A couple questions about med injections

Morning-glory · Jun 15, 2009

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.

leslie :-D · Jun 15, 2009

i've never given more than 3mls im, and NEVER give phenergan in deltoid.

you need a deep, deep muscle.

leslie

southernbeegirl, BSN, RN · Jun 15, 2009

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.

pennyaline · Jun 15, 2009

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?

kstec, LPN · Jun 16, 2009

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.

Ayvah, RN · Jun 16, 2009

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.

pennyaline · Jun 16, 2009

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.

chenoaspirit, ASN, RN · Jun 16, 2009

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.

pennyaline · Jun 16, 2009

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.

casi, ASN, RN · Jun 16, 2009

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?"

pennyaline · Jun 16, 2009

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.