Okay, I need a bit of good nursing practice know-how. If you have a 2ml IM injection is it better to give it all at once (assuming non-irritating med) or divide it into two, 1ml injections? My thought process is that one injection will only break the skin once but will potentially cause a much larger sore spot, while two injections will be more comfortable for the pt.
I ask because the last pt. I gave 2ml IM to (in the VG) c/o moderate-to-severe pain (non-irritating med). It really scared me how much they were complaining and I went home and looked up all sorts of things about muscle separation, tissue necrosis etc.
Thanks for any help you can give.
So far, the responses have ranged from simply asking for more information to downright condescending.
Let me clarify that I am looking for an experienced opinion (or even published literature, if there is any, which I haven't been able to find myself) on outcomes for the pt. to have one large injection (infection control) or two small ones (comfort). Is the potential increase in infection outweighed by pt. comfort at injection sites?
It really doesn't matter if I was technically/prudently "right" last time (and I was). You can be "right" and still have a sub-optimal outcome. The pt. reported pain and was very uncomfortable after I gave them 2ml in a large muscle. If I can help a pt by giving them two 1ml injections then I want to be able to do that with good rationale.
Last edit by samyaira on Feb 14, '12
Feb 14, '12
I may be looking at this all wrong but I haven't seen a response yet that was downright condescending. As far as the ones that ask for information about the med given and pt's age/size, those are pretty legit questions since it wasn't included as those could be determining factors. You wanted opinions of experienced nurses and that's what these responses are.
Either way, there isn't a 'good rationale' in splitting up a 2mL injection other than pt comfort. Injections hurt! That's a part of it! If you have a patient complain of pain/discomfort after a 1mL shot, are you going to consider splitting it up into two 0.5mL injections next?
Use your nursing judgement. Each injection and every patient situation is different. The above responses answer the question on how much is too much but its up to the nurse's judgement and patient's situation. Pain is a 'sub-optimal' outcome for a lot of the things we have to do to provide patient care and assist in the healing of our patients. I agree that we should always look for ways to limit the pain but IM injections are amoung those painful stimuli that we don't always have control over.
Last edit by JSJones,RN on Feb 14, '12
Feb 15, '12
i have not seen any evidence based information whether to divide the dose or not. think of it this way, if you are the patient how many times do you want to be stabbed with a needle. if the dose is going to be more than three ml consideriv route if it possible.
Last edit by jbluehorseh on Feb 15, '12
: Reason: typo