IM sites for anti-psychotics

[felixfelix]

I'm curious, I'm under the impression that around 3ml is the limit for a deltoid IM. But there are plenty of times you can't give an anti-psychotic of, say, 10ml in the glute or the vastus, or other large mm. Sometimes the deltoid is all you can get to, so is it acceptable to give that much in the deltoid? What do you do at your facility?

[Morgan314]

I've never given more than 3ml in any injection. I had a patient on Haldol Dec 350mg IM and I gave it in 2 doses of 1.5cc each.

[Jules A, MSN]

It depends a bit on the situation and size of the pt but I tend not to like shooting >1ml in the deltoid. Exactly which meds are you giving 10mls IM?

[RochesterRN-BSN, BSN, RN]

That's what I was wondering. What anti-psychotic are you givng that much of?

I may have given a larger amount off like Haldol Dec or Risperidal Consta or something but those are not used acutely when you have to worry about finding a larger muscle. Here we use Geodon a lot and that is 20mg in 1cc/10mg in 1/2cc, haldol is what like 5mg in 1 or 2cc, Zyprexa is not a large cc amount--can't think of that one of the top of my head as this psych ED doesn't use it often--then there is Abilify and that's not a loarge amount either.........OK! LOL you've stumped....what med are you asking about?

We give everything in the deltoid here usually one shot in each arm....if there are 2--Ativan and an anti-psychotic. But if its Haldol and Ativan we mix and that is like 3cc together I think. I have had patients way too violent to worry about the discomfort of two shots in one arm.....gave the 2 in one arm as it was just too unsafe of a situation and we needed to hurry and get the meds in before someone got hurt. In a major emergency I'm not real picky! Where I am in the Psych ED they are fresh off the streets and have usually been med non-compliant for a while and are wild and really violent.

[Mr Ian]

I'm happy to be corrected but I have never given an IMI that exceeds 3mL or know of a time where one should be given.

We were taught 3mLs was max dose.

Hmm... or maybe there was one guy on 800mg Clopixol - @ 200mg/1mL that would have been 4mL and that was given in 2 IMIs .... can't think of more than that tho.

[RochesterRN-BSN, BSN, RN]

Clopixol? Never heard of that one in all my time in psych.......???? Is this an old med? An antipsychotic?

[Thunderwolf, MSN, RN]

Clopixol (generic name zuclopenthixol) is an antipsychotic prescribed to alleviate psychotic features such as paranoia and hallucinations sometimes associated with extreme mood swings in those with bipolar disorder (manic depression). Found here are resources and information relating to this medication.

Zuclopenthixol Monograph

This is a comprehensive Canadian monograph from Internet Mental Health. Contents include pharmacology, indications, contraindications, warnings, precautions, overdose information and dosage.

http://bipolar.about.com/od/clopixol/Clopixol_Zuclopenthixol.htm

[RochesterRN-BSN, BSN, RN]

Okay......are you practicing in Canada? Wondering if other American nurses are familiar with this med...Clopixol........Wondering why I have never heard of it. Thunderwolf what generation of anti-psychotic is this drug? I 'll have to ask one of my docs about this one next time I work.....interesting......

[zigzag1047]

I'm not familiar with the med but the article says dosage is 1ml to 3 ml for the average dose.

Zigzag1047

[Mr Ian]

Odd that. Clopixol's been around for donkeys years and was one of the staple typical antipsychotics. In the UK it was the benchmark for all other depot preparations. It may have a completely diff trade name - but I think there's an international uniformity to generic names.

There's a few drugs I used in UK that don't appear anywhere here in Oz.

They're not keen on Lorazepam and I've not seen Procyclidine anywhere. Hyoscine also seems to be absent.

[RochesterRN-BSN, BSN, RN]

Which benzo is used then if not lorazepam/ativan? Never heard of procyclidine or hyoscine....what class are those?.........wow never knew there was a difference in meds used from country to country.......really quite interesting......

[Mr Ian]

Yeah .. well we use Hyoscine for the fillies and geldings to help with their pre-race nerves and Procyclidine helps the crocodiles regulate their blood-body temperature.

This is a veterinary nurses thread?