Learning to give injections

General E. Speaking, RN, RN · Aug 5, 2005

You can't get away from not hurting the patient- it is, afterall, a needle! I listen with a sympathetic ear and politely tell them I am sorry they are sick. Then I ease into explaining why we need to get this IV/IM med administered so they can start feeling better. Just keep trying to start those IV's and give those IM injections...as your skill level increases, so will your confidence!

CritterLover, BSN, RN · Aug 5, 2005

i know that several people will disagree with this, but anyway.......

when you have the opportunity, start all the ivs/give all the injections you can to patients who are unaware, either too confused or too comatose to realize what you are doing.

some will say that it is wrong to "practice" on a patient because they are unaware, but i'm not advocating giving unnecessary injections/ivs to these people, just the ones that are medically indicated. i don't consider that "practicing."

the reasoning behind this is simple: part of your difficulty in doing these tasks the first few times is going to be what the patient's perception of your skill level is.you will have more confidence in yourself and be less nervous if your patient isn't aware.(not to mention that your patient will be a whole lot less nervous at having an inexperienced person give them a shot :) .)

if you are giving an injection to someone who is aware, act confident! it will go a long way to making the patient at ease, and the more relaxed the patient is, the less they will tense up and the less it will hurt.

my very first injection was an insulin shot. i gave it during school to a little old lady who was very confused. i almost passed out when i saw the needle go through her skin, but i made it through (by the way, most who are on the receiving end will tell you that insulin shots don't hurt much, if at all).

my first iv was on the same rotation, but a young kid (maybe 18) who had undergone a splenectomy. he was doped up on pain meds and didn't even seem to notice (and, amazingly, i got the iv......then came a loooonnnngg drought before i got my second one). which brings up two more points: it is also helpful if you can start ivs at first on young people with good veins (talk about pointing out the obvious!) if you ever do a rotation in a trauma unit, this is a good time to look for ivs to do.

the other point is that you will learn more from missing the first few ivs you did than you will from "getting" them. pay attention to what went wrong. i really didn't learn anything on how to start an iv on the first one that was successful, but i still learn tricks on how to improve my skills when i miss ivs today.

my first im injection was actually actually a couple of years into my nursing career, believe it or not. in school, my paitient all had iv pain meds. i worked in icu for the first few years i was out of school, and the first im injection i had to give was to a trauma patient who needed his pneumovax/hib shots due to having a splenectomy (i had to ask someone from the trauma er to help me!) that was it for several years until i started working in an er, where im rocephin seems to be the drug of choice for just about whatever ails you. all i can say, is i still hate to give an im shot, esp of an antibiotic. know your landmarks well, and be sure to pull the skin taunt and give the injection quickly -- "stab" quickly with the needle and inject quickly as well. some ims hurt (antibiotics, phenergan), some don't (usually vaccines -- i didn't even feel the last vaccine i got). personally, i am always truthful about how much a drug is going to burn on the front end. i hate to see a nurse lie and say "it's only going to hurt a little bit" when giving a painful injection. and, when giving those abx, reconstitute with lidocaine if your facility policy allows (mine didn't).

