Giving 25mg IM injection with 50mg prefilled syringe

Editorial Team / Admin · Mar 30, 2015

Recapping needles is how some of us were taught, especially before the wide-spread use of safety needles- should someone really be carrying around an exposed sharp when looking to dispose of it? However, think about where you dispose of sharps...

pixiestudent2 · Mar 30, 2015

I'm in school currently and we were taught to recap, by placing the cap on a table and then scooping it up with the needle.

You never throw away a needle in the trash.

JustMeRN · Mar 31, 2015

When I left the hospital I was working at we had been using only needles with safety devices for years. I thought this was a national initiative? I can't imagine working with "old" needles it's been so long! Lol

BlackNightingale · Mar 31, 2015

Hi Jeddyl,

I think I may be able to help. From the information presented, I think that D is correct. The "C" word is probably "Carpuject". Does that sound familiar? Drawing meds out of pre-filled syringes that are meant to be administered with a carpuject is a no no!

The question is asking when the instructor should get involved. Ideally, instructors should get involved as early as possible in the med administration process.

A. The student would actually be correct to waste the first half of the injection. Remember the rights of med administration. Right dose! :-)

B. If the instructor gets involved when seeing the needle recapped, that would mean that the medication was already administered. This could be too late. And recapping in 2015 for ANY reason is a no-no!

C. If the instructor gets involved when the student places the needle in the trashcan, that is also too late in the process.

D. The instructor intervening as soon as they see the medication being drawn up incorrectly would be the best way to go. At least, that's the route I would take. Then before the student went any further, I would explain the whole process to them. Then, we'd proceed. This would possibly prevent the student from recapping the needle and also prevent them from putting the needle in the trash.

Hope this helps!

Can you come back to let us know what answer was correct?

Nonyvole, BSN, RN · Mar 31, 2015

You would waste half before giving the med.

I'd actually lean more towards C being the correct answer...out of the remaining three, it is the one that jumps out at me the most.

Recapping...perfect world, no. But you'll found that this isn't a perfect world.

And of you don't have a carbujet, it is possible to draw the medication up into a syringe. Although it would probably drive people crazy to see me working with Narcan. Pharmacy - or their supplier - hasn't quite gotten the memo that we can't use the needles that come attached...

TheCommuter, BSN, RN · Mar 31, 2015

I'm assured the answer is 'C' based on the limited information we were provided.

In the healthcare setting hypodermic needles and sharps are to never, ever be placed in a trash can, wastebasket or receptacle. They are to always be deposited in approved sharps containers that have been deemed puncture-proof.

This is an OSHA federal regulatory issue because people who drop sharps into regular trash cans are placing the health and safety of others at risk.

jeddyl · Mar 31, 2015

Thank you everyone! I have been googling and flipping through powerpoints and multiple textbooks all day long! Hopefully I will find out the answer tomorrow in class and be able to get back to everyone.

Here.I.Stand, BSN, RN · Mar 31, 2015

I agree--C.

A: the student/nurse SHOULD waste 25 mg first. Rx'ed dose is 25 mg, syringe contains 50. Get rid of the extra 25 first, so that you don't inadvertently inject >25 mg.

B: recapping isn't ideal, but the only person it puts at risk is the one doing it

C: sharp in a trash can...that puts at risk every single person who is using/emptying that trash can. BIG BIG no-no.

D: the student could have been taking the Luer-compatible tip from the syringe and drawing up the appropriate dose through the little rubber circle.

ERGirl83 · Mar 31, 2015

I'm not sure why withdrawing medication from a carpuject compatible vial would be considered a "no-no." This has been daily practice in every ED I have ever worked, as pharmacy only stocks that type of Morphine and Dilaudid and we don't actually stock the carpuject devices. I mean, essentially, it's just like any other vial, with a port to withdraw medication from with a blunt tipped (or any othe type of) needle. The only caveat being that you don't inject air into these types of vials.

mariebailey, MSN, RN · Apr 1, 2015

I'm in school currently and we were taught to recap, by placing the cap on a table and then scooping it up with the needle.
You never throw away a needle in the trash.

You would only recap this way for a needle that has not been used on a patient yet. Hospitals should have needles with some sort of safety device that you employ after the injection. There's no reason to recap a dirty needle.

thinwildmercury · Apr 1, 2015

It might be answer 4 if the answer was "student was NOT using carpujet" because carpujets promote needle free med administration so they are safer (when used). Otherwise it would be answer 2-student recapped needle after injection. Never recap a dirty needle. 3 is also wrong (needles should be disposed in sharps, not trash) but answer 2 would occur first. So 4 or 2 depending on what 4 was.