Nursing students and new nurses.....about injection sites

[TazziRN]

I heard something today that just flabbergasted me......when I was in school back in the days of the horse and buggy, we had to name all IM injection sites and be able to demonstrate how to administer at each site. I can give VG and glute and VL meds blindfold and asleep. Today we had a medsurg nurse float to the ER. She's relatively new, graduated about a year and a half ago, I believe. She was asking us how to find the glute sites to give an IM to a pt, because in school she had only been taught deltoids. Huh???? Let me add that she went to a very reputable nursing school and she has proven to be an excellent nurse on the floor. All pts admitted to the floors who need anything more than PO meds get IVs and injectables are given IV. My tech said that she received Toradol and Compazine in the doctor's office the other day (same doc's MA who gave my baby the flu vax I talked about here) and the MA gave both to her in the deltoids. My eyes went wide....both meds can be caustic, as well as 2 mls each. Is this what's being taught now???

[marilynmom, LPN, NP]

BSN program and yes we all learned how to give them, landmarks, etc. We practiced on oranges and hotdogs and those fake skin things and then on real patients. We were tested on it all as well in lab and lecture (amounts, where to give, needles size, etc). We were also expected to study some of this on our own at home and to be proactive in clinicals.

But I can see how easily it would be to forget all that if you haven't been giving the chance or the opportunity in clinicals. Same with ANY skill. I'm going to need to review a few things myself coming off of psych clinicals and xmas break.

[loriangel14, RN]

I am in a rpn couse (5 semesters long) and we were briefly taught where the VG was but told that it is not to be used anymore.One of my classmates had a disagreement with a nurse in clinical placement about doing it( she refused) and our preceptor backed her up.Times are changng everywhere.

[HappyNurse2005, RN]

We learned how our first semester of nursing school. then, we had to be checked off on it every semester since htey knew it was a seldom practiced skill.

where i used to work (cardiology) i gave LOTS of flu and pneumonia vax-though all in the deltoid,a s they were 1mL.

now, i work in labor and delivery, and betamethasone is the most common IM injection. The first time i had to give that gigantic needle in a lady's rear end i might have been more nervous than her! it looked barbaric!

[firstyearstudent]

We were given instruction but seldom get an opportunity to practice IMs (outside of flu clinics). I think one of the issues might be that few IM shots are given in med-surg units any more. Everyone is hooked up to IVs...

[TazziRN, RN]

Thanks, guys!

[tookewlandy]

I am just finishing up my first semester of Nursing school, and we had to learn all of the IM, subQ, intradermal, sites and angles and everything that went along with them. Yes the instructor has told us we might not use them anytime soon or even ever, but as nurses we should know when, where, why and how to give those injections.

[ns lpn]

I learned them and then never had to use them untill the last few years and luckly its only B12 (IM) and insulins (s/c) which I am comfortable with. If I had to use all the different IM sites I would need to go over them first with one of the RN's or the DON. If you don't use them for years then I think you just don't feel comfortable with it.

Also I was taught VG site which is not suppose to be used anymore according to all the new grads.

[AnnieOaklyRN, BSN, RN, EMT-P]

I am a current nursing student and can honestly say that there are students in my program who still have yet to give an IM injection and we are in semester #3 of 4. I am sure there are not a whole lot of them now, but still...

[TazziRN, RN]

I ran into the MA who works at my PMD's office and described what the other MA did, and her eyes got wiiiiiiide. She's been out of school less than two years, assured me that MA schools still teach all inj sites. The office now has pedi flu vax, I think I'll take Baby DD back there for the second dose.

[smk1, LPN]

Current ADN student, we need to know the landmarks for deltoid and ventral gluteal sites, also vastus lateralis, however in clinical the only IM opps that have come up were deltoid. I did a flu clinic for more practice (but obviously those are deltoids as well.) We go to OB/peds in January so we will have to know the preferred sites on the babies and the landmarks. It is possible that the nurse just never had an opportunity to practice IM and forgot the landmarks. These are things that I review every now and then so that hopefully won't happen. I will say that many people are still giving dorsal gluteal injections and we are not taught that because of the risk of nerve damage, so I wouldn't know the names of the landmarks for that off hand if someone asked...

[smk1, LPN]

Also shocked about giving over 1 ml in the deltoid...

[TazziRN, RN]

I am really surprised at the answers I'm getting. We do so many glute and VL injections in the ER, I guess that's because of the type of unit? Just today we gave so many butt shots that we were walking around with syringes like they were swords! (needles capped, of course)