NEW GRAD, administering FLU SHOTS for the first time

DookieMeisterRN · Oct 1, 2011

Wasn't this covered in nursing school !?

I understand how you're nervous but I'm sure you've been taught this and possibly gave injections during clinicals?

It really will help you in the long run to research things yourself. Never trust information given on an internet forum. You now have a license to protect and getting into the bad habit of asking advice from just anyone could be damaging to your career.

ckh23, BSN, RN · Oct 1, 2011

Take a breath. You'll be fine. After you do two of them, you'll be a pro. They are just like any other IM shot. Yes, aspirate and if no blood inject. For the really skinny people, use a shorter needle and grab as much flesh as you can before injecting.

mmm cdiff · Oct 1, 2011

OP, I think I work for the company you're talking about, and it's really not so bad giving them by yourself. I was in your shoes about a month ago. Are you sure they're giving you 3ml syringes though? The flu shot dosage is only 0.5 ml.

The CDC says you don't need to aspirate because there are no major blood vessels at the deltoid. It's also shown to decrease pain that way. Here's a website on vaccine administration by the CDC - http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/D/vacc_admin.pdf

If the patient is very thin, I grab the deltoid and inject it while pinched. I've STILL hit bone a couple times, but the patient doesn't seem to flinch.

Good luck. You'll be fine!

Double-Helix, BSN, RN · Oct 1, 2011

Check the policy of the company you are working for. Our facility's policy is not to aspirate. Flu shots are given in the deltoid, unless you are giving one to an infant. You might be getting 3mL syringes, but they should not be full. The max volume you should ever give in the deltoid is 1mL.

With skinny people, pinch the deltoid before you inject. Actually, it's not a bad idea to pinch, or at least hold onto the muscle every time you give the injection. It helps keep you steady and helps keep the patient from flinching away. Unless they are really large, in which case you might pinch so much fat that you don't reach the muscle.

Don't be surprised to see a drop of blood after you withdraw the needle. That's common and doesn't mean you injected into a vessel. Also, if you feel like you hit something firm with the needle, and try to inject, but meet resistance, then you have hit bone. Pull the needle back slightly and then inject.

Review your nursing books for the proper technique for IM injections. Watch instructional videos online. After your first dozen injections, you'll be a pro!

mazy · Oct 2, 2011

I've worked flu shot clinics for years and have given thousands of flu shots and yet every time I go into my first clinic of the year I'm a nervous wreck. All those nervous people, all those needles, it can be overwhelming. After the first shot I'm OK though. The first couple of shots you give will be nerve-wracking but you'll get the hang of it. Just focus on the person you're giving the shot to, focus on the task, and filter out everything else around you.

Just remember your technique. We do usually hold up the muscle at the deltoid. We don't aspirate for flu shots at my agency. And use a fast darting motion to reduce pain. Also, 3 ml does sound like a big syringe, the dose is only 0.5 ml.

You'll do fine.

sunny314 · Oct 2, 2011

You will be fine. I believe I work for the same or a similar company. I am also a new grad. I do not aspirate, as this is not required. Also for geriatric and peds patients I bunch up the muscle as not to hit the bone. I also ask the patient to relax his/her arm prior to administration. Most patients say they don't feel a thing :)

mixtapes · Oct 2, 2011

I think it's okay for you to ask advice on this forum despite the other comment. It's a place to ask questions and feel comfortable. Of course, use your best judgement. Or ask another nurse you feel comfortable with. Yes, ultimately ask your supervisor. Protect yourself and license.

I am in your situation too. I was told NOT to aspirate. We are using the 25 g 3ml 1 inch syringes. As you know, fill only only to 0.5ml. I try and carry some other sizes too for larger people (1.5 inch). I should have some smaller ones too! I hit the bone last week. The patient did not even flinch. It was the weirdest feeling. Almost, like dragging your finger nails down a chalkboard. Ugh....Yes, make sure to pull back on the needle and pinch. The flu clinics are good practice. I think a new grad is perfectly suited for this position. They have to give us a chance at doing something w/o 1 year of experience!

AreEn17 · Oct 2, 2011

I worked my first flu shot clinic recently and the paperwork gave me much more anxiety than giving the actual shots. I'm pretty comfortable giving shots though. I give them at the clinic I work at all of the time. If you have time at the beginning of your shift, my advice is to familiarize yourself with the paperwork required of each person. It can be quite confusing at first.

pc2801 · Oct 2, 2011

I think if the pharmacist at CVS can give flu shots a trained nurse can too. My experience with the pharmacist this week was she asked which side, when I gave her my right arm she said "Oh, I've never done that side before". OK, so why did you ask?

So, fake confidence until you are confident and you will be fine.

RFRN · Oct 2, 2011

I was told NOT to aspirate.

Ok - I have to ask why NOT aspirate? Other than the needle is in the patient for the extra half a second it takes to do this and might cause a little extra discomfort (but in my experience, patients do not notice if you do or don't aspirate). I was taught to aspirate with ANY IM injections.

Double-Helix, BSN, RN · Oct 2, 2011

Ok - I have to ask why NOT aspirate? Other than the needle is in the patient for the extra half a second it takes to do this and might cause a little extra discomfort (but in my experience, patients do not notice if you do or don't aspirate). I was taught to aspirate with ANY IM injections.

There really aren't any large blood vessels in the deltoid- pretty much all arterioles and capillaries, so the risk of actually injecting into a vessel in the deltoid is extremely low. Also, studies have shown that aspirating increased the discomfort/pain associated with the vaccine, even if that's not your experience.

OP, ask the pt what arm they prefer to get the vaccine in. Remember that the vaccine can cause some soreness the next day, so always try to give it in the non-dominant arm.