Deltoid IM injection - axillary muscle

[Olga30]

Hi all,

I took a year off from nursing when I had my daughter last year. I recently got a job at the clinic. We are now giving flu shots as deltoid IM injections. I felyt that I needed to refresh my knowledge on how to do them a bit so I reviewed online materials and watched some videos and had someone watch me do it on a few patients before I started giving them on my own and everything was fine up till today. I had a patient who had a very tight sweater but did not want to take it off and pushed it all the way up her shoulder. I gave her flu shot and then she screamed "ouch" and I could see a muscle twitch after I aspired an injected the medication. She had tear on her face and looked in a lot of pain. I felt terrible. I think I got her axillary nerve. Of course, I apologized to her but now I am home and freaking out. I thought my technique was correct but apparently not.

Here are two issues.

1. I am hoping and praying she will be ok as I worry about her and love my new job and don't want to loose it. What are the chances that this will lead to a serious nerve injury and what are the chances it will just resolve quickly?

2. Does anyone know any good sources to check for deltoid IM injections? Any tips or advice?

[Anna Flaxis, BSN, RN]

Wouldn't you basically have to inject in her armpit to hit the axillary nerve? Why on earth would anyone do that?

I'm sorry, but the patient sounds like kind of a jerk. If you're going to the clinic, you're going to have your BP taken and maybe get a shot, and yet you choose to wear a tight sweater and not take it off at least one arm?

That doesn't mean the patient deserves to be hurt by any means, but it can shed a little insight into their personality and maybe, just maybe they might overdramatize things just a titch?

[xoemmylouox, ASN, RN]

I agree. I'm sure you did fine, but in the future explain that taking their arm out of their shirt gives you better visualization and can help prevent injury..

[krisiepoo]

she sounds like a jerk however we were just discussing this that some people had issues if the injection was given too high in the shoulder, and ended up with bursitis

[Altra, BSN, RN]

Google Image Result for http://upload.wikimedia.org/wikipedia/commons/e/e2/Gray818.png

Now ... what makes you think you "got" her axillary nerve?

[Olga30]

Thank you, all. I guess what I am trying to ask is - with the muscle twitching and pain she had, is she at risk of a serious complication? I used the smallest needle we had for IM injection. I read that radial and axillary nerve damage from IM injection can happen.