Accidentally gave an IM intradermally

Nurses General Nursing

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I am a new nurse who finally is off orientation. I had a question or more of an issue that came up during my orientation. I am hoping somebody has an answer to it. I was supposed to give a Vitamin B12 injection as an IM to my patient. He had really skinny arms. Maybe it was because I got really nervous, but someone how I accidentally gave him an intradermal injection instead of an IM. The medicine pooled underneath his skin. I asked another nurse what do I do in this situation and she said to let it just absorb through the skin. I search online and couldn't find an actual answer. I wanted to know if anyone knows what to do in this situation.

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Specializes in LTC.

ouch... Don't sweat it... Next time just go at a 90 degree angle and a darting motion. It takes practice.

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Specializes in geriatrics.

Exactly. Pretend you are playing darts. The key to administering a proper IM injection is to landmark correctly, pull the skin to one side, and inject. You have to commit. With practice, it gets easier.

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Specializes in geriatrics.

I would also suggest administering an IM in either the ventrogluteal or the thigh (vastis lateralis). It hurts more in the deltoid, especially if they have skinny arms.

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Specializes in LTC.

Yep I agree with joanna73...give it in the larger muscles..I always do B12 in the tushie.

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Accidents happen, but I would have done an incident report because it was given by the wrong route.

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Specializes in Spinal Cord injuries, Emergency+EMS.

intradermally ? or sub-cut ?

an unknown proportion of IM injections are given as deep SC injections in people who are not skinny ... becasue you never really know how think the SC fat is ...

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Yep I agree with joanna73...give it in the larger muscles..I always do B12 in the tushie.

Do they still do that? Because of the sciatic nerve located there?

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Specializes in geriatrics.

Actually, many facilities will tell you it isn't best practice anymore to give an IM in the butt, because of the danger of hitting the sciatic nerve. We were taught this in nursing school a few years ago. The ventrogluteal site (hip) is the recommended spot.

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Specializes in Post Anesthesia.

Yep -your first mistake is wrong injection site. B hurts as an IM, I can't imagine what it would feel like intradermally, but picking the right muscle-one big enought to take the shot is your responsibility- As to what to do after- I'd call the pharmacy to check for any complications you may need to watch for. Strictly speaking you should call the doctor on call and notify them. I would be tempted to put on a warm compress wrapped with cling wrap on the site to promote absorbtion (unless contraindicated by what pharmacy tells you). If I sound like I'm scolding I don't mean to, but I firmly believe that even the most mundane decisions and interventions we do as nurses have consequences. "It was just....." is a dangerous mind set. We are educated on proper IM technique- we need to take that action just as seriously as any of the other more complex decisions we make. I've cared for 2 patients who developed abcesses for poorly placed IMs from thier doctors office and the ER, that required surgical intervention, drains, and in one case healing by tertiary intention, leaving a huge scar and some muscle damage.

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Intradermally? You mean subQ, I hope. B12 can be given subQ, it just changes the metabolism a bit.

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Specializes in LTC.
Do they still do that? Because of the sciatic nerve located there?

Tushie being the large area encompassing both hip and behind..I was tired and couldn;'t think of the ventrogluteal...just gluteal..

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