A couple questions about med injections

  1. Hi -

    What is the maximum you can use for an IM injection? Depending on the source, I have read anywhere from 1cc-2cc in the deltoid ans 3cc-5cc for the glut. I have no idea why all these different sources contradict each other. What about for infants & children?

    Also, has anyone ever recieved or given phenergan in the deltoid?

    Thanks in advance!
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    About mnnurse29

    Joined: Jun '09; Posts: 34; Likes: 2

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  3. by   Morning-glory
    I was taught that it was max 3cc in the glutte. I personally will not give more that 1 cc in the deltoid-it hurts too much. If you have more than 3cc's to give it has got to be in 2 syringes. I don't give phenergan so I can't help you there. We use the VG site for most IM meds. Long acting rispiridol and emergengy meds go in the glutte.
  4. by   leslie :-D
    i've never given more than 3mls im, and NEVER give phenergan in deltoid.
    you need a deep, deep muscle.

    leslie
  5. by   southernbeegirl
    remember when you used to dilute rocephin with 4 cc a LONG time ago?

    i had just started this new job in an ICF LTC facility. went to give a pt Rocephin and had it in 2 syringes. the patient refused to let me give it to him because "the other nurses dont give it that way. they give it in 1 shot." and he reported me to the DON for trying to kill him.

    i got wrote up for not giving it in one shot. i swear it's the truth.
  6. by   pennyaline
    Quote from southernbeegirl
    remember when you used to dilute rocephin with 4 cc a LONG time ago?

    i had just started this new job in an ICF LTC facility. went to give a pt Rocephin and had it in 2 syringes. the patient refused to let me give it to him because "the other nurses dont give it that way. they give it in 1 shot." and he reported me to the DON for trying to kill him.

    i got wrote up for not giving it in one shot. i swear it's the truth.
    Did you follow all the directions for dilution and administration?
    Last edit by dianah on Jun 17, '09 : Reason: Re-worded for TOS
  7. by   kstec
    I was given phenergan IM in my deltoid during a surgery by the nurse anesthetist (sp). No I did not have any nausea post surgery, but my arm hurt for 3 weeks post-op. I actually asked the surgeon at my follow up appt. if the darn needle had broken off in my arm because it hurt so bad for so long. Eventually the pain did go away, but I am here to say "Do not give phenergan IM in the deltoid." My common practice in family practice re: injection amount is 1cc can be given in the deltoid except for infants and children older than 5 or 6 years old, they are given in the VL. Any injection more than 3cc is to be seperated into two syringes.
  8. by   Ayvah
    Quote from pennyaline
    I would have written you up, too. Directions for reconstitution are on the labels of each and every vial of dessicated med, and specify what diluent to use, how much to use, and the volume of reconstituted med along with the mg dosage of that volume you'll have when it's done. You didn't read the directions for preparing the med, so who knows what else you overlooked
    I read her post differently - that she diluted it in 4 cc, then put 2cc in 1 syringe and 2cc in another, instead of 4cc in 1 shot, since the max dose in one area is 3cc. There is nothing wrong with splitting volume into 2 shots.
    Last edit by dianah on Jun 17, '09
  9. by   pennyaline
    Quote from Ayvah
    I read her post differently - that she diluted it in 4 cc, then put 2cc in 1 syringe and 2cc in another, instead of 4cc in 1 shot, since the max dose in one area is 3cc. There is nothing wrong with splitting volume into 2 shots.
    That's how I read it, too. I understood what was done. And I understand that there is no reason at all to reconstitute it into a volume so big it can't be handled with a single syringe/injecton.
  10. by   chenoaspirit
    Ive had to give rocephin in two injections also. If dose exceeds the maximum dose for one injection, then you have to split it into two.
    You have to reconstitute according to instructions, not to suit yourself so you can get by with only one injection.
  11. by   pennyaline
    Quote from chenoaspirit
    Ive had to give rocephin in two injections also. If dose exceeds the maximum dose for one injection, then you have to split it into two.
    You have to reconstitute according to instructions, not to suit yourself so you can get by with only one injection.


    1000 mg Rocephin can easily be reconstituted into a > 3 ml IM injection. reconstituting it according to the directions that come with the med. So you see, I'm not suiting myself to get by with just one injection.

    If a dose greater than 1000 mg is ordered, you might want to forgo IM and ask for an IV order -- less painful, more dilute solution for better tolerance, run at speed better tolerated by the patient, faster systemic availability.
    Last edit by dianah on Jun 17, '09 : Reason: Reworded for TOS
  12. by   casi
    Quote from pennyaline

    1000 mg Rocephin can easily be reconstituted into a > 3 ml IM injection, reconstituting it according to the directions that come with the med. So you see, I'm not suiting myself to get by with just one injection.

    If a dose greater than 1000 mg is ordered, you might want to forgo IM and ask for an IV order -- less painful, more dilute solution for better tolerance, run at speed better tolerated by the patient, faster systemic availability.
    It looks like the 4ml practice was the standard of practice at the time she gave this medication since the post starts "remember when you used to dilute rocephin with 4 cc a LONG time ago?"
    Last edit by dianah on Jun 17, '09 : Reason: Cont. to edit for TOS
  13. by   pennyaline
    Quote from casi
    It looks like the 4ml practice was the standard of practice at the time she gave this medication since the post starts "remember when you used to dilute rocephin with 4 cc a LONG time ago?"
    I noticed that, and wondered about the same thing. However, since the time frame wasn't specified...

    I remember how we used to do things way back when, too. We don't necessarily do them the same way now.
  14. by   southernbeegirl
    Quote from pennyaline
    I would have written you up, too. Directions for reconstitution are on the labels of each and every vial of dessicated med, and specify what diluent to use, how much to use, and the volume of reconstituted med along with the mg dosage of that volume you'll have when it's done. You didn't read the directions for preparing the med, so who knows what else you overlooked
    I carefully followed the instructions on the bottle, and when it was diluted it made over 4cc to inject.

    Because there were questions after that incident, i raised heck about it and backed myself up with proper IM admin. literature, so that the facility changed it's policy on injections and how much to adm.
    Last edit by dianah on Jun 17, '09 : Reason: Edited for TOS

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