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First IM injection question

Posted

Specializes in DOU, Medical-Surgical.

Today I gave two IM injections for the first time and I don't believe I did it correctly. My school has a new policy that doesn't let its students practice giving injections on other students or even allowing to take syringes home. So, our first experience has to be on a patient. So, to say the least I was REALLY nervous and my hands were shaking while giving both injections. While giving the first one, I didn't penetrate the skin hard enough. When I went to aspirate, I pulled back and I was met with resistance. I didn't know if I needed to pull harder? When I went to pull out a gush of blood followed...:eek: does this mean that I did not aspirate correctly and that I hit a vessel? I asked my instructor who walked me through it and she said no because I did not aspirate blood...but I'm not even sure if I aspirated correctly. So, my question is, is it normal to feel resistance when aspirating or did I need to pull harder? I'm so glad my patient was cooperative and nice about it all...my next patient might not be though so I really need to get this down :confused: thanks!!!

Daytonite, BSN, RN

Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience.

Yes, it is normal to feel that bit of resistance when aspirating. When you get blood in the syringe when you aspirate it is because the tip of the needle has entered a capillary and you need to withdraw the needle and do a new injection. If you inject into the capillary the medication will go directly into the blood stream and that is no longer an IM injection.

NamasteNurse, BSN, RN

Specializes in Pediatrics, Geriatrics, LTC. Has 8 years experience.

I don't know if any schools allow you to practice on each other! We practice in the lab with pods. And practice and practice. Even with all the practicing, you'd still be nervous the first time. If there was a gush of blood why did the instructor say what she said? You do feel resistence when you aspirate and its surprising how tough some peoples skin is! Good luck next time, and get some lab hours in! :)

Very normal to have resistance. Even with some empty syringes you will feel resistance when trying to draw up a medicine, the stoppers inside is very tight and may need to be "worked a little" before drawing up medications. And no school lets you practice on each other anymore. Try making time to go in for extra practice at the labs, see if they will let you practice on an orange.

casnee

Specializes in DOU, Medical-Surgical.

Thanks for all your replies!!! I wasn't aware that all schools had this policy, but I guess it makes sense...liability issues I suppose? Tomorrow we have open lab after our regular skills lab, so I think I'll take the opportunity to practice more then.

I am here nervous because all of the so called lab practice was one day on an orange and TOMORROW WE DO HAVE TO PERFORM AN IM DELTOID INJECTION ON A CLASSMATE! I cannot remember some of the steps.

melmarie23, MSN, RN

Specializes in L&D/Maternity nursing.

there is little evidence to suggest that aspirating before giving the IM is necessary and say that it is a dated practice. About half of my professors do it, and the other half dont.

Aspiration

Aspiration of the syringe plunger once the needle has been inserted into the muscle is an accepted part of IMI procedure but there is no evidence of the need to do this. Justification includes to ensure the drug does not enter the capillaries (Hunter, 2008) or to avoid inadvertent IV administration (Workman, 1999).

Aspiration may be relevant to detect possible penetration of gluteal artery when the dorsogluteal muscle is used – this would indicate incorrect initial land-marking. However, official guidance (DH, 2006; WHO, 2004) does not recommend routine use of the dorsogluteal muscle, and this should be sufficient to justify changing practice. If this site were removed from routine practice, aspiration could be removed from the procedure, simplifying it and reducing the risk of adverse events. Pharmaceutical developments including reduced volume and less caustic injectates, along with prescribing changes, now support its removal from selected injection sites.

Some auto-disable devices (syringes where the needle retracts automatically after IMI administration to prevent needle-stick injuries) are triggered by the ‘aspiration’ type manoeuvre, so the technique has already changed in many countries.

http://www.nursingtimes.net/nursing-practice-clinical-research/are-techniques-used-for-intramuscular-injection-based-on-research-evidence/1952004.article

When I was in school (in the Dark Ages, haha), we practiced all kinds of injections and did IV inserts on each other, which made it much easier to do it on clients in the clinical setting -- but most schools have dropped this practice because of liability issues, which I think is a shame.

You probably got a "gush" of blood when you withdrew the needle because the needle went through a vessel going in -- but, if the tip of the needle was in a vessel you would know it -- you would have no resistance when you aspirated, and the barrel of the syringe would fill with blood. After you have that experience once, you never forget it or mistake it for anything else (the other injection thing you never forget is hitting bone :)). If you've done everything right, you're supposed to get resistance when you attempt to aspirate.

The trick for IM and SC injections is the "wrist action" -- you don't just put the syringe to the skin and push, you sort of "throw" it like a dart, so you get a nice quick, efficient stick (hurts less, too).

Best wishes!

First off, it's normal to feel extremely nervous when doing injections, especially for the first time or for the first few times. I know a lot of schools nowadays do not let students practice on each other unless it's something like a finger stick for blood glucose or something. My first IM injections were when I volunteered at a flu shot clinic last year. One of the junior-level students showed me how to do them and then I took over. My hands were visibly shaking and the patient non-chalantly looked over to me and said, "nervous much?" :lol2: Anyways, I stuck him successfully and he said he didn't even feel it, which made me feel a lot better. After doing a couple I got really comfortable - I could stick people all day! :D It gets easier with time.

Second, it is normal to feel resistance when aspirating. As long as you don't see any blood in the syringe, you're okay. If you do, you need to pull the syringe out and get a new syringe/needle and try again. As for bleeding after the injection, you're causing injury to the tissue with the needle and probably went through a vessel on your way in, so that's why ;) Some patients will bleed a lot; others will bleed very little or none at all.

I find it helpful to hold the syringe exactly how you would hold a dart. Don't hesitate. Use your anatomical landmarks, find the spot you're going to inject it and literally "dart it in" - give the patient warning, though. Aspirate (ALWAYS ALWAYS ALWAYS with IM's!) and if you don't see any blood in the syringe, inject.