IM injections - divide into 2 or keep as 1?

  1. 0 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.
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  3. Visit  samyaira} profile page

    About samyaira

    Joined Feb '08; Posts: 20; Likes: 5.

    36 Comments so far...

  4. Visit  6spdftwtm} profile page
    4
    If your patient was an adult, they were a WEENIE. The vastus lateralis and dorsal gluteal muscles on a normally sized adult can handle 3 mL (irritating med or not) with no trouble. If I remember correctly, 1.5 mL is max for deltoid.

    Peds is different. For pediatric patients, 2 mL is the max in the VL. If over age 2, then 2 mL in DG is ok, even though I never do it because I HATE giving DG injections. Don't even think about delt on little ones, unless it's a tetanus vaccine.

    I give 3 mL doses ALL THE TIME in DG (and VL on patients that I can talk into it).

    P.S. what med did you give??
    poppycat, jhCMA, VivaLasViejas, and 1 other like this.
  5. Visit  CrunchRN} profile page
    0
    Doesn't seem unreasonable for that site. What was the med?
  6. Visit  Altra} profile page
    0
    Did you also go home and look up the med you gave in your drug guide? (or do the same with whatever resources you have available at work) What do you recall learning about IM injections? Do you know off-hand what quantity is appropriate for injecting into which sites? These are the things you needed to know before you gave the injection.
  7. Visit  xoemmylouox} profile page
    2
    In our peds patients we tend to max out at 1ml per injection (of course the 7ft 200lb kiddo can handle more).
    noahsmama and wooh like this.
  8. Visit  IdrilRN} profile page
    4
    If I'm getting a shot, I only want one and only one shot, as long as it's appropriate. It's a needle getting stuck in my skin, of course it's going to hurt. Some years my flu shot hurts, some years it doesn't, depends on who I'm getting it from.

    I've had people covered in tattoo's whining about getting a shot or their blood drawn.

    Your patient sounded like a person who didn't like shots.
    poppycat, VivaLasViejas, jadelpn, and 1 other like this.
  9. Visit  Esme12} profile page
    2
    There are various sources that will say that 2.5 ml is max for VL and DG and others will say 3 ml is max and others say 5ml. I stay pretty close to the 2.5 ml for my personal comfort. In cildren under 80 to 100 pounds I stick to 1.5 to 2 ml depending on the med.

    Here is a good link.
    Administer Intramuscular, Subcutaneous, and Intradermal Injections
    linzellern and wooh like this.
  10. Visit  samyaira} profile page
    0
    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
  11. Visit  JSJones,RN} profile page
    11
    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
  12. Visit  ckh23} profile page
    0
    Doesn't sound like it should be causing that much pain. What guage needle did you use?
  13. Visit  6spdftwtm} profile page
    0
    Fact of the matter is, MOST sources will say 3 mL for large muscles, 2 mL for peds VL injections. But the fact of the matter is that there hasn't been much true research on what is an acceptable volume to administer IM. We give clindamycin 600mg IM frequently for dental complains in the ER. That's a 4 mL total volume...and if the person is very large and they request to, I have given 4mL injections several times.

    A lot of texts will say that "general consensus" is to limit volume to 3 mL in adults, 2 mL in children and if the patient is very small, 1 mL. You won't find much supportive, evidence-based practice proving or disproving that these are acceptable volumes, though.
  14. Visit  zorabanks} profile page
    0
    2ml in VL should be fine. I agree that an injection is going to cause some pain/discomfort regardless. Did you change your needle after you drew up the medication? Giving an injection with a dull needle will hurt more. I have given many IM injections to adult pt's without complaint. Evaluate your technique...are you a new nurse? Maybe a co=worker can help you. I don't mean to sound rude, but an IM injection should not cause pain like you describe. Good Luck!!
  15. Visit  jbluehorseh} profile page
    0
    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


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