Giving IM inject in a SQ space?

[onehusbandsevenkids]

So, I'm a nursing student in the middle semesters (graduate in May).

They pair us up with a nurse to be with for a shift and we follow her along and basically do everything for her, with her supervising and teaching us.

So, there was an order for two IM injections, a flu shot and a pneu. shot

I had just given an insulin injection to a patient in the arm and now had to give these two IM injections to a different patient.

As we were walking to the room the nurse says to me, "now you'll give these two inj in the same spot you gave the insulin injection." I questioned her and said that the inj. were IM and she said "I know, but yoiu give these in the same spot you gave the insulin." I questioned her again and said "I gave the insulin into a SQ spot and thats where I am supposed to give these two IM injections?" and she says "yes, just like where you gave the insulin."

I thought for a second and then said "so, you want me to give these two IM injections into the SQ space?" and she said "Yes, thats where we give them."

I later asked my clinical instructor about it and he just kind of shrugged and said, sometimes that how they do it. Hmmmm.....

But whats weird about it is this......I have a friend who is a semester behind me and she had a skills evaluation check off recenly for injections. Come to find out one of the evaluating instructors told her the same thing.

So, I'm puzzled. Are IM's sometimes given SQ? I wouldnt think they would absorb correctly????

[hispanicpanic]

Medications have different routes for very specific reasons. IM is not SQ and Vice Versa. As a student if you come across a problem like this in clinical rotations you always have the right to tell your preceptor that you are uncomfortable giving the medication as this was not the way you were to taught and then let your instructor know right away. Don't let yourself be bullied by sloppy nursing.

[jjjoy, LPN]

When giving an injection SQ, it's common to sqeeze the skin and SQ fat beneath it between your fingers. When giving an IM injection, you generally pull the skin tight with your fingers and then inject. With the longer needles for IM's, that injection is bound to get into the muscle on most skinny arms. As others have stated, the external location would be the same, but the two different techniques and needle lengths should ensure that the SQ injection goes into SQ tissue and the IM injection goes into muscle.

In regard to how the nurse you were working with described and maybe even misunderstood SQ and IM injection techniques... well, even with the rigors of nursing school and licensing, you'll find nurses who do things incorrectly and/or don't understand what they are doing. It's frustrating when you are a student or a new nurse because it's not clear to you when something is wrong versus when it's just done differently than you've been taught. This won't be the last time you run across this type of situation.

[#1ME]

It doesn't sound like the nurse was wrong. From reading OP, seems like she was the one confused, thinking the certain part of the arm (deltoid region) is for SQ only, she keeps saying 'the SQ site.' I'm thinking the IM injections were given with (23 G w/ 1-1.5" needle), and OP is confusing location with actual needle gauge and size

[xtxrn, ASN, RN]

How did you give it into the SQ? Was the needle slanted at a 45 degree angle? The needle on an insulin syringe is not long enough to enter the muscle and the syringe is held at a 90 degree angle. A pneumonia or flu vaccine should be given with a 1-1 1/2 inch needle. That would still be held at a 90 degree angle and given into the deltoid of the arm. To give either of these vaccines SQ would require either a insulin syringe, a TB syringe or a 45 degree approach.

That's what I learned also (back in the early to mid 80s)....when I was talking to the diabetic educator as I began insulin myself, I found out that it's now given at a 90degree angle... Also depends on the 'padding' of the area.... With some of the skinny little LTC diabetics, the 8mm and 12mm needles easily got into muscle.... JME :) Next decade, they'll be using a dart gun....

[Isabelle49]

Sub Q is generally given with the shortest needle available and the skin and fatty tissue is pulled up for the injection, with the exception of Heparin or any other anticoagulant meds. IM would be given with a 1 inch or longer needle, the length determined by the size of the patient, the gauge determined by the viscosity of the medication.

The problem with giving a medication SQ that is meant to be given IM is damage to tissue that might result, such as necrosis. Always good to make sure the route is appropriate for the medication, since the doc ordering it is only human .