Vivitrol shots: Troubleshooting

[Nursing On The Run]

I know not many of you will have given Vivitrol shots. This is an Addiction Medicine thing, but the Addictions Nurse forum doesn't get much traffic. So I hope you don't mind my asking it here.

I'm somewhat new to giving these shots. Sometimes I inject the patient in the right location-- upper outer quadrant of the buttocks-- and I aspirate without getting a blood return....but I truly can't inject the medicine. I wind up having to pull out and put another needle on and re-inject the patient.

Recently someone commented that the problem is that Vivitrol is a suspension, not a solution. In other words, a micro-sphere is in the funnel of the needle and blocks the opening. That's what prevents me from pushing the medicine in.

i haven't had a patient since hearing this but it makes me wonder if just re-aspirating might work to remove the microsphere from the needle's funnel. Or is it something else? Also, does anyone else have this problem?

[rdsxfnrn]

Yes, I have had this issue.This med is very very thick. Make sure it is well mixed before you draw it up, then you have to inject very slowly.

[Danny, Are_In, BSN]

Also with the Vivitrol after it is mixed, make sure u change the needle after u draw it up to a fresh one. I know sometimes it's hard to mix the contents up in the vials. And it also helps if u warm vials up in hands before drawing up. Hope this helps!

[Crush]

Absolutely, mix well and change the needle after you draw it up. I like the idea of warming it first a little as suggested. I will have to try that. Thanks.

[Nursing On The Run]

Thank you for the comments! I wasn't sure a Vivitrol post would get any traction on the general forum, so that was a nice surprise. Still, I warm the medication to room temperature by leaving it out for 3 hours. It is well mixed and I use the preparation needle until it's time to inject. To me, it sounds like you all are NOT having the same problem as I am. When I move the shot I eventually wind up at a spot where I can push it in. It's not an issue of the med being too thick-- because it's not getting thinner as I wait to inject it in a spot where it works.

I've also had someone watch me (a NP ) who confirmed I was in the right spot. But she watched me have to move it when it couldn't inject.

Wish I knew what I was doing wrong.

[czarnec4]

Hey guys,

I'm an addictions nurse and we just started giving vivitrol injections. My counterpart is giving the injection in ventrogluteal. I am giving in upper putter buttocks. Not sure which is right? I had a heavier patient today and now I'm really freaked out I gave it subq on accident. How bad would it be if it was subq? Any experience? I'm going to check injection site obsessively because I'm worried. Advice please!

[czarnec4]

I know that once the med is mixed and drawn up it should be given right away. If you wait more than lol like 5 minutes, the med can start to separate again. If you aren't already, you could try giving the med sooner after you have it drawn up. I've never had a clogging problem, but the only thing I can think I did different might be timing?

[redladybird]

Goodness!  I am not the only one having this problem? I may have a solution that may save you from a lot of stress.

I have now found THREE boxes where the syringes had a malfunctioning lure locks!  Meaning that if you actually twist the needle it turns but does not actually "lock" as a lure lock is supposed to. Sometimes it acts as though it gets a little tight but it does not actually stop.  Sometime it just turns and turns and never locks at all!  What this means is that when you push the plunger the medication will not inject because it's not a closed system.  You can change the needle, it won't inject.  You must change the actual syringe!  

This totally stressed me out the first time because I was afraid the medication would solidify but it did not.  It stayed viscous.  Through quick problem solving I was able to fix it. 

Now always have back up syringes and double and triple check my syringes.