I Hit A Bone!!

Nurses General Nursing

Published

Oh, wow... I hit a bone! I was injecting an older, thin lady with 0.5mL pneumococcal vaccine IM in deltoid. I used a #23, 1 inch. needle. After seeing the client, my instructor told me to insert 1/2 of the needle. It went in her skin like butter - all the way. I heard a pop sound. My instructor stated "you didn't go in half the way." I have administered numerous IM injections, mostly in the deltoid and ventrogluteal sites without any complications. I thought I was doing a great job - until this! I'm thinking I should have gotten a shorter needle, or chosen a different site. I don't know if I can just stick the needle in 50% of the way.

Any comments are appreciated.

Thanks for all of the great tips! I will remember them all.

Specializes in Looking for a career in NICU.
I've hit a bone a couple of times. When this happens, look at the bevel after you pull the needle out to make sure the bevel tip did not break off in the pt.

Ok, I have to ask..what happens if it breaks off?

Specializes in Education, Acute, Med/Surg, Tele, etc.

If a needle breaks, it must be removed...typically local surgery to the site using a local analgesic...someone is going to have to cut in and find it and remove it (MD time!).

Don't know the whole insurance thing about that...I mean, how it is paid for by the nurse or nurses employer for this...but I was just told never to break it off inside a pt (like that helps...LOL!).

I mean think of the ramifications...metal inside not self, and heck...what if they go into an MRI? WOW! EEK!

Yep...has to be removed by an MD.

I would have used a shorter needle of the same guage. (5/8 seems to work fine with most little old ladies)

Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.
What is your rationale for thinking that the instructor was wrong?

That's easy. First of all it should have been given in an area with more muscle. Second, she should have used a shorter needle. And third, who teaches a new nurse to insert a needle halfway when the proper way is to jab it in like a dart. Duh.:trout:

Specializes in Pediatrics.
If a needle breaks, it must be removed...typically local surgery to the site using a local analgesic...someone is going to have to cut in and find it and remove it (MD time!).

Don't know the whole insurance thing about that...I mean, how it is paid for by the nurse or nurses employer for this...but I was just told never to break it off inside a pt (like that helps...LOL!).

I mean think of the ramifications...metal inside not self, and heck...what if they go into an MRI? WOW! EEK!

Yep...has to be removed by an MD.

I know it's a little off topic but this made me think of it- someone who told me in nursing school, her instructor was helping take out an IV and the cathelon broke off into the patient!! I'm not sure how they managed that one.

Specializes in Education, Acute, Med/Surg, Tele, etc.

YIKES! I know we always have to list "cath in tact" on iv d/c but I always wondered how one would break...maybe an autoimmune thing that makes it weak and break? OH lordie that would be very bad!!!!!!!!! Scary!

Or perhaps when putting it in the needle punctured the cath and during withdrawl that part loosens and breaks? EEK!

Or of course manufacturer error....

Just scary..thank goodness I have never seen that one! You hope that a valve keeps that from the cirulation long enough to retrieve it! EEEEEKKKKKKK!

in home health we do alot of injections, B12, flu etc, i use a needle that is 23 G with 5/8" works beautiful for deltoid injections even in those tiny old ladies

Specializes in Case Manager, Home Health.
And third, who teaches a new nurse to insert a needle halfway when the proper way is to jab it in like a dart. Duh.:trout:

Thank you!!! "Make sure you dart it." Been told that several times (IM, flu vaccine that is).

How could anyone experienced or not only dart "half way"? That's nuts!

My first IM was in our class lab and the "pt" was a healthy fellow student with excellent musculature and I hit her bone, too. It freaked me out as I never thought about going too far. No one but me knew as I didn't hit it too hard. I looked at the tip when I removed the needle casue I wondered if it "fish hooked" and it didn't. The needle was intact.

No one ever told us what to do if we hit a bone. Now I know. Check the tip and if it is in the pt, call the doc. Thanks again, Allnurses team!~

Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.
Thank you!!! "Make sure you dart it." Been told that several times (IM, flu vaccine that is).

How could anyone experienced or not only dart "half way"? That's nuts!

Your welcome.:chuckle

Never Fear , My Dear. In 30 Yrs. Believe Me I Hit Bone Often. You Will Encounter Many Other Things Before You're Through Working. At Least You Care. I Know Some Who Would Not.

Just Keep Plugging Away. I'm Sure Your Instructors Could Share Horror Stories With You.

I can't imagine quickly holding onto the hub and trying to aspirate with the needle only halfway in.

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