Hmm......what would you do?

  1. I work in a smaaaaall town. Only one of the docs has so far managed to get a supply of pedi flu vax (not my doc) so I took my 2-yr-old in on Monday. He employs an MA in his office. (Before I go any further, I have ABSOLUTELY NOTHING against MAs.) First thing I noticed was that she didn't aspirate after poking, but I decided to let it go. Because of how I was holding my daughter, I couldn't really see anything else, but when we got home and I changed her diaper, I noticed the bandaid was in a funny position. Took it off and found the needle hole.......right smack dab in the front middle of her thigh, rather than lateral and higher up. Since she's under three she needs to go back in a month for her second dose.

    Would you talk to the doc?
    •  
  2. 11 Comments

  3. by   lovingtheunloved
    Yeah. Wrong site and wrong technique.
  4. by   augigi
    I'd talk to the MA in question when I go back before the next dose is given.
  5. by   babynurselsa
    I had a similar situation when my 5 year old was an infant. the MA was so tentative that she required 2 jabs to break the skin then the site was about 1 inch above the knee.
    The Doc and I had a heart to heart about this individuals lack of skill and knowledge about where the vastus lateralis was, and that she would not be giving my child anymore injections. From then on I took her the the county Health Dept for all immunizations.
  6. by   AfloydRN
    Not to be rude, but I would ask if there was a nurse available. Do speak w/ the MD and let him know your concerns. Chances are likely he's heard it before.
  7. by   TazziRN
    Quote from AfloydRN
    Not to be rude, but I would ask if there was a nurse available. Do speak w/ the MD and let him know your concerns. Chances are likely he's heard it before.
    None of the docs in this town employ nurses except one, which is my doc, and he didn't have any pedi vax. I did talk to the doc and no, he wasn't aware.
  8. by   GatorRN
    So, if I'm understanding your last post Tazzi, you did speak to the doc at the office that gave your daughter her vaccine. That was definately the right thing to do. He needs to be aware that his MA is using the wrong technique, and the wrong site, for sure. When you take her back next month, I'd be sure to clarify with the MA, before she does the injection, that she now knows how to do it correctly.
  9. by   TazziRN
    Actually I found out the site is okay for small kids. I don't remember the rationale, but that doc as well as mine said it's been used for a few years now. I let that one go, but I did tell the doc I wasn't happy about the not aspirating. He wasn't either.
  10. by   DutchgirlRN
    Quote from TazziRN
    found the needle hole.......right smack dab in the front middle of her thigh, rather than lateral and higher up. Since she's under three she needs to go back in a month for her second dose.

    Would you talk to the doc?
    I would and I have. My grandson got shots and the LPN didn't aspirate either with 3 different injections. I questioned the doctor and he said they don't aspirate on young children with nice meaty thighs because it delays the injection for no reason and the quicker the better. I don't agree but well, he knows, he agrees and it's over. Next time if I'm present I will ask the nurse to aspirate. She also gave the injections right in the middle of his thighs. The doctor didn't see a problem with that either. Like I said, if I'm present next time...(those nurses will be talking about me when I leave)

    From my understanding, yes, the flu vaccine is repeated in children in 30 days but it's best to ask.
    Last edit by DutchgirlRN on Nov 21, '06
  11. by   dosamigos76
    Quote from TazziRN
    Actually I found out the site is okay for small kids. I don't remember the rationale, but that doc as well as mine said it's been used for a few years now. I let that one go, but I did tell the doc I wasn't happy about the not aspirating. He wasn't either.

    Ask the Experts: General Vaccine Questions

    "ACIP does not recommend aspiration when administering vaccines because no data exist to justify the need for this practice. Intramuscular injections are not given in areas where large vessels are present. Given the size of the needle and the angle at which you inject the vaccine, it is difficult to cannulate a vessel without rupturing it and even more difficult to actually deliver the vaccine intravenously. We are aware of no reports of a vaccine being administered intravenously and causing harm in the absence of aspiration. (10/05)"

    From the CDC:
    http://www.cdc.gov/mmwr/PDF/rr/rr5102.pdf (page 12)

    "Although certain vaccination specialists advocate aspiration
    (i.e., the syringe plunger pulled back before injection),
    no data exist to document the necessity for this procedure


    Cheryl

    "Although certain vaccination specialists advocate aspiration
    (i.e., the syringe plunger pulled back before injection),
    no data exist to document the necessity for this procedure."
  12. by   NRSKarenRN
    rectus femorus muscle in front of vastus lauteralus is ok for peds immunizations.

    landmark pics + peds precautions when giving injections:
    excerpts from nursing procedures


    donna wong:
    with the rapid advances in immunizations against childhood diseases has come the dilemma of choosing safe sites for multiple intramuscular injections. by 18 months of age, infants can receive 20 injections, with as many as 5 in one visit, and each should be given at a separate site! literally our infants have become "pin cushions."
    ventrogluteal site for intramuscular injections
    cdc does not recommend aspiration as noted above.
  13. by   TazziRN
    Yeah, I found that out about the sites, Karen. Thank you for the link, I've been trying to find something on line about it.

    I still disagree with the "don't aspirate" thought. It may be rare but hitting a vessel can happen...I've seen it done and I've done it myself. I do not want to risk injecting a med IV by accident.

close