PEDS NURSES: What am I doing wrong??

Specialties Pediatric

Published

I hope I'm not the only one who this has happened to, but I also want to know what I am doing wrong.

I work for a private practice. We had patients scheduled for the end of day and about 10 minutes before closing, the MD ordered some shots. I am new to the field and don't have that much experience with shots, so I take my time reconstituting each vaccine and making sure there are no air bubbles and ensuring I have the correct dose. Of course the MD is annoyed and rushes me because it's Friday and he wants to go home, which makes me nervous. I should also note we are a small practice and there is no one else with me other than MD. So I have no help.

What had happened was I injecting a vaccine subcutaneously into a Pediatric patient (the kid was crying and squirming, so I injected it kinda quickly as the MD has told me to do in the past with peds patients). I noticed a few drops leak out after withdrawing the needle. This happened on two different patients. This has never happened to me before until today. Does this happen? I wasn't thinking too much of it when it happened becsuse it was such a small amount. I figured it was excess medication seeping out because I saw the whole thing go in. But now I'm worried. Are the patients going to be okay? It was honestly a tiny bit, but the parent noticed. What do I need to do to prevent this from happening? I heard I'm supposed to wait a few seconds before withdrawing the needle, but that seems difficult with children.

I've been struggling so much in this field. I was the top of my class and picked up on everything within a week during my internship and had no problem with my skills. Does it get easier or is it just me? I've been working a little less than a year. I have a degree outside of the medical field in addition. Sometimes I feel like I should give up on medical all together and look for work with my other degree.

Please give me some insite on this and let me know if this has happened to you or someone you know and what happened?

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Specializes in Psych, Addictions, SOL (Student of Life).

If this has only happened a couple of times I wouldn't worry - the child likely received enough vaccine to confer immunity ( Vaccines are only 90% effective anyway. I have been vaccinated for with MMR three times in adult hood and my tires continue to show I am susceptble to measals. You may want to try Z-tracking your injections. It prenets back flow of serum through the puncture.

Hppy

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Specializes in ED.

You say you are by yourself delivering vaccinations to patients with just the physician? Is there somewhere you can go to shadow someone performing injections for a day?

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This was the first time this has ever happened to me. If it helps at all it happened with one patient's second Varicella and with the other patient, it was her second MMR. So this was their second dose for the vaccines. I was never taught the Z-Track method. I suppose I could ask the MD to teach me when he has the time.

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Twin mommy+2. There is another person who works for this MD, but not on the days I work. We are both part time, so on the days I work it is just myself and the MD.

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Specializes in Psych, Addictions, SOL (Student of Life).
This was the first time this has ever happened to me. If it helps at all it happened with one patient's second Varicella and with the other patient, it was her second MMR. So this was their second dose for the vaccines. I was never taught the Z-Track method. I suppose I could ask the MD to teach me when he has the time.

Your Physician doesn't sound very approachable you might want to see if there's a large clinic where you can go and observe for a day. With peds half the battle is just getting the needle in. :)

Hppy

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Thank you for your advice! Kids are strong. If they aren't trying to push me away they are trying to kick me. Sometimes it takes me several minutes before I feel like it is safe for the patient as well as myself to administer the injection.

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Specializes in ER.

I work in the ER, therefore give a lot of shots. I regularly have a wee bit leak from the site. I wouldn't worry about it.

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Specializes in LTC.

That is, from my experience, normal. I worked at a pediatric clinic and I noticed the same thing when I administered MMR and varicella vaccines. Also, allergy shots too.

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Specializes in hospice.

Kinda hard to ztrack when the patient is kicking and squirming, but do look that up. I don't think you need a physician to teach you, just look up a description of the method. It's pretty simple and is in my LPN fundamentals book. However, I also had a RN at my clinical site tell me that for IM, leaving a bubble in the syringe helps keep leaking from occurring, because you inject a tiny air pocket on top of the serum which helps hold it in. Anyone else heard of that?

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Specializes in LTC.

Also, if I'm not mistaken (and y'all please correct me if I am!) the Z-track method is for IM injections. I've never heard of it being used subcutaneously.

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Specializes in hospice.

Ok wait, I saw vaccines and assumed we were talking IM. Are there vaccines that get injected subcut? I guess I missed that part. What vaccines get injected subcutaneously?

ETA: just found a document that says subcut is preferred for Hib. That's news to me. My kids had that vaccine and I've never seen anything but IM administration. Hm.

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