Giving IM inject in a SQ space?

[onehusbandsevenkids]

So, I'm a nursing student in the middle semesters (graduate in May).

They pair us up with a nurse to be with for a shift and we follow her along and basically do everything for her, with her supervising and teaching us.

So, there was an order for two IM injections, a flu shot and a pneu. shot

I had just given an insulin injection to a patient in the arm and now had to give these two IM injections to a different patient.

As we were walking to the room the nurse says to me, "now you'll give these two inj in the same spot you gave the insulin injection." I questioned her and said that the inj. were IM and she said "I know, but yoiu give these in the same spot you gave the insulin." I questioned her again and said "I gave the insulin into a SQ spot and thats where I am supposed to give these two IM injections?" and she says "yes, just like where you gave the insulin."

I thought for a second and then said "so, you want me to give these two IM injections into the SQ space?" and she said "Yes, thats where we give them."

I later asked my clinical instructor about it and he just kind of shrugged and said, sometimes that how they do it. Hmmmm.....

But whats weird about it is this......I have a friend who is a semester behind me and she had a skills evaluation check off recenly for injections. Come to find out one of the evaluating instructors told her the same thing.

So, I'm puzzled. Are IM's sometimes given SQ? I wouldnt think they would absorb correctly????

[UM Review RN, ASN, RN]

I've never heard of that.

Is it possible that you gave the SQ into the deltoid (SQ) area, but with a longer needle, it would penetrate muscle tissue and not SQ tissue?

I learned what you wrote--that IM meds were not given SQ and vice versa.

[onehusbandsevenkids]

I've never heard of that.

Is it possible that you gave the SQ into the deltoid (SQ) area, but with a longer needle, it would penetrate muscle tissue and not SQ tissue?

.

No, it was definately into the SQ space in the arm, not the muscle.

[km5v6r, EdD, RN]

How did you give it into the SQ? Was the needle slanted at a 45 degree angle? The needle on an insulin syringe is not long enough to enter the muscle and the syringe is held at a 90 degree angle. A pneumonia or flu vaccine should be given with a 1-1 1/2 inch needle. That would still be held at a 90 degree angle and given into the deltoid of the arm. To give either of these vaccines SQ would require either a insulin syringe, a TB syringe or a 45 degree approach.

[UM Review RN, ASN, RN]

Hmm...if it was ordered IM, then you give it IM. I'd have called the Pharmacy for backup as certain meds given SQ instead of IM can have a harmful effect.

Flu shots are given IM:

http://www.medicinenet.com/flu_vaccination/page3.htm

Pneumonia shots can be either SC or IM:

http://www.medicinenet.com/pneumococcal_vaccination/page2.htm

How is pneumococcal vaccine administered?The pneumococcal vaccine is given as one dose for most people. The vaccine is injected as a liquid solution of 0.5 mL into the muscle (intramuscular or IM), typically deltoid muscle, or under the skin (subcutaneous or SC). The area injected is typically sterilized by rubbing alcohol onto the skin prior to the injection.

[onehusbandsevenkids]

How did you give it into the SQ? Was the needle slanted at a 45 degree angle? The needle on an insulin syringe is not long enough to enter the muscle and the syringe is held at a 90 degree angle. A pneumonia or flu vaccine should be given with a 1-1 1/2 inch needle. That would still be held at a 90 degree angle and given into the deltoid of the arm. To give either of these vaccines SQ would require either a insulin syringe, a TB syringe or a 45 degree approach.

The insulin inj was given with an insulin syringe into the SQ space at a 90 degree angle as it was supposed to be given.

The two IM injections were given with an IM needle into the SQ space at a 90degree angle, not the muscle.

I'm baffled as to why I was told to give IM injections in SQ spaces.....

[onehusbandsevenkids]

Hmm...if it was ordered IM, then you give it IM. I'd have called the Pharmacy for backup as certain meds given SQ instead of IM can have a harmful effect.

Flu shots are given IM:

http://www.medicinenet.com/flu_vaccination/page3.htm

Pneumonia shots can be either SC or IM:

http://www.medicinenet.com/pneumococcal_vaccination/page2.htm

How is pneumococcal vaccine administered?The pneumococcal vaccine is given as one dose for most people. The vaccine is injected as a liquid solution of 0.5 mL into the muscle (intramuscular or IM), typically deltoid muscle, or under the skin (subcutaneous or SC). The area injected is typically sterilized by rubbing alcohol onto the skin prior to the injection.

Thanks for the info/websites.

[leslie :-D]

The insulin inj was given with an insulin syringe into the SQ space at a 90 degree angle as it was supposed to be given.

The two IM injections were given with an IM needle into the SQ space at a 90degree angle, not the muscle.

I'm baffled as to why I was told to give IM injections in SQ spaces.....

was the im needle a 23 gauge?

25 and up are reserved for sc.

insulin syringes are 29g...big difference between that and a 23g.

if you used an im needle, just by size alone, it would have surpassed the sub q tissue and penetrated the muscle...unless the pt was large.

i guess i'm just wondering what size the im needle was...

leslie

[Spacklehead, MSN, NP]

Just to be on the safe side in the future, when you have a question about how a certain med or vaccine should be given, always look up the answer in a drug book or consult with pharmacy. It is a good practice to get into as a student and/or a new grad. I have been an RN for nine years and still look up how unfamiliar meds/vaccines are to be given. Trust me - you will be doing yourself a favor in the long run not to completely rely on what others tell you regarding how meds are to be given.

[RazorbackRN, BSN, RN]

So what did you do? Did you give them?

Did you aspirate? Was there blood return? What size needle was used?

It's not really so much the site that matters as much as the needle size. More than likely, as others have said, unless it was a really lg person, the needle would penetrate the muscle if the correct size were used.

[NRSKarenRN, BSN, RN]

Deltoid arm triangle area can be used for both IM and SQ injections.

What makes difference between types of injection is depth of needle and angle of needle. Other factors to consider are viscosity of medication which would affect absorption rate of med through the tissues in whether I would use same area for multiple injections.

Insulin is absorbed fairly quickly though skin tissuse so perfectly safe to give other medication/immunizations in same area at later time during shift.

It's pretty rare that you actually inject exactly same area of skin using same trajectory for injections...most are off by few millimeters/cm.

Two schools of thought:

a. Give each immunization in seperate arm so can tell if reaction occurs.

This can cause patient to have TWO sore arms.

b. Give each immunization in same area, 1" apart so only one arm sore.

If I was planning to give all three at same time, would use abd for SQ insulin, deltoids for injection.

My preference while working in hospitals was to always rotate sites to avoid long term problems, especially when pt had long term hospitalization. Short term stay, didn't worry about need to rotate so much.

[km5v6r, EdD, RN]

The two IM injections were given with an IM needle into the SQ space at a 90degree angle, not the muscle.

IM needles; those that are 1-1.5" long given at a 90 degree angle will go through the SQ and enter the muscle. SQ injection given with that size needles are administered at the 45 degree angle. Tetnus is another one given IM in the deltoid. It's not so much about the location as the needle. Unlike real estate it's not "location, location. location." :chuckle Insulin can be given into the SQ of the hip and I will some times as an alternative site.