by the way, i'm assuming you are a student....your profile didn't really specify

rambisisking · Aug 5, 2005

i know that several people will disagree with this, but anyway.......
when you have the opportunity, start all the ivs/give all the injections you can to patients who are unaware, either too confused or too comatose to realize what you are doing.
some will say that it is wrong to "practice" on a patient because they are unaware, but i'm not advocating giving unnecessary injections/ivs to these people, just the ones that are medically indicated. i don't consider that "practicing."
the reasoning behind this is simple: part of your difficulty in doing these tasks the first few times is going to be what the patient's perception of your skill level is.you will have more confidence in yourself and be less nervous if your patient isn't aware.(not to mention that your patient will be a whole lot less nervous at having an inexperienced person give them a shot :) .)
if you are giving an injection to someone who is aware, act confident! it will go a long way to making the patient at ease, and the more relaxed the patient is, the less they will tense up and the less it will hurt.
my very first injection was an insulin shot. i gave it during school to a little old lady who was very confused. i almost passed out when i saw the needle go through her skin, but i made it through (by the way, most who are on the receiving end will tell you that insulin shots don't hurt much, if at all).
my first iv was on the same rotation, but a young kid (maybe 18) who had undergone a splenectomy. he was doped up on pain meds and didn't even seem to notice (and, amazingly, i got the iv......then came a loooonnnngg drought before i got my second one). which brings up two more points: it is also helpful if you can start ivs at first on young people with good veins (talk about pointing out the obvious!) if you ever do a rotation in a trauma unit, this is a good time to look for ivs to do.
the other point is that you will learn more from missing the first few ivs you did than you will from "getting" them. pay attention to what went wrong. i really didn't learn anything on how to start an iv on the first one that was successful, but i still learn tricks on how to improve my skills when i miss ivs today.
my first im injection was actually actually a couple of years into my nursing career, believe it or not. in school, my paitient all had iv pain meds. i worked in icu for the first few years i was out of school, and the first im injection i had to give was to a trauma patient who needed his pneumovax/hib shots due to having a splenectomy (i had to ask someone from the trauma er to help me!) that was it for several years until i started working in an er, where im rocephin seems to be the drug of choice for just about whatever ails you. all i can say, is i still hate to give an im shot, esp of an antibiotic. know your landmarks well, and be sure to pull the skin taunt and give the injection quickly -- "stab" quickly with the needle and inject quickly as well. some ims hurt (antibiotics, phenergan), some don't (usually vaccines -- i didn't even feel the last vaccine i got). personally, i am always truthful about how much a drug is going to burn on the front end. i hate to see a nurse lie and say "it's only going to hurt a little bit" when giving a painful injection. and, when giving those abx, reconstitute with lidocaine if your facility policy allows (mine didn't).
by the way, i'm assuming you are a student....your profile didn't really specify

this is wonderful advice, i hope you have oppurtunities to do this. always keep in mind that what you are doing is going to help them in the long run and that may ease your feelings of hurting someone. there are measures that can be taken to decrease the hurt after an injection depending on the med given, massage and ice packs come to mind but read about med first.

LilRedRN1973 · Aug 6, 2005

I completely agree with the previous poster that said practice on those who aren't quite as "aware". I work in the ICU and have since after my first semester of school. After my 2nd semester, I was able to start IV's. I started any and every IV I could in the ICU, mostly to patients who were on paralytics and sedation.

It was a GREAT learning experience and when I had to start IV's in front of my instructors my second year, I received tons of compliments on my level of comfort as well as my ability to actually get the IV's started. Plus, learning on ICU patients can be really difficult as many of them are long time diabetics, renal patients who are swollen all to heck, and dehydrated patients who have wonderfully collapsed veins. And the ICU nurses were more than happy to step aside and let me have a go at it!

Melanie = )

rbnNurse · Aug 6, 2005

Wow, great topic.

I was one of those "Shaky Sam's" in my lab on injections. It all seemed so simple until it was my turn at the dummy. It was a DUMMY and I was nervous. Well, I did my student to student after practicing on a dozen oranges over the next week and got the feel for IM, SC, ID down.

Then I asked if there were opportunities to give a lot of injections. My instructor pointed out that it might be possible to get a group together to do a flu-shot clinic. I plugged the idea with a few of my fellow students and we came up with a large enough number of volunteers. Our intructor contacted one of the local hospitals and volunteered us. It was the single most valuable experience in injections I could have ever asked for. I did over 25 injections in a few hours!

Now I'm orienting in my nursing home and have had to give injections to residents who've known me as an aide for the last year. I'm not nervous at all because I know that I can give the injections well and many of them, just like the clients at the flu clinic have told me that I give a good stick.

