Injection Gone Wrong: Part 3

This is part 3 and the final entry for Susan’s story. Her story gives us pause and makes us feel her pain and frustration. I want to take this opportunity to publicly say thank you to the real author of this story, for allowing me to tell it for her. She gave me such rich details to put in her story, and I loved partnering with her in this project. Through it all she has kept her sense of humor and spice, and that is what I admire about her. Nurses General Nursing Article

Driving to get her MRI under fluoroscopy, Susan kept reflecting on the fact that she was told that her first one didn't show any damage to her left shoulder. Being claustrophobic added to her anxiety as she pulled into the parking lot. However, she did feel an inkling of hope as she stepped up to check in.

Susan told the tech what had happened at the first MRI, and he knew exactly what she was talking about.

"That is what we call shadowing. When a patient is small statured, then the machine sometimes has difficulty focusing on the area of interest. Positioning is very important for patients like you, we will position you with your left shoulder closest to the center of the machine rather your whole body being in the center. Don't worry, we will get some good pictures." the tech reassured her.

Sitting once again in front of a doctor for her results, the doctor who failed to listen, investigate, or even care made Susan's stomach twist and turn.

"The test shows bone marrow edema in the area that the injection was given," he began, "But I want you to have a full body scan, Susan. There must be something else wrong. I want to see if something else shows up."

There it was, in black and white, the flu shot had hit the bone and the trauma had caused the edema... Finally! She had proof! Leaving his office, Susan now realized that the doctor wanted to find something else wrong so that he could say it wasn't the flu shot. Susan could only say, "bring it on."

The full body scan required more needles and an extra bonus of a nuclear medicine chaser. It would show any fractures, dysplasia, arthritis, or cancer in Susan's bones. She knew what they would find, exactly what she had been telling them for months.

Once again, back in the doctor's office for another test result, Susan was handed a piece of paper, "Have you seen this?" Looking at it, she realized it was an addendum to her first MRI. After her full body bone scan, the radiologist had looked back at the first MRI and wrote an additional note stating that there was damage there three months ago along with specific image numbers for reference. The full body scan showed one hot spot - her left shoulder, exactly where the flu shot was given. Not only that, the radiologist wrote in the report that the damage was due to the flu shot.

Susan now knew that the first radiologist had not read her MRI correctly, not only that the doctor had told her he had looked at the MRI disc which he most likely didn't or he would have seen the damage.

"I'm beginning to think your problems are related to the flu shot. Since I've never treated anyone with your problem, I don't know how to treat it. You could probably google it," he said with a chuckle, scratching his head. (Pause and let that sink in)

"I have googled stuff about this, but all it did was scare me to death!" Susan responded, her eyes wide, cheeks flushed.

Trying to process all she had learned and heard in the past ten minutes made her heart beat fast. They discussed sending her to another doctor, which was something Susan wanted to do anyway.

When he left the room, the nurse leaned over and whispered,"He is just very conservative."

Oh, so what exactly does that mean? It's ok to waste four months of my life calling me a liar, ignoring my pleas, or the fact that he would resort to googling my problem because he didn't know what to do.

Several weeks later, Susan got word that she had a new doctor, and it was the one she wanted in the beginning. This made her the happiest she had been in months. A case worker was also assigned to her case and would attend the doctor visits with her.

Seeing the new doctor walk in the room made Susan want to cry with relief. Gulping, she shook his hand.

"Hello, Susan, nice to meet you. I have reviewed your scans, and I can see the exact trail that the needle took, and all the cartilage, tendons, rotator cuff, and bone it affected. I also wanted to let you know that I have at least 15 other patients that have the same problem as you. Why in the world did someone give a shot there? I just don't understand." He paused and looked up from his paperwork, "Let me tell you, Susan, this will not be an easy, or quick recovery. It will take over a year, but you will get better."

Susan let out her breath, not realizing she had been holding it. She smiled and tears came to her eyes. Having validation meant the world to her after all she had been through. He had other patients like her, and he had a plan! The tension in her shoulders loosened, the sudden blood flow made her dizzy.

Before she left his office, he gave her a steroid injection in her left shoulder joint, and put her back in physical therapy, telling her she should have been in therapy the entire time. He also told her that surgery would not help at this point, but instructed her to be patient.

Susan went back to work with restrictions, but at least she was on a path to recovery.

Even though the steroid shot helped, Susan still had limited range of motion, and continued to have pain. Sleeping on her left side still hurt, and the OTC anti-inflammatories she was taking kept her stomach upset. About a month later, she had another injection which again gave limited relief. The doctor concluded that surgery may be exactly what she needed so he could see exactly what was going on.

Susan had the shoulder arthroscopy that showed inflammation on the rotator cuff that had spread into and throughout her muscle, tendon, cartilage, joint and joint bursa. He showed Susan's husband the pictures from the surgery and they showed what looked like red spider veins that was the actual inflammation. He told her husband that he had washed out the inflammation, and shaved part of her rotator cuff as well as had done a decompression because she had not been able to use her shoulder for so long it had become compressed. Because he had to shave so much bone, Susan continues to have pain and popping of the shoulder joint.

Back to work and life, Susan continues to have pain daily, limited range of motion, and still can't sleep on her left side. Repetitive movements using her left arm causes pain in her shoulder. She can't lift her arms above her head or lift anything. Susan had to change the way she dresses, and how she blow dries her hair. Now she has chronic tendonitis and bursitis in her left shoulder from the injections that cause her continued pain.

