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

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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???

Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

In my nursing school I went to was a hospital school of nursing and we practiced all kinds of skills on each other. We learned no more then 1 ml can go into the Dl site and if you do have say like 2 then you put 1 ml into one arm then another 1 ml in the other arm. anything more then that needs to go into the VL, VG, DG. We learned all the sites from DG to VL. oh and dont ever put Rocephin in the deltoid use the butt for that.

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I am in semester three at the university I attend in the BSN program. So far I have given only 1 IM, and it was when we were in Long term care (year one).

As far as teaching goes, we learned injections by practicing on oranges, and "injection sites" plastic that is now used to resemble something real.

The practice of students injecting other students never happens period.

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Specializes in pure and simple psych.
I am in semester three at the university I attend in the BSN program. So far I have given only 1 IM, and it was when we were in Long term care (year one).

As far as teaching goes, we learned injections by practicing on oranges, and "injection sites" plastic that is now used to resemble something real.

The practice of students injecting other students never happens period.

That is really too bad. Back in the days of yore, we swallowed ng tubes, took shots, sacrificed blood, etc. Instructors never let us perform on a patient until we had shown "perfect" technique. And no aritficial arm is as sensitive as a fellow student who can critique your work, in vivo. Practice, practice, practice. Ah, those were the days...

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TazziRN...We were taught you give very few IM injections anymore. We were also taught to give it in the deltoid or the vastuslateralis rather then the vastus gluteus.

This is exactly what I was taught - and the reason for using the vastus lateralis instead of the gluteal site was the risk of hitting the sciatic nerve and causing the patient excrutiating, unnecessary pain that can last months. The risk is real, too - it happened to both me and my daughter.

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Specializes in LTC, Pediatrics.

Hi all.. I just graduated from an LPN program here in Connecticut. I can tell you my instructor tested, re-tested and re-re-tested all of us on injection sites.

Maybe the nurse forgot and was trying to cover it up, but my first IM injection was in the glute... I didn't do any injections in the delt until I could tell my instructor 'alternate' sites for administration.

Proud to be ... a GPN :) Step 1, change the S to a G.. Step 2, change that G to an L. :)

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Specializes in LTC?Skilled and dialysis.

We were definately taught the different sites and how much can be injected into each site IM. It has been pounded into our heads and we were taught easy ways to locate these..

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We also learned all the sites, but if you check the newest clinical skills manuals, the gluteal site is no longer recommended for IMs and isn't even shown. At my school, they did teach us how and where to do it, but said to go to the vastus lateralus instead because it was safer.

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Specializes in Rehab, LTC, Peds, Hospice.

My first IM (and first injection) was given to a tiny lady in my ambulatory care rotation in clinicals. I was absolutely petrified. Because she was tiny of course my instructor felt it would need to be given in 2 injections in the vg s. And since she was fearful of needles (and most likely the student as well) my instructor was gracious enough to invite her husband to stay and watch. I could have killed her! My hands shook and when I gave it to her she bled like a pig, which absolutely horrified me. ( I know, I shouldv'e known right needle pierces skin- may bleed, but the dummies never did) I froze while the husband anxiously asked are you ok honey repetively. Then I had to go through this again on her left, realizing I had never practiced on this side of our dummies and was very awkward and hesitant finding my placement. The whole experience was truly awful. Even though my techniques were fine I got a lecture about remaining professional and that I needed to get used to having family members present. Years later this is so funny, but I still think my instructor could've realized a student might get a touch of stage fright for their first time. Let me tell you every inj after that was a breeze though!:rotfl:

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Citing how to find the location for an injection and actually finding it on a variety of different shapes and sizes (as opposed to the dummy or young healthy lab partner) and injecting into a real person are very different things.

I often felt chastised for "not knowing" things as a student or a newbie because I'd ask "is this right?" I "knew" it but since I didn't have the experience, I wanted confirmation before actually doing something undoable to someone.

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Specializes in LTC.

I am scared to death of giving an IM injection. I'm an LPN and I've given 5 of them so far, each time I had a supervisior or experienced RN with me... I HATE needles, afraid to death of them!!!!!!!! When I look at the IM needle I get very pale and I get light headed and feel like I'm going to pass out!!!!!!

I can give an insulin shot without flinching now!!!!!!!!! so maybe someday I will get over the fear.....

But I also have a problem finding the sites--- I think it's the scared thing though......

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Specializes in ER/Trauma.

Tazz:

Not only were we taught the sites, but we were advised on a list of "prefered sites" in adults. We were also taught about "safe sites" for infants/kids.

The explanation provided was that IMs carry inherent risk of hitting nerves or big blood vessels (hence why you aspirate).

We were tested on prefered needle gauge and length.

Finally we were tested on injection method.

This whole process was repeated for SQ and ID as well.

cheers,

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I am in my last semester of lpn school. We have had plenty of opportunities to give injections. My fundamentals instructor always stressed to give IM injections in the ventrogluteal. I have given lots of subq injections-Lovenox, Epogen and lots of insulin. At clinicals it seems like everyone gets an Accucheck!

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