afraid I hurt Pt w/injection

Jolie, BSN · Apr 12, 2005

I don't understand how "...blood came up into the syringe..." while you were injecting the medication. The laws of physics seem to preclude that from happening. Perhaps what you saw was a few drops of blood at the injection site upon completing the injection. That is not uncommon.

At any rate, a small amount of air in the syringe is not harmful with an IM injection. Some nurses intentionally utilize this technique to clear all the medication from the needle and "seal" it into the muscle.

Were you supervised in giving the injection? If you have any questions or concerns regarding your technique, you should direct them to your instructor or supervising nurse.

Now relax!

SmilingBluEyes · Apr 12, 2005

Did you report this to your instructor? I am concerned about the technique used to give this shot and whether the Rho GAM was or was not given correctly. I am not sure, based on what you say, what really happened here. I can't say I have seen blood rise up into the syringe during IM shots I have given.

Anyhow, *Please* do follow up on this; it's really important. My best to you. It takes courage for us to own up to any *possible* errors we make and fix them; I have made some doozies in my time, myself. Just fortunately, no harm has come to my patients in any situation. Thank you for caring enough to ask about this. I commend you. You may have done NOTHING wrong, but you do need to talk w/your instructor about it, ok?

If I am missing something here, or misinterpreting, please forgive me. I do want to help, if I can.

baby&mommynurse · Apr 12, 2005

I don't know why after aspirating and injecting, you still got some blood return as this has not happened to me before. It does sound by the way you described, that you did everything correctly. However, a couple of things concern me about your post. Wasn't a nurse or your clinical instructor observing? Generally, when we have students in our unit, a nurse or the clinical instructor has to observe. And why are you, after this happened a few weeks ago, bringing it up only now? Please do as Jolie & Deb says and report this to your instructor. We all make mistakes and part of making mistakes is correcting them.

Krojas21 · Apr 13, 2005

Possibly after you aspirated, you may have then pushed the needle into deep and did hit a vessel, while injecting , thus seeing a flush of blood. Did you stabalize the syringe well while injecting? I don't know what the consequenses of the Rhogam going into a vessel are, but you could ask the pharmacist. I also think that your instructor should know about it right away, did you say anything to the RN you were working with after it happened?

meownsmile, BSN, RN · Apr 13, 2005

Im kind of with Krojas on this one. I too wonder if you pressed a little harder while you injected,after you checked for aspirate and ended up in a vein you werent previously in.

I understand why you werent with a instructor,, if you had successfully given up to 10 injections previously the instructor was probly confident that you were competent with your technique, however, you should have immediately told the instructor of what happened. Wondering a few weeks later doesnt mean diddly for the patient.

Even as nurses we would usually report something like this to the doctor and see if he had further orders. I'm not a chemist so i dont have any idea how Rohgam would be metabolized if given IV(which is what it would have been) rather than IM. The doctor may have wanted another dose given after a certain amount of time or something. Not much can be done now probly, but just think a little harder and work a little smarter next time i guess. JMO.

baby&mommynurse · Apr 13, 2005

Even though chilloutrelax has given 10 successful IM injections (and this has nothing to do with her capability to perform as a nurse), she is still a student. She should still be under either her instructor or a nurse's supervision. Whenever we have students at our department... and we have them all the time now, 6 days a week from 3 different schools... we are told by their instructors that when they are giving injections or other meds, they are to be observed by the instructor or a nurse. We have to get the meds out of the pixis for them anyway. And legally, the nurse is still responsible for the patient, so a licensed person should have been present. I do hope she does report the incident to her instructor.

I also agree that the syringe may not have been stabilized well enough. Which is another reason why someone else should've been with her at the time.

jeepgirl, LPN, NP · Apr 14, 2005

I don't know anything about the med IV or what could have caused what happened in the OP... but I do know that for my last semester in nursing school when we starting precepting (with an RN) we just checked off meds with the nurse between patients before walking in the room and went at it. I gave IM's many times while in nursing school... not many but a couple of them (towards the end) unsupervised.

chilloutrelax · Apr 14, 2005

I made a big mistake. I didn't tell an instructor, because an instructor wasn't present. I was the only student at the health dept. I did not have a nurse w/me. It was busy, I had confidence I could do it alone.