Almost two years after she received a shot that has forever changed her life, Susan continues to fight to get better. She has since found out that the person giving the flu shots were medical assistants contracted by the hospital, and when she searched online, she could not find any certifications for that person. She wants you to know that she is changed forever. This event has affected her not only physically, but emotionally and financially as well.

An injection of any kind given in the wrong place by an untrained person can result in severe injury. We are advocates for our patients and we must be advocates for each other as well. The telling of this story is part of being an advocate for one of our own.

Her story is far from over, and I have been honored to share it. I hope and pray for her full recovery, physically and financially.

For the first 2 parts of this story, please read:

Injection Gone Wrong: Part 1

Injection Gone Wrong: Part 2

I have been following this and am so glad for the update, what a terrible ordeal. Hoping the writer continues to get better, and knows a good attorney because if that was me I'd sue the socks off them-and I am not the kind to say that normally.

Specializes in Psych.

How can we protect ourselves from something like this?

Some people give shots like they have to push the needle in to the point it shows through the other side of the arm. I worked as a flu shot nurse and have given thousands of flu shots over the years. In one day I gave over 300 shots and never game close to hitting the bone on any patients because it is all about technique. Feel where you are going to stick first and make sure it is the proper place etc. You can't give the shot in the same exact place as you did one person. Everyone's bone and muscle is placed slightly different (some muscle is atrophied). You also have to pay attention to the size of the person (thin vs a heavier person). It is thanks to the flu-shot job that I developed an ability to give pain free shots as a whole. Many patients would say thanks for me not hurting them because it usually hurts. I do think of the patient and also try to be careful knowing that there is a chance harm can be had my the patient if I am not careful (plus I can get sued).

Wow this is such a powerful story. This is a prime example of the representation of frustration many face with the health care system. My heart breaks for all this nurse has been through. I pray for a continued recovery as well.

Specializes in Med/Surg, post surgical.

They are. I started on my road to nursing after getting MA certification from a regional occupational center. I think it was 16 weeks and we had to practice blood draws on each other and demonstrate correct injection, but I don't remember how; perhaps an orange? The warnings about hitting a sciatic nerve scared me from that time on.

Specializes in Rehab, Med Surg, Home Care.
It's a hospital! Why didn't they get a team of nurses to administer the flu shots!

Seriously! Justifiable or not, I feel the training a nurse receives in giving injections is more of a defined quantity: anatomical target areas, sterile/ aseptic technique, reaction and side effects, rationales, etc. I've received many, many flu shots; once from a pharmacist, many time at flu clinics where I've volunteered, or in hospital/ clinic settings where the clinical leaders, Assistant Nurse Managers, or clinical educators performed this role for their unit, administering shots to their staff over 2-3 weeks. If there were student nurses, we often let them give the injection, supervised by their instructor. That being said, I've only had one given incorrectly-BY MY CHARGE NURSE!! I didn't react in time; just watched, stupified as he grabbed my arm midway and gave the injection a good 2 inches below the deltoid. I did comment at the time "kind of low, wasn't that"?, which he shrugged off. I did end up with a warm, inflamed area and mentioned to my ANM that I had had a reaction. Not sure if anything she reported anything in writing; I was not given anything to fill out and did not persue it because it did resolve with no residual effect.

Specializes in Psych, Peds, Education, Infection Control.
Exactly! Why didn't they? We all assume that that would be protocol, but in this case not so much

MA's cost less? ...would be my guess. In any case, this has been a definite wake-up call to watch your sites closely for deltoid injections! And know who is giving you a shot and what training they have. I got a Hep B booster yesterday due to an exposure and I had this story on my mind. When I saw the MA examine my arm and measure properly with the two-finger trick, I felt a lot better...

And after hours, our ER staff administered flu shots, tetorifice, TB, etc.

This is the problem in most doctor's offices and vaccine administering facilities. There is very seldom a nurse in charge of the staff. I have been to doctor's office where medical assistant did not know how to take a manual blood pressure (and apparently didn't care either). The automatic BP machine stopped functioning so they did not have a blood pressure to place on the medical record. The comment by the MA: "oh, I have to get someone who knows how to do a manual blood pressure" Is that pathetic or what?

I can't imagine one of these incompetent fools giving me an injection. I would wonder if they even selected the right medication or dosage; much less the correct site and technique. The days of the RN in the Doctor's office are now long gone. It is ashamed that the Doctor does not see the value of having an RN in charge of his patients assessment, nursing care and counseling (over the cost of the salary). This "injection gone wrong" probably would never have happened with a nurse in charge (and most likely administering all injections).

Arthur Condra RN, BSN, MS

Yes, I cringe just reading it. I hit bone one time giving a deltoid injection to a very thin patient. She did not complain, but the memory freaks me out many years later.

I am very scrawny-armed, and a nursing student bounced off my humerus trying to give me a flu shot....she freaked out and froze with the needle still in my arm, then looked me in the eye and said "OH MY GOD I HIT YOUR BONE." I said, "yes I know....can you maybe inject and take the needle out, though?" :)

I was having an allergic reaction and went to an urgent care. One of our ER docs was there; I knew his orders by heart. The nurse came in with SQ epi and tried to give it to me IM in my hip. I refused; she argued. The M.D. came in and corrected her.I filled out an incident report. The doc overseeing Urgent Care spoke with me my next work day, and he spoke with the ER doc. The RN went through corrective action.

Specializes in ED, Informatics, Clinical Analyst.

Very interesting article. I think the importance of safe injection practices and good injection technique is undervalued and that many people administering the injections underestimate the potential to do harm. An IM injection can lead to complications even when done correctly; I won't inject the dorsogluteal muscle unless I absolutely have to for that very reason, and I often cringe when patients describe how someone else gave them an injection.