Injection in buttocks: 1" vs. 1 1/2" needle

Nurses General Nursing

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I am a new graduate who has yet a lot to learn but I am a bit confused :confused:about giving injections in the buttocks. One of the nurses who trained me told me to use a 1 inch needle when you give Depo-Provera, Phenergan, Kenalog and B12 injections. The only time I use the 1 and 1/2 inch needle is when I give Depo-Testosterone and Rocephin.

Last week I had to give a Phenergan injection to a dehydrated patient who came into our clinic for an office visit (I work in Family Practice). I started her IV and once she was settled I gave her anti-nausea medication in her bottom using a 1" needle. Another nurse (20 year veteran) who was working with me told I should have used a 1 and half inch needle instead of a one inch needle. Then yet another nurse (30+) told me I should have given injection in the arm with 1 inch. Who is right? Please help!

Specializes in multispecialty ICU, SICU including CV.

Wow. Those were some icky pictures.

I guess I'm not sure how IM would be any better --- to have THAT directly into muscle?

I don't remember the last time I gave phenergan...it's definitely been awhile, and was likely central as most of my patients where I work have central lines. Our docs seem to prefer other drugs for nausea (perhaps for this reason?)

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Specializes in Med/Surg.

We were told in school NEVER to give gluteal injections, that it wasn't evidence based practice. The only injection I give at work is flu shots/pneumonia shots and one of our docs who always orders IM demerol. I almost always use the deltoid.

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I'm a home health nurse and I administer cyanocabalamine (B12) to one of my patient monthly.I use a 1 1/2 needle and I give it in the deltoid muscle (arm) because the dose is 1ml.

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CNL2B said:
Hmmmm....by that rationale, I am not sure why it would be given IM at all, unless it's just old practice. Seems to me like diluted in a 50cc bag and given in a large bore IV along with the fluids would be the way to go. IDK, interesting.

Yes it is a rather newer protocol. Vescicants are being looked into much more and the rules of administration are being changed.

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CNL2B said:
Wow. Those were some icky pictures.

I guess I'm not sure how IM would be any better --- to have THAT directly into muscle?

I don't remember the last time I gave phenergan...it's definitely been awhile, and was likely central as most of my patients where I work have central lines. Our docs seem to prefer other drugs for nausea (perhaps for this reason?)

Phenergan is usually a second line anti nausea medication, Zofran being the most preferred.

Phenergan is a black boxed medication because it is a vesicant, also is a sedative...

Those chemically dependent will sometimes prefer Phenergan to be used over Zofran because of a phenomenon known and the "Phenergan Power Hour." This is when Phenergan is pushed fast, usually in conjunction with an opioid, causing extreme intoxication. Using the two meds together causes a much greater net intoxication than using the two alone.

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I was told as well in school that injections were not administerd directly into the gluteal muscles. However, in an outpatient clinic we give injections in the U.O.Q (Upper outer quadrant) of the glut.

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azilliRN said:
I was told as well in school that injections were not administered directly into the gluteal muscles. However, in an outpatient clinic we give injections in the U.O.Q (Upper outer quadrant) of the glut.

You will find as your career progresses that different facilities operate in different decades of knowledge. Whichever decade the leadership of the facility lives in/can afford is the level of practice typically observed.

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Specializes in LTC (LPN-RN).
azilliRN said:
I am a new graduate who has yet a lot to learn but I am a bit confused about giving injections in the buttocks. One of the nurses who trained me told me to use a 1 inch needle when you give Depo-Provera, Phenergan, Kenalog and B12 injections. The only time I use the 1 and 1/2 inch needle is when I give Depo-Testoserone and Rocephin.

Last week I had to give a Phenergan injection to a dehydrated patient who came into our clinic for an office visit (I work in Family Practice). I started her IV and once she was settled I gave her anti-nausea medication in her bottom using a 1" needle. Another nurse (20 year verteran) who was working with me told I should have used a 1 and half inch needle instead of a one inch needle. :uhoh21:Then yet another nurse (30+) told me I should have given injection in the arm with 1 inch. Who is right? Please help!

My institution no longer allows buttocks injections. I am surprised inst are still doing this. The issue is the SQ tissue in the buttocks, so that is why if they are done a 1.5 in needle is used.

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katherine100 said:
My institution no longer allows buttocks injections. I am surprised inst are still doing this. The issue is the SQ tissue in the buttocks, so that is why if they are done a 1.5 in needle is used.

so.....where are you allowed ?

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Specializes in LTC (LPN-RN).
morte said:
so.....where are you allowed ?

In all the other places. Arm, legs, VG

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P_RN said:
Here you go. Straight from the FDA

http://www.youtube.com/watch?v=79lJuEM5FnQ

If you have ever had it IV you will NEVER forget it. I have a sclerosed vein in my right arm that reminds me daily.

And after I had surgery, I don't forget it because it gave me great wonderful relief.

You don't give it in a questionable IV, you don't give it undiluted.

I'm tired of people doing stupid things being a reason to take away tools that can be very useful if used correctly.

Diluted in a good IV site, it's wonderful wonderful stuff.

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Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.
P_RN said:
Here you go. Straight from the FDA

http://www.youtube.com/watch?v=79lJuEM5FnQ

If you have ever had it IV you will NEVER forget it. I have a sclerosed vein in my right arm that reminds me daily.

When I ended my PACU career in 2007, IV Phenergan was prohibited from being given IV (in the PACU where I worked) because of the reasons stated in the you tube video. Phenergan could only be given in the gluteus muscle by deep injection. I have a personal hate for Phenergan. After reconstructive mandibular surgery, I was given Phenergan for narcotic potentiation (which has been debated as to effectiveness by a number of critics) one hour after extubation. I had a dystonic reaction from it, and ended up reintubated....it was a nightmare!

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