As for the IV's, I have to let others give advice there. I'm not 'rated' until next semester (Fall 05). I assume the same principle applies, get as many chances to practice as you can, learn from the mistakes not the successes, and project confidence (even if you are a "Shaky Sam") :) .

I'm kind of squeamish around needles (which I'll have to get over I know) and I was just wanting some advice and/or personal stories on how you learned the best way to give injections/IV's and not be so afraid of hurting the patient.
Thanks!

onesmallspark · Aug 7, 2005

Wow, great topic.
I was one of those "Shaky Sam's" in my lab on injections. It all seemed so simple until it was my turn at the dummy. It was a DUMMY and I was nervous. Well, I did my student to student after practicing on a dozen oranges over the next week and got the feel for IM, SC, ID down.

STUDENT TO STUDENT??? You mean I practice on one of my fellow students and then they stick ME??? :uhoh21:

I'm not a student yet - what is an IM, SC and ID??

nicolel1182 · Aug 7, 2005

intramuscular, subcutanous and intradermal

mandrews · Aug 7, 2005

When I was in school we practiced on an orange, injected each other in the arm with saline, then we heploc'd each other one time. The school had a small 8x8 block that resembled fake tissue with veins under it and we practiced feeling the mushy veins and inserting the introcan.

** one tip. do not ease the needle in and prolong the pain. a swift injection is much better.

melissa :)

VickyRN, MSN, DNP, RN · Aug 7, 2005

Simple tips:

Know your landmarks well.

Practice, practice, practice on the mannequins in the lab as much as possible. (The old adage is very true - "To fail to plan is to plan to fail")

Allow the skin prep with alcohol to dry thoroughly before injecting. (Otherwise you are pushing alcohol deep into the skin and tissue - OUCH!).

Use as small a gauge of needle as possible to adequately inject the medication.

Don't ever say "This won't hurt." The patient knows you're lying and you will lose all credibility. Say instead, "I will be gentle."

jsteine1 · Aug 7, 2005

Simple tips:
Know your landmarks well.
Practice, practice, practice on the mannequins in the lab as much as possible. (The old adage is very true - "To fail to plan is to plan to fail")
I always enjoy Vickis posts. I wish I had profs like her when I was in school, during the dark ages. (:

Nurseinthemaking · Aug 7, 2005

STUDENT TO STUDENT??? You mean I practice on one of my fellow students and then they stick ME??? :uhoh21:
I'm not a student yet - what is an IM, SC and ID??

We were not aloud to do student to student. My poor orange was so injected it was pitiful. I had to put a face on him so my kids wouldn't eat him.

My tips for getting over the shakes is just do it, it really is not as bad as I thought it was going to be. Although, the first time I hit bone, I about fainted. I stopped midstream and my instructor was like, what are you doing, keep injecting, and I was going, uh, uh, uh....then I came to and finished, after I was done, I said I hit her bone and the pt goes, "Yeah, you did", I felt so bad, but after doing that, there is no explaining how it feels to hit bone. Ick, gives me the heebie jeebies, but after living through that I knew I could do anything.

Just remember Sub Q, they are so "Q"ute, you have to pinch them. IM, you are going in the muscle so asperate first to make sure you are not IV, in the vein. Then there are those that have to be given Z-track. That one was hard for me to get down, but practice, practice, practice.

Does that help?

One other thing, IV's, well they are few and far between, atleast at the hospital I was at, they generally came on the floor with IV in tow. I only got one chance in the hospital, it was during my ER rotation, I got it, but I needed 10 other hands to assist, my trick on that has been, now that I know what is going on, watch, watch watch other nurses do them, different nurses have different technigues. Then after nursing school go and take an IV certification class.

We tried to get our instructor to get us through atleast one day of pre-op, that could have gotten us several opportunities, but she never did get that done for us. Maybe she can do it for next years group. It would have been a great opportunity.

Good luck, just breathe in and breathe out. You have got to get past the bed making and transferring patients, first. Baby steps, one thing at a time. :)