I'm still thinking, is it possible now, to inject the medication and get a blood return at the same time? I feel I stabilized the needle well. You aspirate, you get blood return if you're in a vein. But, is it possible to get a return of blood while injecting the needle?

I know rhogam can be given IV. But, the rhogam designed for IM injections is not supposed to be given IV. So I don't think the chance of harm is great.

It didn't happen a few weeks ago, it happened yesterday. I won't see her again until tomorrow. I'm scared I will get kicked out of school if I tell the truth. I truely believe they will find a way to flunk me out if I tell. I will be in serious trouble for not having a nurse w/me while giving it, and I think they will kick me out for that.

I just pray to God that woman is OK. I'd rather be kicked out than her have some kind of problem b/c of what I did. :crying2: This is awful. I was thinking today, I was just being paranoid, it's probably just blood from the injection site, maybe I did it too hard, or I moved it around without not realizing it?? But, I'm still confused about the whole thing.

meownsmile, BSN, RN · Apr 14, 2005

Hi, I am a nursing student. A few weeks ago, I gave Rho gam IM.
QUOTE]
Sorry, was just using the time frame from your OP.

jeepgirl, LPN, NP · Apr 14, 2005

did you not check off the med with an instructor / licensed nurse? if so, i think that would be a major problem.

if the flash happened AFTER you started to inject, that is something you could not have prevented... if you had aspirated without a blood return before starting to inject, that is. i don't know how that would happen, but if it did and you had performed the technique correctly, then i would just notify the doc and tell them what happened.

you mentioned something about an air bubble. there are times when an "air lock" is used when giving an injection IM... this is to flush the med out of the needle or to "lock" in the med sometimes with IM injections. it is usually like 0.1 or 0.2 ML of air. I have never used this method myself, as i was not taught this way. it was usually mentioned when giving meds using the Z-track method. however, i am currently studying for the NLN pharm test (my pharm in my ADN was integrated into the program, not a separate test!) with a MOSBY study guide and it does mention it vaugly. i actually asked about this method to some more experienced nurses that i work with and none of them used this method either.

jeepgirl, LPN, NP · Apr 14, 2005

Hey, I just posted this on student forum. Thought I'd post here b/c you guys may be able to help me more.
Hi, I am a nursing student. A few weeks ago, I gave Rho gam IM. I believe it came in a prefilled syringe, where you attach the dose into the syringe. Now, I inserted the needle, I aspirated...no blood. So, I injected it. As I was injecting the vaccine, blood came up into the syringe.
I have given I'd say about 10 IM injections. I have been thinking about this. Is it the syringe? Anyone familiar w/it? I aspirated, but there was no blood return. I aspirated sufficiently enough to get a blood return. Why would blood come up into the syringe as I am injecting the medication?
Another thing I was thinking about. Was there air in the syringe, could something like that have happened and me not know it???? Even so, I still aspirated, and blood would return if I had hit a vein.
Please help. I am scared I harmed a pregnant woman. Please tell me what you know.

I made a big mistake. I didn't tell an instructor, because an instructor wasn't present. I was the only student at the health dept. I did not have a nurse w/me. It was busy, I had confidence I could do it alone.
I'm still thinking, is it possible now, to inject the medication and get a blood return at the same time? I feel I stabilized the needle well. You aspirate, you get blood return if you're in a vein. But, is it possible to get a return of blood while injecting the needle?
I know rhogam can be given IV. But, the rhogam designed for IM injections is not supposed to be given IV. So I don't think the chance of harm is great.
It didn't happen a few weeks ago, it happened yesterday. I won't see her again until tomorrow. I'm scared I will get kicked out of school if I tell the truth. I truely believe they will find a way to flunk me out if I tell. I will be in serious trouble for not having a nurse w/me while giving it, and I think they will kick me out for that.
I just pray to God that woman is OK. I'd rather be kicked out than her have some kind of problem b/c of what I did. This is awful. I was thinking today, I was just being paranoid, it's probably just blood from the injection site, maybe I did it too hard, or I moved it around without not realizing it?? But, I'm still confused about the whole thing.

In the first thread you said a few weeks ago. In this last post you said yesterday? Which is it?

You should really tell your instructor or at least the nurse you were working with at the health dept.