Am I doing something wrong?

[x19amanda]

Hello, I recently started working in outpatient psych, and regularly give Haldol and Prolixin Decanoate injections, as well as Invega Sustenna and Risperdal Consta. So far, I have been able to give the injections effectively, without any site reactions or decompensation. Sometimes though, I get nervous that I am not administering the injection correctly. I have noticed every once in a while the Prolixin oozes out a little, but I started using larger needles to prevent this. Also, I have one client who receives the Invega injection in the deltoid, and has been having issues. The first injection apaprently I gave too far down, and caused a hardened area under the skin and pain. I felt horrible, and he was afraid to come back to me. I finally got him to come in again, and administered the injection again in the deltoid (per request) and he explained it was great and didn't hurt at all. I just called him today a month later and is now complaining of hardness and pain under the skin at that site too! I feel so stupid and that I am doing something terribly wrong. He has never had this issue before. I give at least 20 other people Invega and they have no problems. Can someone help me understand or give me advice as to prevent this from occurring?! Feeling helpless. P.S-I either pinch up the skin and insert fast at a 90 degree angle or use the z-track if they are larger.

[BelindaJessup]

Hi depending on the weight of the should consider whether deltoid is the best option. I would leave the needle in for at least 10 sec after giving it to stop the ooze and use the z track. :)

[msygrnbw]

I am not sure about this particular injection, but I learned you use the Z track method for IM and do not pinch the skin. Pinching the skin in an SQ shot helps make sure you are not going into the muscle tissue. I also leave the syringe in for a short period of time if it's a medication I know carries additional risks (i.e. phenergan) if it leaks into the SQ at all when I take the needle out. That gives it a little time to start getting absorbed.

[Meriwhen, ASN, BSN, MSN, RN]

The Z-track should settle any oozing problems, though if it's a very large amount of medication injected and/or a small muscle,you might still get a trace of oozing anyway.

As for why your patient's arm site is hurting, did you use the correct needle size?

[twinkerrs]

I don't like giving invega in the arm always have complaints of pain. I always go for bigger muscle groups and rotate sites because of the sheer amount these patients usually get way too hard on their bodies. I have one patient who has gotten injections for 18 years and her arms are a train wreck.

[chevyv, BSN, RN]

I used to have a pt that had injections with the same result no matter who did the IM. The doctor finally had to switch meds because it was a reaction. I would give in the gluteal though and see if it's the same result.

[x19amanda]

Thank you for all of the feedback. I saw the client today, and he stated he was only sore for a few days which is expected. Over the phone he made it seem as though his arm was swollen and tender which was not the case. I do give many of these in the gluteal, but in this case hes a young male and I am 22 and he does not like the idea of this. I have noticed I no longer have an issue with oozing, because I do not remove until at least 10 seconds and use the 11/2 needle on all clients unless they do not have much body fat. So far so good. I find the men to be bigger babies when it comes to the shots than the women haha. Good suggestions everyone!