Please stay up on your CEUs (NOT a medical assistant bash)

[HeartsOpenWide]

First I want to say that this is not a Medical Assistant bash, it just happens that a Medical Assistant was involved; it could have easily been a nurse.

When I went through the medical assisting program back in 2001, they were still teaching us to give IM injections in the Glut and to rub after an IM injection. By the time I got to nursing school they said never rub after an IM injection to prevent spreading a systemic reaction, and never inject into the glut to avoid the sciatic nerve.

(I mention that this is not an MA bash because I recently took over on a patient that had gotten an IM injection in the glut by a Nurse)

I recently got a Tetorifice injection in the left deltoid. With injections it is better to give than receive...so I was not looking, therefore I can not say if the MA aspirated or not. However, what I know is that she rubbed after the injection and when she withdrew the needle I bled all the way down my arm, she commented "Oh I hit a capillary". That evening I woke up with numb and tinging arms and hands, over the course of the evening it spread head to toe on my entire left side and started to radiate slightly to my right. I had to take a five hour drive that morning; which turned out to be quite discomforting, my entire left side (and I do mean my ENTIRE left side) was numb, tingly, and painful like when you leave a tourniquet on too long. It also felt cold like when you have poor circulation, I could feel it in my hand and when I stuck both of my hands under my legs my left hand felt colder than the right. Finally this morning when I woke up the symptoms seem to be residing. I hope.

My point of this post is to keep up your education, never assume that practice never changes. I can not say for sure if this MA aspirated or not, but I would venture to guess that she did not since she hit a capillary and continued to inject. On top of being injected into a capillary, the injection was rubbed in; totally systemic injection of Tetorifice Toxoid. Having your entire left side go numb and then become painful like some one is cutting your circulation off is not fun and is very scary. Had the MA been using proper technique she would have not rubbed in my injection and possibly I would have avoided these last two days of annoyance, pain, and worry.

[Spacklehead, MSN, NP]

I have given too many injections to count via SQ/IM routes and have sometimes had blood trickle out like that upon needle withdrawal (well, actually I would catch it with the alcohol pad or gauze before it ran all the way down the arm) and never had blood come back into the syringe upon aspiration. I agree with morte, maybe she went through a capillary - nothing one can do to prevent that. Did you follow up with your health care provider regarding your symptoms?

I'm sorry that you had such a bad and scary experience, and hope you are feeling better.

[Meriwhen, ASN, BSN, MSN, RN]

I have given too many injections to count via SQ/IM routes and have sometimes had blood trickle out like that upon needle withdrawal (well, actually I would catch it with the alcohol pad or gauze before it ran all the way down the arm) and never had blood come back into the syringe upon aspiration. I agree with morte, maybe she went through a capillary - nothing one can do to prevent that. Did you follow up with your health care provider regarding your symptoms?

I'm sorry that you had such a bad and scary experience, and hope you are feeling better.

The first time I had that happen to me, I panicked because I aspirated before injecting and had no blood come back. I asked my supervisor (a well-seasoned RN) about it. She said that sometimes IMs can bleed after withdrawing the needle: provided I had no blood when I aspirated, then it was likely caused by a damaged capillary when I inserted/withdrew the needle.

OP: I hope everything is working out for you.

[Spacklehead, MSN, NP]

Not to harp on this, but I'm just curious after thinking about what you learned about IM injections in your OP - do you have links to evidence-based research that state IM injections (in general) should not be given in the gluteal area? As far as I know, as long as you locate your landmarks properly you should be able to avoid hitting the sciatic nerve. I, personally, have never heard that the gluteal area should not be used ever (in adults).

Also, I believe massaging after an injection depends upon what the manufacturer of the particular drug states - and this should be checked prior to administration of the injection. Now, this could be the case with a tetorifice vax - but it might not be the case with another drug.

How are you feeling today? Hopefully better!

[~Mi Vida Loca~RN, ASN, RN]

Not to harp on this, but I'm just curious after thinking about what you learned about IM injections in your OP - do you have links to evidence-based research that state IM injections (in general) should not be given in the gluteal area? As far as I know, as long as you locate your landmarks properly you should be able to avoid hitting the sciatic nerve. I, personally, have never heard that the gluteal area should not be used ever (in adults).

Also, I believe massaging after an injection depends upon what the manufacturer of the particular drug states - and this should be checked prior to administration of the injection. Now, this could be the case with a tetorifice vax - but it might not be the case with another drug.

How are you feeling today? Hopefully better!

We learned injections at the end of last semester, so about November and my school is pretty up to date and adamant about all the "evidence based practice" stuff. They said the injections were said to be more effective by being better absorbed and less risk of injury if done in the Ventrogluteal Muscle (except Vaccines can just do deltoid in adults) and no longer use the Dorsogluteal Muscle. They said we aspirate on the IM injections except the vaccines as well. I am not sure why vaccines are different. We were told to not massage ever after an injection anymore and off the top of my head I can't remember why. Since as long as I can remember, I have only had injections done in my deltoid of Dorsogluteal Muscle

[Spacklehead, MSN, NP]

We were told to not massage ever after an injection anymore and off the top of my head I can't remember why. Since as long as I can remember, I have only had injections done in my deltoid of Dorsogluteal Muscle

This is exactly why I'm curious to see the research. I want to know why any injection area should not be massaged if the manufacturer of the drug does not specifically state that it shouldn't be (I know why for the obvious drugs like heparin, insulin and lovenox). It's not that I doubt people are correct - but I want to know for my own knowledge and curiousity why. I checked Pubmed rather quickly and could not find anything - but I will try again when I have more time.

Also in the OP, it was mentioned that "gluteal" sites, in general, should not be used. That is why I was kind of confused and questioned it because I always had read that the ventrogluteal muscle was a good site to use because of the lack of nerves in the area.

[CBsMommy]

Hi Softballmama - I was told the same information Mi Vida Loca was. I was also told to go ahead and do Z-track injections for all IMs and not to rub so we don't push the medication back out of the muscle, through the needle track for max. absorption. I'm not sure of the research but that is what we were told.

[~Mi Vida Loca~RN, ASN, RN]

Hi Softballmama - I was told the same information Mi Vida Loca was. I was also told to go ahead and do Z-track injections for all IMs and not to rub so we don't push the medication back out of the muscle, through the needle track for max. absorption. I'm not sure of the research but that is what we were told.

Oh yeah, I forgot to say always Ztrack for the IM

Softballmama if I see one of my instructors from last semester at school this week I will ask again.

[Spacklehead, MSN, NP]

Thanks, much appreciated! I found two different sources just now (neither were studies, however) that stated two different things. One said not to massage since it can add to the patient's discomfort after the injection and the other source mentioned that massage should be performed to help disperse the medication in the muscle for quicker absorption (which would be good for pain meds).

Hmmm....maybe a good topic for an evidence-based project for an MSN or DNP student! :)

[Happylady123]

I know this is an old thread, but just in case some happens to be reading it. I'm currently in a BSN program. The newest guidelines are to only give gluteal shots in the ventrogluteal area. This is to avoid the possibility of hitting the sciatic nerve. Even though it is rare, when it happens it can cause significant injury, so the risk isn't worth it.

Also, the newest teaching is that IM injection sites should not be massages. You can apply gentle pressure for 10-15 seconds. Massaging the site can force the med into the subcutaneous tissue, which can cause irritation and isn't the goal of that route anyway. The Z-track method is preferred to keep the medication in the muscle as well.

aspiration is no longer required based on CDC guidelines. Apparently evidence didn't support it. We were taught not to aspirate.