute care area you work in. Working in the ER, yes, I give a TON of IV meds, but if I'm working in our fast track area (or depending on how the night is going in our behavioral med area...) I will give a TON of IM meds. Tetanus, toradol, sometimes dilaudid or morphine, I've given IM solu-medrol over there, muscle relaxers, and good Lord if we have to give the first Rabies vaccine, it's like a jigsaw puzzle figuring out where to put them all if the patient is on the heavier side (we will literally draw a diagram of where all their injections are going bahahaha).
  14. by   Tenebrae
    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

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Did I harm the patient??