Annoyed

[kkostelnikPN]

So I'm a brand new nurse on my second week of orientation on a vent unit in LTC. The nurse who has been training me watched me give a subQ lovenox shot today and freaked out bc I went in at 90degrees saying that I was doing it like an IM shot and that's totally incorrect and I'll bruise the pt. this really bugged me bc that's how we learned to do it in clinicals and all the nurses I've followed went in at 90 degrees. So I looked it up to be sure and it says that's correct unless the pt doesn't have a lot of subQ tissue. Just looking for some thoughts on this. It was insulting the way he acted after I gave the injection and now knowing I was doing it correctly makes me even more annoyed!!

[DeBerham]

It's going to happen throughout your career, let it roll off your back. I was taught several years ago to go in @ a 90deg angle and as far as I'm aware the recommendations on this have not changed recently. Really though, bruising isn't terribly unusual with heparin or lovenox because (shockingly!) they're anticoagulants. Instruct the patient not to massage or rub the site, but at the end of the day some bruising is going to happen. He is likely mixing up anticoagulant and insulin administration. His method will actually increase the likelihood of bruising as you are more likely to place the anticoagulant into a capillary bed and this will definitely be the more likely scenario where bruising will take place. File his inflexibility away in the back of your mind and keep on going knowing that you were right. To be honest, on this issue, it's probably not worth getting into a ******* contest over.

[LindaNLPN]

I was taught in school to give subcutaneous injection with a 45 degrees angle. Inter muscular with 90 degrees angle. If the person has enough subcutaneous tissue than 90 degrees would be okay.

[mariebailey, MSN, RN]

The manufacturer instructions say to pinch a 1 inch fold of the skin and to administer at a 90 degree angle into the fold. As long as you followed the manufacturer's instructions/facility policy, you should be fine. http://www.lovenox.com/hcp/dosing/lovenox-administration.aspx

This is by no means the method for all subcutaneous injections though. Vaccines administered SC are administered at a 45 degree angle. See p. 2 http://www.immunize.org/catg.d/p2020.pdf

[AngelicDarkness]

Let it roll of your back - you'll be seeing a lot of this in your career. The problem is evidence based practice is always changing (not a bad thing) but some nurses do not keep up with it. Technically your mentor could have been right when she was taught, or technically you're right for the updated practice. Don't worry about it:) Everything is updated in this career:)

[devonette]

you done it how i would have done it, and you have a responsibility now to educate those who do not know how to do it right, show her the evidence you have based your practice on you cant have her running lose on the ward getting things so wrong! x